A Liberated Mind
A Liberated Mind
“In all my years studying personal growth, Acceptance and Commitment Therapy is one of the most useful tools I’ve ever come
across, and in this book, Dr. Hayes describes it with more depth and clarity than ever before.”
—Mark Manson, New York Times–bestselling author of The Subtle Art of Not Giving a F*ck
“In our crisis-ridden society psychological flexibility is more needed than ever. Transcending shallow and ineffective behavioral
approaches, Dr. Steven Hayes here presents a methodology, a skill-set, for emotional liberation that enables us to pivot from self-
limitation to self-awareness and self-affirmative action.”
—Gabor Maté, MD, author of When the Body Says No: Exploring the Stress-Disease Connection
“We can spend our lives avoiding the thoughts and feelings that cause us pain. But Steve Hayes has become a leader in his field
by understanding that things that cause us pain are things about which we care. By learning to use psychological flexibility we
can turn toward the difficult places to live with richness and meaning. Compassionate, helpful, and authoritative, A Liberated
Mind shows us a powerful way to a fulfilling life.”
—Susan David, PhD, author of Emotional Agility
“The key to evolving consciousness is cultivating a flexible mind—open, present, empowered and aligned with deep values—and
Steven Hayes does a brilliant job showing us how. This book is organized around developing six psychological skills that clinical
research shows, beyond all other factors, promote flexibility and translate into a happier and healthier life. As you read this
illuminating book, you’ll see how these skills are learnable, that you can start right now, and how when woven together, they
offer a path to inner freedom.”
—Tara Brach, PhD, author of Radical Acceptance and True Refuge
“A Liberated Mind provides an outstanding introduction to a psychological approach that has changed many lives by turning us
toward focusing on our values. The ideas and advice presented here help us truly understand what matters so that we can live
with greater freedom, courage, and joy.”
—Kelly McGonigal, PhD, author of The Willpower Instinct and The Upside of Stress
“Steven Hayes possesses an extraordinary trifecta of skills: A brilliant theoretical and research psychologist, he’s also a
compassionate clinician and a wonderfully engaging writer. A Liberated Mind is packed with jewels of insight and information
that could change the way we deal with suffering as individuals and as a society. A compelling, revelatory read.”
—Martha Beck, PhD, author of Finding Your Own North Star
“Dr. Steven C. Hayes is one of the greatest thinkers, psychological theorists, and clinicians alive. He has contributed an enormous
amount to the field of psychology and is well-known for being the creator of ACT (Acceptance and Commitment Therapy), a
treatment that has now become the first-line approach for many psychological problems. The book, A Liberated Mind: How to
Pivot Toward What Matters, tells a very personal story about the origin and development of this treatment. Written for a very
broad audience, Dr. Hayes is able to clearly translate the science and clinical complexity of this treatment into concrete guiding
principles for people’s lives. These principles not only apply to psychological suffering, but also to physical illnesses,
relationships, corporations, societies, and cultures. The book is honest, compassionate, and profoundly insightful. It will
transform your life by liberating your mind.”
—Stefan G. Hofmann, PhD, professor of psychology at Boston University
“In this highly accessible book, Steven Hayes identifies pathways to connecting with our deepest values and pursuing what really
matters. Filled with compassion, wisdom, and down-to-earth methods for change, A Liberated Mind is a refreshing ‘how to’
manual for overcoming the obstacles, judgments, habits, and prejudices that so often stand in the way of a life worth living.”
—Richard M. Ryan, professor at the Institute for Positive Psychology and Education, Australian Catholic University, and
co-developer of Self-Determination Theory
“Many of our inborn behavioral tendencies were wonderfully well adapted to the world they evolved in fifty thousand years ago.
But disaster ensues when our primitive and automatic impulses inflexibly control us, rather than us flexibly controlling them.
Hayes combines a scientist’s precision with a poet’s sensitivity in freeing us to be more loving and fully human. This is a great
self-help book for people who would never dream of reading a self-help book.”
—Allen Frances, professor emeritus and former chair at the Duke Department of Psychiatry, chair of the DSM-IV Task
Force, and author of Saving Normal
“Steve Hayes is a brilliant thinker and doer, and nowhere is this more evident than in this book. It weaves together research and a
lifetime of practical experience into an accessible, personal, and positive guide to thinking about our lives in a fundamentally
more helpful way.”
—Kelly D. Brownell, PhD, director of World Food Policy Center and Robert L. Flowers Professor of Public Policy at
Duke University
“Steven C. Hayes is today’s B. F. Skinner—a great intellect, equally passionate about basic knowledge and practical applications.
In A Liberated Mind, you can get to know him as a person and apply his wisdom to your own life.”
—David Sloan Wilson, president at The Evolution Institute and author of This View of Life: Completing the Darwinian
Revolution
“Based on a broad and deep knowledge of cutting-edge psychological science and a wide-ranging appreciation of philosophical
and religious wisdoms, one of the leading psychologists in the world, Steven C. Hayes, provides an antidote to the conundrum of
human struggle and despair. Everyone experiencing anxiety, depression, or pain in their life and striving for emotional well-being
should be aware of the surprising revelations in this well-written and easy-to-read book.”
—David H. Barlow, professor of psychology and psychiatry emeritus, founder and director emeritus at the Center for
Anxiety and Related Disorders, Boston University
an imprint of Penguin Random House LLC
penguinrandomhouse.com
Version_2
This book is dedicated to the memory of John Cloud: reporter,
rascal, raconteur, friend. You believed in me and in this book,
which has lifted me up every single day I’ve worked on it. The
world asks reporters to do such hard things, without understanding
the cost. Be at peace, my friend. Be at peace.
CONTENTS
Part One
CHAPTER ONE: The Need to Pivot
CHAPTER TWO: The Dictator Within
CHAPTER THREE: Finding a Way Forward
CHAPTER FOUR: Why Our Thoughts Are So Automatic and Convincing
CHAPTER FIVE: The Problem with Problem Solving
CHAPTER SIX: Turning Toward the Dinosaur
CHAPTER SEVEN: Committing to a New Course
CHAPTER EIGHT: We All Have the Ability to Pivot
Part Two
INTRODUCTION: STARTING YOUR ACT JOURNEY
The First Pivot
CHAPTER NINE:
Defusion—Putting the Mind on a Leash
CHAPTER TEN:The Second Pivot
Self—The Art of Perspective-Taking
The Third Pivot
CHAPTER ELEVEN:
Acceptance—Learning from Pain
CHAPTER TWELVE: The Fourth Pivot
Presence—Living in the Now
CHAPTER THIRTEEN:The Fifth Pivot
Values—Caring by Choice
CHAPTER FOURTEEN:The Sixth Pivot
Action—Committing to Change
Part Three
INTRODUCTION: USING YOUR ACT TOOLKIT TO EVOLVE YOUR LIFE
CHAPTER FIFTEEN: Adopting Healthy Behaviors
Dieting and Exercise
Coping with Stress
Sleep
CHAPTER SIXTEEN: Mental Health
Depression
Anxiety
Substance Abuse
Eating Disorders
Psychosis
CHAPTER SEVENTEEN: Nurturing Relationships
Helping Others Nurture Flexibility
Parenting
Relationships with Romantic Partners
Combating Abuse
Overcoming Prejudice
CHAPTER EIGHTEEN: Bringing Flexibility to Performance
Tackling Procrastination
Learning and Creativity
Dealing with Constraints at Work
Sports Performance
CHAPTER NINETEEN: Cultivating Spiritual Well-Being
Practicing Perspective-Taking
Cultivating Forgiveness
ACT and Religion
CHAPTER TWENTY: Coping with Illness and Disability
Chronic Pain
Diabetes
Cancer
Tinnitus
Terminal Illness
CHAPTER TWENTY-ONE: Social Transformation
Epilogue
Notes
Index
About the Author
ACKNOWLEDGMENTS
I began to think about this book shortly after my first self-help book, Get Out of Your Mind and
Into Your Life, became popular in 2006. I drafted a crude proposal but it was odd and it
languished. I’m a geek by training and personality, and even among psychologists it is a bit of a
joke that I can be incomprehensible. It was not until Linda Loewenthal reached out a few years
later and became my agent that the project began to move. Linda brought that needed mixture of
support, pushing, wisdom, skill, patience, and caring that by 2011 had turned the project into
something real. Her trust in me, and her unwaveringly honest feedback over the years, lifted me
up and pushed me forward.
The late John Cloud, the Time magazine reporter who plucked me out of obscurity in 2006
when he wrote the story that launched the success of Get Out of Your Mind, helped produce the
first well-crafted proposal and sample chapter drafts. I have dedicated this book to him because
in an alternate universe, he and I would have written the entire volume together as I had
originally hoped. He was a brilliant writer and a deep soul, and I so hope the spirit of John is
reflected in this book.
Spencer Smith, a professional writer and co-author of Get Out of Your Mind, also helped with
the proposal. Spencer is what my Jewish relatives would call a mensch—he is an honorable,
kind, reliable, ethical straight shooter. I am blessed to call him a friend and colleague.
Emily Loose was my development editor for this book. Amazingly able, wise, and persistent,
she deliberately allowed the ideas in the book to enter into her life so she could bring her gut feel
to the development process. I was honored, moved, and impressed by that approach—she is
simply the best.
Caroline Sutton at Penguin/Avery gave very helpful input on the text at critical points of the
development processes.
All of my adult children (Camille, Charlie, and Esther) were sounding boards and gave specific
input, from Esther’s drawings to Camille’s title ideas.
My wife, Jacque, stood by me for the many years and endless rewrites it took to get these
words produced. Trips, interviews, writing binges, research—all shifted obligations onto her
shoulders. I can’t ever repay that debt, but it brings tears to my eyes to acknowledge and
remember it. Jacque also provided key input regarding the new ideas in this book as they were
vetted one at a time in long discussions that delayed our sleep. She especially pushed me to look
more closely at social context and privilege issues, which are critical to the arc of this work.
Thank you, my love.
My doctoral graduate students of the last few years helped with discussions of nuances of ACT
theory, including Brandon Sanford, Fred Chin, Cory Stanton, and Patrick Smith. Almost all of
the forty-eight doctoral students of mine who already have their PhDs are in the backstory of
specific parts of this book. I mentioned just a few of them in the text and endnotes but they are
there anyway, in ways that only they and I will know specifically but that the reader will benefit
from. Thank you, gang. (No, this does not mean you can tell people the secret behavioral
handshake.)
I was helped in considering various titling options by Greg Stikeleather and Till Gross. Hank
Robb and Inge Skeans kindly helped with proofing and calling out confusing sentences.
The section on lying in Chapter Four was originally written for a book that Guy Ritchie and I
were considering writing, to go along with a film he was working on regarding the impact of the
ego. The book project did not move forward (I hope someday the film will appear—it is a
powerful piece), but it was Guy who first made me aware of the deep connection between the
conceptualized self and lying, and the clarity of his vision made a lasting impact. I would like to
thank him for his insights.
I would also like to acknowledge the clients who have changed ACT work with their very
lives. Some of their stories are in this book, anonymized, but others are here indirectly because
of the ways their pain and courage informed the work. For example, a substantial portion of the
metaphors used to explain ACT came from clients, not me or any other professional. We will all
be forgotten, but maybe, just maybe, your courage has put things into the culture that will
reverberate for a long time. ’Tis a consummation devoutly to be wished.
I want to give a deep bow of appreciation to the entire contextual behavioral science
community. It is an amazing group of clinicians, teachers, basic researchers, philosophers,
applied researchers, policy experts, evolutionists, behaviorists, cognitivists, prevention scientists,
nurses, physicians, coaches, psychologists, and social workers (I could go on like that for a
while) spread across the globe. I’ve told some of their individual stories in this book, but the
reader should know that behind every name in every endnote relevant to ACT, RFT, and CBS is
a committed human being. I know many of them, perhaps the majority of them, and they deeply
care about working together to create a psychology more worthy of the challenge of the human
condition. I have tried to give their ideas and aspirations voice in this book. I may have instigated
this work, but I am only a co-founder or co-developer because by the time it came together in
book form in 1999, it needed the able hands of Kirk Strosahl and Kelly Wilson, and to be refined
for research and practice it needed hundreds of caring professionals and researchers. That
continues to be even truer as it has entered the world community. We are all better human beings
when we are groups, and my colleagues have lifted me up with their values, vision, and
friendship every step of this journey.
As I will repeat in the very end of this book, life is a choice between love and fear. Those
human beings who have loved me—friends, family, and colleagues—have helped me choose
love. There is no better gift. Thank you.
This book is fairly heavily referenced, but in order not to distract the reader almost all of the
documentation is in the endnotes. If you see me writing about a study, stating facts, or suggesting
that books are available and so on, and you want to follow up, check in the back. The endnotes
are “blind,” meaning there is no indication in the text that I’ve provided references, comments, or
resources, but I’ve tried to do so whenever I detected a possible need, so look there first
whenever you need further information. In order not to slow down the volume by mentioning
names of people the normal reader will not have a reason to learn, I sometimes cite and credit
people in the endnotes rather than the text, even using words like “my colleagues” or “my team”
to speak of people in my lab tradition or the contextual behavioral science community writ large.
To normal academic readers that will at times seem self-focused, but it is in the service of the
reader and seems to be necessary in books of this kind. All I can do is to beg for tolerance of that
decision and ask people to look in the endnotes.
I also mention my website with some regularity (http://www.stevenchayes.com) for tests you
can take or lists of resources you can access and the like, but that too can get tiresome, so in the
final edit I cut that down a fair amount. In some of those cases I wrote an endnote instead.
There is also a lot of useful information about this work on the website for the Association for
Contextual Behavioral Science (ACBS), which is the group most focused on the development of
the work I write about in this book: http://www.contextualscience.org. Some of the information
on that site requires that you log in as a member in order to see it, but public members are
welcome and it is inexpensive.
Finally, vast resources are also available for free online, such as an ACT YouTube channel,
ACT-based TED talks (you can see my two TEDx talks at http://bit.ly/StevesFirstTED and
http://bit.ly/StevesSecondTED), Facebook groups, an ACT discussion list for the public (in
Yahoo Groups—https://groups.yahoo.com/neo/groups/ACT_for_the_Public/info), and so on—a
careful online search will turn up such things.
Part One
Chapter One
L ife should be getting easier, but it’s not. It’s a paradox of the modern world. At the very
moment that science and technology are providing us previously unimagined longevity,
health, and social interaction, too many of us struggle to live meaningful, peaceful lives
full of love and contribution.
There is no question that we’ve made incredible progress over the last fifty years. That
computer in your pocket called your phone is 120 million times more powerful than the guidance
computer for Apollo 11—the first rocket to land people on the moon. Progress in health
technology has been similar. Leukemia killed 86 percent of the children who contracted it fifty
years ago—now it kills less than half that. In the last twenty-five years, child mortality, maternal
mortality, and deaths from malaria all declined 40 to 50 percent. If physical health and safety
were the issue and you could pick only the moment to be born in the world but not to whom, you
could not do better than to choose today.
Behavioral science is another matter. Yes, we are living longer. But it is hard to make the case
that we are living happier, more successful lives.
We have more accurate information than ever about illnesses that are largely due to lifestyle.
Yet despite billions of dollars spent on research, our healthcare systems are staggering under the
dramatically rising rates of obesity, diabetes, and chronic pain. Mental illness is rapidly
becoming much more of a problem, not less. In 1990, depression was the fourth leading cause of
disability and disease worldwide after respiratory infections, diarrheal illnesses, and prenatal
conditions. In 2000, it was the third leading cause. By 2010, it ranked second. In 2017 the World
Health Organization (WHO) rated it number one. Approximately forty million Americans over
age eighteen have been diagnosed as having an anxiety disorder, and almost 10 percent of
Americans report “frequent mental distress.” We don’t feel as though we have adequate time.
We don’t take care of ourselves the way we’d like. Our health suffers. Many of us are putting
one foot in front of the other while lacking a real sense of purpose and vitality. Every day,
someone who seems to have a good life decides to eat a bottle of pills rather than continue one
more day.
How can this be?
I believe it is because we have not risen to the challenges of being human in the modern
world. Some of the very things we have been doing over the last hundred years to foster human
prosperity have created our conundrum. Take the case of innovations in technology. Each step
forward—radio to TV to the Internet to the smartphone—has created greater mental and social
challenges, and our culture and minds haven’t adjusted rapidly enough in effective and
empowering ways.
As a result of our technology, we are all exposed to a constant diet of horror, drama, and
judgment. In addition, many of us are left feeling overwhelmed and threatened by the rapid pace
of change. A concrete example: only a few decades ago children ran and played freely in ways
that could bring child endangerment complaints today. This increased protectiveness is not due
to the world actually becoming more dangerous; research suggests it has not. Our impression that
the world is less safe results more from exposure to uncommon events through the media. No
matter how calm we feel, we can turn on our computers and see a tragedy unfold, complete with
images of those who died just minutes ago. The twenty-four-hour news cycle shreds our veil of
safety with constant videos of capricious violence.
When the external world changes at this speed, our internal world needs to change too. That
sounds logical, but it is hard to know what steps to take.
The good news is that behavioral science has developed a plausible answer to how we can do
better. Over the last thirty-five years, my colleagues and I have studied a small set of skills that
say more about how human lives will unfold than any other single set of mental and behavioral
processes previously known to science. That is not an exaggeration. In over one thousand
studies, we’ve found that these skills help determine why some people thrive after life challenges
and some don’t, or why some people experience many positive emotions (joy, gratitude,
compassion, curiosity) and others very few. They predict who is going to develop a mental
health problem such as anxiety, depression, trauma, or substance abuse, and how severe or long-
lasting the problem will be. These skills predict who will be effective at work, who will have
healthy relationships, who will succeed in dieting or exercise, who will rise to the challenges of
physical disease, how people will do in athletic competition, and how they will perform in many
other areas of human endeavor.
This set of skills combines to give us psychological flexibility. Psychological flexibility is the
ability to feel and think with openness, to attend voluntarily to your experience of the present
moment, and to move your life in directions that are important to you, building habits that allow
you to live life in accordance with your values and aspirations. It’s about learning not to turn
away from what is painful, instead turning toward your suffering in order to live a life full of
meaning and purpose.
Wait, turning toward your suffering?
That’s right. Psychological flexibility allows us to turn toward our discomfort and disquiet in
a way that is open, curious, and kind. It’s about looking in a nonjudgmental and compassionate
way at the places in ourselves and in our lives where we hurt, because the things that have the
power to cause us the most pain are often the things we care about most deeply. Our deepest
yearnings and most powerful motivations lie hidden inside our most unhealthy defense systems.
Our impulse is usually either to try to deny our pain, by suppression or self-medication, or to get
caught up in dwelling on it through rumination and worry, allowing it to take charge of our lives.
Psychological flexibility empowers us to accept our pain and live life as we desire, with our pain
when there is pain.
I believe psychological flexibility is a means of achieving human liberation; it is the
counterweight that people need to rise to the increasing challenges of the modern world. And
hundreds of studies show that the skills that allow us to develop psychological flexibility can be
learned, to a degree even through books such as this one. I know these are big claims, but if I do
my job, by the end of this book you will understand why the skills that build flexibility are so
powerful and how you can begin developing them in yourself.
It’s perhaps not surprising that the core message of turning toward our pain echoes other
approaches, such as the mindfulness literature developed out of spiritual traditions, or the
emphasis on exposure in cognitive behavioral therapy. But the new science of psychological
flexibility is not aping old themes—by repeatedly asking why these methods work, it has arrived
at a deeper understanding of the importance of flexibility skills and how to establish them. This
understanding was produced by a scientific community that followed a new path of research,
resulting in a new and more integrated set of methods for living happier and healthier lives.
Our own natural tendencies and life experiences have provided a deep wisdom inside us that
naturally guides us toward the manner of living that science is showing is the healthy way to rise
to life’s challenges. You would think that having the wisdom within would steer us on a healthy
course, and it might except for one thing: the organ between our ears. Our minds are constantly
tempting us to head in the wrong direction.
Every one of us engages in behaviors that, deep down, we know don’t serve our best interests.
The examples are endless: the diet that goes awry when you binge on a pint of Ben and Jerry’s
after a long day at work; those extra drinks you have at the party even though you know you
won’t feel your best the next day; the looming deadline that you keep procrastinating about; or
the time you picked a fight with your spouse for no real reason. Each of these alone is innocuous
enough. But the same psychological mechanisms that drive these behaviors can lead us to very
dark places when left unchecked. For too many of us, the occasional binge becomes habitual.
That extra drink at the party turns into substance dependence. Procrastinating on a deadline
unfolds into life dreams that are not pursued. Picking fights with the people you love becomes a
method for avoiding the intimacy you so desperately crave.
Why do we do these things?
The simple answer is that our minds get in our way. We fall into patterns of psychological
rigidity, where we try to run from or fight off the mental challenges we face, and we disappear
into rumination, worry, distraction, self-stimulation, work without end, or other forms of
mindlessness, all in the attempt to evade the pain we’re feeling.
Psychological rigidity is at its core an attempt to avoid negative thoughts and feelings caused
by difficult experiences, both when they occur and in our memory of them. Let’s say you fail a
test. A frightening thought may flicker by: “I’m a failure.” Before you know it, that thought is
pushed off into a corner and told to stay there, and you have decided to self-soothe by going out
to have some drinks with friends. That is fine so far as it goes, but if the cycle repeats itself and
you then begin avoiding preparing for the next test, you are paving a route to pathology by
suppression and unhealthy forms of self-soothing.
Suppose instead you try to reassure yourself that you are smart and able. Doing so makes
enormous sense, superficially speaking. Surely it is helpful to think positive thoughts, right? It is
logical, yes, but it may not be wise. If you’re thinking positive thoughts explicitly to avoid or
contradict negative thoughts . . . well, that’s another form of psychological rigidity and now the
positive thoughts will remind you of the very thoughts you hoped to avoid. A recent study
showed that positive affirmations like “I’m a good person!” work great as long as we don’t really
need them. When we do need them, like when we start feeling bad about ourselves, such
affirmations make us both feel and do worse!
It’s a cruel joke.
The punch line is that if the purpose of any coping strategy is to avoid feeling a challenging
emotion or thinking an upsetting thought, to wipe out a painful memory or look away from a
difficult sensation, the long-term outcome will almost always be poor.
Psychological rigidity predicts anxiety, depression, substance abuse, trauma, eating disorders,
and almost every other psychological and behavioral problem. It undermines a person’s ability to
learn new things, enjoy his or her job, be intimate with others, or rise to the challenges of
physical disease. Mental rigidity even plays a role in areas we wouldn’t necessarily expect. For
example, suppose you examine rates of trauma in people who were in New York near Ground
Zero during the 9/11 attacks. Who do you suppose developed more trauma afterward? Those
who were more horrified, such as by seeing people jump to their death, or those more determined
not to be horrified by the same experience? The research was done and we know the answer. It’s
the latter.
But mental rigidity doesn’t only expose us to greater incidence of psychological disorders and
behavioral problems; it does two final terrible things that truly make it monstrous. First, although
you begin on a path of rigidity to avoid pain, soon enough you have to avoid joy as well. Studies
have shown that anxious people who are rigid and avoidant start out intolerant of anxiety, but
they end up intolerant of happiness too! Joy makes them nervous. If you are happy today, you
might be disappointed tomorrow. Better to be numb.
Second, rigidity makes it more difficult to learn from your emotions. If you are a chronic
emotional avoider, it can lead to alexithymia—the inability to know what you are feeling at all.
This is part of the most hidden and most horrible cost of psychological rigidity: as you fight, and
run, and hide from your insides, you become distant from your own history, your own
motivation, and your own caring. Studies show that if you do not understand your emotions well
simply because your family never discussed them, then you can improve your emotional
understanding by intentionally learning more about them, and the outcomes are not bad. But if
you don’t know what you feel because you’re avoiding your feelings, horrible outcomes follow
in a vast range of areas. I’ll give you an example: people who have been abused by others are
more likely to be abused again, but that effect is not direct—it’s particularly likely to happen to
those who respond to the initial abuse by becoming distant from their own feelings. Once that
lack of feeling settles in, victims of abuse have a hard time reading who is safe and who isn’t,
and the last people who should ever have to face abuse again are the very ones revisited by it. It
is unfair, cruel, and yet predictable.
Why are we so given to psychological rigidity? Even if a wiser part of our minds knows what
is good for us, a domineering problem-solving part does not. I call this aspect of our minds the
Dictator Within, because it is constantly suggesting “solutions” for our psychological pain, even
though our own experience, if we listen carefully, whispers that these solutions are toxic. As with
many political dictators, this voice within our minds can cause great harm. It can lead us to buy
into a damaging story about our pain and how to deal with it. It weaves its advice into tales about
our childhoods, about our abilities and who we are, or about the injustices of the world and how
others behave. It seduces us into acting on these stories even though there is a part of us, deep
inside, that knows better. We are being conned by ourselves.
Think about how often we run from the things we fear in our daily lives and how much
needless suffering it causes. You’ve been feeling down recently and you know that somehow this
is connected to the fact that you haven’t been working out enough, but going for a jog or a hike
or getting to the gym just seems like more than you can bear, so you turn on the TV instead. You
have a deadline at work on a project you aren’t in the mood to deal with so you procrastinate,
which only compounds the problem. You’re totally stressed out because you spend sixty hours a
week in the office. You know you need time off, but you don’t take it because you’re trapped in
the idea that if you don’t go in on the weekend or carry work home, something catastrophic is
going to happen. The Dictator convinces us that engaging in these mentally rigid avoidant
behaviors makes good sense.
Running from our pain, or trying to deny it, seems logical. Because we don’t like feeling pain,
it seems appropriate to treat difficult thoughts, feelings, and memories as “the problem” and to
view elimination of them as “the solution.” We bring all of our problem-solving tools to the task.
Unfortunately, too often this leads to following rigid problem-solving formulations or rules such
as “get rid of it” or “figure it out” or “just fix your problem.”
We are paying a psychological price because what is really wrong within is treating life as a
problem to be solved rather than a process to be lived. In the external world, acting to eliminate
pain is a vital survival instinct. Responding to get your hand off the hot stove or to eat because
you haven’t eaten all day is important to our successful functioning, and anyone who ignores
such commands will pay a high price. But in the internal world of thoughts or feelings, it’s a
different story. A memory or emotion is not like a hot stove or a lack of food. What makes
logical sense for action in the outside world does not necessarily make psychological sense in the
world of thoughts and feelings.
Take the example of a painful memory, such as that of a major betrayal or trauma. Difficult
emotions tempt us to try to protect ourselves against ever having to experience that suffering
again, to attempt to make the emotions just stop. But in order to get rid of something
deliberately, we have to focus on it. If we are working to get rid of something, we need to check
to see if it’s gone. When we do that with internal events laid down by our own history, such as
memories, we have now reminded ourselves of the events connected with these memories yet
again. When we do this with echoes of the past, we increase their centrality and build out the
history we have with them.
If we instead distract or self-soothe in order to deal with the pain—say, by reading a good
book or listening to a favorite piece of music—these otherwise enjoyable activities can actually
over time become related to what we are avoiding and can even open a back door into them.
After just a few times, that soothing book or piece of music might remind you of the memory
you are avoiding or trigger a revisiting of the trauma you hoped would recede.
Meanwhile we often attempt to fuel our motivation to change with mental threats about the
dire things that will happen if we do not, which also often only makes painful or traumatic
memories more powerful and central. Those threats produce emotional reactions—which
sometimes are kin to the reactions we are trying to evade, thus increasing the pain we feel. We
end up in a kind of demonic feedback loop. Trying to combat anxiety, for example, can lead to
increased anxiety about our anxiety. Similarly, when we disappear into rumination, we convince
ourselves we are figuring out how to solve our problems, but we become so focused on them that
they increasingly control our lives. We turn our insides into virtual war zones in a frantic but
losing attempt to find peace of mind by eliminating and subtracting offending experiences.
I am not telling you anything you do not know, at least intuitively. Most of us have noticed
that our minds can lead us to strange places. But most of us don’t yet understand that when we
have a painful memory or a frightening feeling, doing things to escape them can increase their
importance. If we are afraid of being rejected by others, we see signs of imminent rejection
everywhere. We know that buying into that fear will not liberate us, but the possibility of
rejection is so fear-inducing that it seems like a violation of basic logic not to focus on it. If we
are browbeating ourselves about supposed weaknesses, we are likely to feel even less able, and
we are more likely to fail.
Liberating ourselves from the trap of rigidity is made harder by the messages we’re barraged
with by the culture at large. Many businesses thrive on this messaging. Are you worried about
your appearance? A beauty product will remove the worry. Unhappy? The right beer will cheer
you up. Look at the themes of virtually all the major self-help books and programs—it’s more of
the same: manage your anxiety, feel good, control your thoughts, and life will be better.
Most self-help books also ask people to do one or another form of self-soothing or self-
correction. Somehow, we are supposed to relax, focus on the positive, or have different thoughts.
In the conventional conception, our names for mental conditions hang the hook of blame on
emotions and thoughts. We have “anxiety disorders” or “thought disorders.” An array of pills
and therapy approaches promise the elimination of difficult thoughts and feelings (for example,
notice that term anti- in antidepressants). And yet as the adoption of this entire model has spread
around the world, misery and disability have increased, not decreased.
Piled on top of this encouragement to avoid or eradicate our pain is the new addictive
invitation that social media constantly offers us to compare ourselves to others and to distract
ourselves. No matter how successful we are, we can reach into our pockets and find a social-
comparison tool called a smartphone that will dutifully show us that others are seemingly doing
far better.
The fields of psychology and psychiatry have also inadvertently contributed to the problem.
Ideas that are not evidence-based proliferate, such as Freud’s Oedipus complex (you are sexually
attracted to your parents, which creates a hidden conflict, giving rise to anxiety), while evidence-
based ones lie dormant.
But even the major science-based efforts have not given the public the tools they need. They
have also promoted a compelling but flawed understanding of how we ought to cope with our
negative emotions and thoughts. In the midtwentieth century, psychological strength would often
have been defined largely as emotional avoidance. One of the most famous scenes from the
award-winning drama Mad Men shows the lead character—successful ad man Don Draper—
visiting a young colleague in the hospital after she has given birth to an unwanted baby in 1960.
Peggy Olson has denied that she was pregnant—even to herself—and becomes depressed to the
point of psychosis after she delivers. In the psych ward, Draper leans in toward Olson and tells
her to snap out of it. “Do whatever they say,” he says of her doctors. “Get out of here . . . This
never happened. It will shock you how much it never happened.” In the next scene, he’s pouring
himself a long shot of whiskey at his office.
Sure, that’s just television. But the cultural rule delivered in that scene—that you can and
must learn to change your thoughts at will, and only if and when you do so will you reduce or
eliminate uncomfortable emotions—has been deeply ingrained in our minds. One of the most
important approaches to psychotherapy is partially responsible.
Working separately in the 1960s, University of Pennsylvania psychiatrist Aaron Beck and
New York City psychologist Albert Ellis (1913–2007) wrote papers arguing that many damaging
emotions were caused by faulty cognitions: “black-and-white thinking,” for instance—seeing
complicated relationships or life events as simply awful without considering the more nuanced
possibilities. They argued that people look at a difficult discussion with a boss or a fight with an
old friend—typical things in life—and see them in an unrealistic, irrational, or distorted way.
The solution suggested came to be called cognitive behavioral therapy (CBT). CBT is a
whole package of therapeutic approaches that includes many very well-supported behavior
change methods, and CBT is now evolving in ways I support. But a central tenet of traditional
CBT that is problematic came to dominate the popular understanding of the approach—we need
to change negative or distorted thoughts and convert them to positive and rational ones. This
“cognitive restructuring” was supposedly the route to mental health because it was flawed habits
of thinking—not Freud’s “neuroses,” not nightmares, not repressed memories—that most
controlled our emotions and shaped our behavior.
The idea permeated our culture. When Phillip McGraw (stage name Dr. Phil) gives advice,
for instance, much of it flows from a cognitive behavioral perspective. “Are you actively creating
a toxic environment for yourself?” he has asked on his website. “Or are the messages that you
send yourself characterized by a rational and productive optimism?”
The research I describe in this book has led to a fundamental reappraisal of the notion that we
should challenge and restructure our thoughts. Research shows that this part of the CBT
approach is not what is powerful about it, and it often doesn’t work as well as learning to accept
that we are having unpleasant emotions and thoughts and then working to reduce their role in our
lives instead of trying to get rid of them.
On a parallel track, psychiatry has promoted the idea that we need to treat a host of
psychological conditions as if they are the face of a hidden disease. That implies they will
eventually be shown to have known causes, mechanisms of development, and responses to
treatment. Yet after spending several decades and many billions of dollars on research in this
pursuit, in how many cases have mere conditions turned into mental diseases with a known
cause?
The answer may shock you. Not one. The truth about mental health is that the causes of all of
the mental conditions you hear about are unknown, and the idea that “hidden diseases” lurk
behind human suffering is an out-and-out failure.
Meanwhile the idea that psychological conditions should be treated as hidden diseases has
taken a troubling toll. It is a soothing idea because it contains a real truth: suffering is not your
fault. But when people buy into it, they often begin to feel that they must be on medication for
life because of what they “have” hidden inside.
Consider just the ten-year period from 1998 to 2007 (the most recent decade with solid
numbers) and people in the United States who sought out treatment for psychological struggles.
In that time, the number of people using only psychological change methods fell nearly 50
percent, while the number of those using psychological approaches along with medications fell
about 30 percent. What shot up? People using only medications to address their difficulties. By
the end of that decade, more than 60 percent of people with psychological conditions were using
only medication; it has only gotten worse since.
That would be fine if science supported that approach, but it doesn’t. Medications can be
helpful if they are used to leverage psychosocial methods, with lower doses and shorter
durations, but as prescriptions have skyrocketed and medication-only has become the norm, the
incidence of mental health problems has risen. What’s more, when people are falsely convinced
that they have a “mental disease,” they tend to be more pessimistic that they can do anything on
their own to improve their condition, such as through behavior change. Friends and family feel
less hopeful for them as well.
This book will reveal how powerfully we can transform our lives by seeking not to eradicate
our difficult thoughts and emotions or numb them away but to cultivate psychological flexibility,
which allows us to accept them for what they are and not let them rule our lives. It will show that
trying to eliminate or completely restructure our thoughts is unnecessary and even futile. Our
nervous system does not contain a delete button, and thought and memory processes are too
complex to make them neat and tidy. It will also reveal how flawed the cultural message is that
people have something that makes their lives difficult. It is what we do that matters, and that
gives us the means to live in a way that is richly meaningful to us, despite even quite difficult
challenges.
1. Defusion.
Requires pivoting from cognitive fusion to defusion; redirects the yearning for
coherence and understanding.
Cognitive fusion means buying into what your thoughts tell you (taking them
literally, word for word) and letting what they say overdetermine what you do. This trick
of mind happens because we are programmed to notice the world only as structured by
thought—we see the terrible this or the awful that—but we miss the fact that we are
thinking. In our attempts to have the world make sense, we judge our experiences and
then buy into the judgment instead of realizing it is a judgment to begin with. The flip
side of fusion is seeing thoughts as they actually are—ongoing attempts at meaning-
making—and then choosing to give them power only to the degree that they genuinely
serve us. This flexibility skill involves just noticing the act of thinking, without diving
in. Our made-up word for “just noticing” is defusion. With this ability to distance from
our thoughts, we can begin to free ourselves from our negative thought networks.
2. Self.
Requires pivoting from allegiance to a conceptualized sense of self, or our ego, to a
perspective-taking self; redirects the yearning for belonging and connection.
In the simplest sense, what I mean when I’m talking about your conceptualized self is
your ego—your stories about who you are and who others are in relation to you. Inside
our stories, we note what is special about us (our special skills; our special needs), and
we hope this will earn us a place in the group. We all have these stories, and, held
lightly, they can even be helpful. However, when we hold tightly to them it becomes
difficult to be honest with ourselves or to make room for other thoughts, feelings, or
behaviors that would benefit others and ourselves but that don’t fit the story. In this
event, the conceptualized self leads us to defend these stories as if our life depends on it,
which creates alienation, not true connection. The alternative is to connect more deeply
with a perspective-taking self—a sense of observing, witnessing, or purely being aware.
This sense of self allows us to see that we are more than the stories we tell ourselves,
more than what our mind says. We also see that we are connected in consciousness to all
of humanity—we belong not because we are special, but because we are human. Some
people think of this as a transcendent or a spiritual sense of self.
3. Acceptance.
Requires pivoting from experiential avoidance to acceptance; redirects the yearning to
feel.
Experiential avoidance is the process by which we run from or attempt to control our
personal experiences (thoughts, feelings, sensations) and the external events that give
rise to them, all the way from going to a party to trying to cope with the death of a loved
one. We do this because our mind tells us it’s an easy way to avoid pain, and we will be
able to feel freely only when we feel GOOD. But avoidance typically only compounds
our difficulties and restricts our capacity to feel at all. Acceptance is the full embrace of
our personal experience in an empowered, not in a victimized, state. It’s choosing to feel
with openness and curiosity, so that you can live the kind of life you want to live while
inviting your feelings to come along for the ride. As a result of the Acceptance pivot, the
focus moves from feeling GOOD, to FEELING good.
4. Presence.
Requires pivoting from rigid attention driven by past and future to flexible attention in
the now; redirects the yearning for orientation.
Processes of rigid attention show up as ruminating about the past, or worrying about
the future, or mindlessly disappearing into our current experience the way teenagers
disappear into video games. As we struggle with life’s challenges, we often fear
becoming lost, and we tend to look to the past and future to become oriented. But
instead we find ourselves in a mental fog of what was or what will be, when there is
really only what is. Flexible attention in the now, or being present, means choosing to
pay attention to experiences here and now that are helpful or meaningful—and if they
are not, then choosing to move on to other useful events in the now, rather than being
caught in mindless attraction or revulsion.
5. Values.
Requires pivoting from socially compliant goals to chosen values; redirects the yearning
for self-direction and purpose.
People often attempt to achieve goals because they feel that they have to. Otherwise
people we care about, or whose views we care about, would be displeased, or they will
be disappointed in themselves. Research shows that such socially compliant goals give
rise to motivation that is weak and ineffective. We may try to drive our own behavior
with such external goals, but we also secretly resent them because they undermine our
own process of unfolding. The yearning for self-direction and purpose cannot be fully
met by goal achievement since that is always either in the future (I haven’t met my goal
yet) or the past (I met my goal).
Values are chosen qualities of being and doing, such as being a caring parent, being a
dependable friend, being socially aware, or being loyal, honest, and courageous. Living
in accordance with our values is never finished; it is a lifelong journey. And it provides a
way to create enduring sources of motivation based on meaning. Ultimately what your
values are is up to you—they are a matter between you and the person in the mirror.
6. Action.
Requires pivoting from avoidant persistence to committed action; redirects the yearning
to be competent.
We are always building larger patterns of action, known as habits. When we think
about building habits, we tend to focus on perfect outcomes, such as quitting smoking
entirely hard-stop. In fact, habit building is a moment-by-moment process. If we try to
change our habits in one fell swoop, our efforts tend to lead to procrastination and
inaction, impulsivity, or avoidant persistence and workaholism. The Action pivot
focuses us instead on the process of competently and continuously building habits in
small steps linked to the construction of larger habits of loving, caring, participating,
creating, or any other chosen value.
The six pivots can be more simply summarized with this cheat sheet:
1. See our thoughts with enough distance that we can choose what we do next,
regardless of our mind’s chatter.
2. Notice the story we’ve constructed of our selves and gain perspective about who we
are.
3. Allow ourselves to feel even when the feelings are painful or create a sense of
vulnerability.
4. Direct attention in an intentional way rather than by mere habit, noticing what is
present here and now, inside us and out.
5. Choose the qualities of being and doing that we want to evolve toward.
I’ve dubbed the initial moves to embrace these practices “pivots” because the word pivot in
English comes from an old French word that referred to the pin in a hinge. Pivots in hinges take
the energy that is headed in one direction and immediately redirect it in another. When we pivot,
we take the energy inside an inflexible process and channel it toward a flexible one. If we learn
to feel feelings as they are—with openness, curiosity, and self-compassion—pain can be a
powerful ally in living. Take for example, the pain of personal betrayal that can lead to a process
of experiential avoidance: with acceptance skills we can channel that painful energy of wanting
to feel loved and cared for back toward its original purpose—creating the very relationships for
which we yearn.
Pain and purpose are two sides of the same thing. A person struggling with depression is very
likely a person yearning to feel fully. A socially anxious person is very likely a person yearning
to connect with others. You hurt where you care, and you care where you hurt.
Think of making these pivots as learning the moves to a dance, like following steps laid out
on the floor. As with dance steps, the pivots combine to form a seamless whole, and without
each, the dance will not flow smoothly. As you practice the skills, you develop increasing
flexibility. And just as it is easier to swing your partner around if your partner is always in fluid
motion, rather than stopping after each move, by continuously developing your flexibility skills,
you become increasingly able to take the energy of your existing thoughts and feelings, even the
negative ones, and swing them into energy for growth. Ironically, when we pivot we can actually
begin to satisfy the deeper yearnings that lie inside our logical but mistaken strategies.
Relatively speaking, these flexibility practices account for the lion’s share of psychological
health. Learning them leads to more effective patterns of living and behaving, of being and
doing. Said in another way, the flexibility skills not only help contend with specific life
problems, such as depression, chronic pain, and substance abuse, they allow all of us to live
healthier and more meaningful lives. They promote prosperity.
Making the pivots may seem daunting, but ACT research has shown that we can learn these
six skills through quite simple methods and can turn them into living habits. I will introduce a
host of research studies that have shown how to make the pivots and build the skills and have
proven the remarkable positive effects of the practices on growth and life enhancement.
For a taste of the findings, take the example of one recent study. Researchers randomly
assigned several hundred people who were recovering from a completed course of cancer
treatment with its horrors of chemo and surgery to receive either usual aftercare (such as
following up with the needed lifestyle changes in diet and exercise to avoid a relapse) or eleven
short ACT-based phone calls about how to use flexibility skills to rise to the challenge of cancer
recovery. Finding out you have a serious, life-threatening illness can be traumatic. But over the
next six to twelve months, compared to the usual care group, the ACT participants not only
showed lower anxiety and depression and better compliance with their new medical regimen
(e.g., they started following a better diet and exercising—key steps to avoid relapse), they
showed notably higher levels of quality of life, especially in terms of physical well-being, as well
as higher levels of acceptance and posttraumatic growth.
In some ways, that last result is the most exciting because it is a clear indication of what it
means to respond to life’s challenges with flexibility. Yes, cancer is a shock, but if you survive,
life is giving you a chance to learn and to change. That is what posttraumatic growth means.
Over the next six or twelve months, those in the ACT group showed more appreciation of life,
more spiritual growth, more of an embrace of new possibilities, and more focus on relationships
with others. They grew, and they turned their recovery from cancer into an asset—a source of
personal strength.
In another study, my colleagues and I looked at one population many researchers had avoided
because of its complexity: poly-drug users. These are the addicts who often show up in rehab
facilities and say, “Oh, I take everything. I’ll take a bunch of Gas-X if someone tells me you get
high when you use it” (by the way, you don’t). To make it even more challenging, we chose to
examine those whose addiction patterns included opioids such as heroin and who were already
being treated with methadone (which is a legal, long-acting opioid) but were failing.
We randomized well over a hundred participants into three groups: one that would simply
continue taking methadone; one that would take methadone but also learn ACT; and one that
would continue on methadone but be exposed to a program that facilitated the use of a twelve-
step program like AA or NA. After six months, the ACT participants were taking far fewer
opiates (as measured by their urine) compared to the group that just stayed on methadone. The
twelve-step facilitation group showed an initial change but by the end of the follow-up they were
not better than those on methadone alone. Since that study, dozens of studies on substance use
have confirmed that people can stop smoking, reduce excessive marijuana use, get through
detox, or succeed in alcohol addiction treatment more quickly using ACT. The methods work
because urges become less dominant; values become more important; unpleasant sensations less
entangling. It becomes possible to choose what you do.
The science of psychological flexibility now spans well over a thousand studies, which have
tested it in almost every area of human functioning. In clinical research this breadth is called a
transdiagnostic, meaning that targeting psychological flexibility works across a wide range of
traditional mental health categories (anxiety, depression, substance abuse, eating disorders, and
so on). It turns out even that is not broad enough. ACT is transdiagnostic on steroids. The same
flexibility processes also help us step up to the challenge of physical disease, or manage our
relationships better, or reduce stress, or organize our business well, or play competitive sports.
Psychological flexibility measures can predict whether you can manage your diabetes, or the
number of assists and points the professional hockey team makes while players are on the ice.
Specific psychological flexibility measures predict whether you will develop trauma when bad
things happen, or whether you will be an effective parent.
In Part One I tell the story of the discoveries that led to the development of ACT methods.
Part Two introduces important additional findings about why flexibility skills are so powerful
and shares a wealth of methods developed to help people make the initial pivots and then
continue to develop the skills. In both parts, I share the stories of people who have transformed
their lives. Part Three introduces findings about how helpful the ACT skills are in coping with a
host of specific challenges, such as facing substance abuse, dealing with cancer, managing
chronic pain, letting go of depression, quitting smoking, losing weight, sleeping better, learning
better, and being more engaged and fulfilled in one’s work.
People’s problems and difficulties are not fixed by the snap of fingers; fundamental change
takes time for most people. Our lives are never smooth and our growth is never “finished.” But a
change in direction does not take much time at all. Like pivoting on the ball of your foot as you
turn a corner, the core of the process of creating a more psychologically flexible life can take just
an instant—especially when you know how to undo the trick our minds are playing on us.
Learning how to pivot in that way need not take years, or even months. In the over 250
randomized controlled trials of ACT currently available, dozens were based on only a handful of
hours dedicated to creating a new life direction.
An example—one of many—is a study I conducted with my graduate students that examined
the impact of a single day of ACT training targeting shame and self-stigma for overweight and
obese people already in other weight-loss programs (e.g., Weight Watchers). We found that our
training reduced shame and improved both psychological flexibility and quality of life. We did
not target weight loss specifically, so it was a real surprise that when overweight people learned
to pivot with their self-shaming and blaming, they naturally lost more weight over the next three
months as well. Weight loss came along for free once people stopped beating themselves up for
being heavy and instead learned to sit with their emotions and thoughts. In a related study, we
showed that the level of psychological flexibility overweight people exhibit correlates directly
with their ability to lose weight, engage in exercise, and stop binging.
• • •
My deeply hopeful message is that dramatic change is possible, and it is not very far away. How
far away? How much effort will be needed? Well, let me ask you this: If you are walking in one
direction and you pivoted on the ball of your foot in another direction, how far away was that?
How much effort did it take?
You might be tempted to answer my question by saying it takes virtually no time and no
effort to do it, but that is true only after a fashion.
Have you ever watched a baby learn to walk? If you have, you know that walking takes time
and effort to learn. Research shows that infants learning to walk take about 2,400 steps an hour—
enough to cross seven football fields!—and they fall, on average, seventeen times. Do the math:
this means that if a baby walked even half of its waking hours, it would cover forty-six football
fields and fall a hundred times in a single day. No wonder parents of toddlers are tired! Even
with all this enormous practice, toddlers initially can change direction only by a series of short
rocking steps, adjusting direction a little each time. That is why we call them “toddlers.”
Eventually, a new skill will be learned and normal children and adults can pivot smoothly on the
ball of the foot, shifting from one direction and carrying momentum into another direction.
Pivoting while walking is both effortless and a skill that took effort and practice to learn.
The good news is that mental pivots are actually a lot simpler to learn than walking. With
guidance, you will not need to fall down anywhere near as often as you did as a toddler.
If I’m right, and psychological flexibility is a key missing ingredient in addressing the
modern world in a healthy way, it means we are not very far from creating more loving and
empowered environments at home, at work, in our communities, and in our hearts. There are no
money-back guarantees, of course, but it has been shown again and again that once you learn the
key set of pivotal psychological skills, beginning a healthy process of change is about as far
away as saying the word begin.
Chapter Two
I began to develop ACT in earnest after I hit bottom with my struggle against anxiety in the
middle of one dreadful night. Many people with anxiety disorders, as well as many of those
who’ve experienced addiction, depression, and so many other entrapping psychological
conditions, will recognize parts of the experience. I share the story not only because it
demonstrates how the psychological rigidity of avoidance can become so crippling, but also
because that night I made several important steps toward recovery. In fact, I made three of the six
pivots, though I didn’t come to think of them as such until I’d done a good deal of later reflection
and research focused on what had happened to me that night. The story illuminates what the
experience of pivoting is like; how rapidly we can make pivots—often making more than one at
once—and how they can lead to the conviction to pursue a new course in our lives. My
experience that night led me to the conviction that we in psychology needed to discover methods
by which people could learn to make pivots without hitting bottom and that would allow them to
truly free themselves to live healthy, fulfilling lives.
The studies that my team and I conducted in the several years following this dreadful but
transformational night confirmed the core hypothesis at the heart of ACT: that changing our
relationship to our thoughts and emotions, rather than trying to change their content, is the key to
healing and realizing our true potential. Had I not experienced the set of realizations I had that
night, I don’t think that I would have come to understand that as fully, or as quickly. I was firmly
in the grip of the monkey trap.
Try to expose yourself to frightening situations because that is supposed to make the fear subside.
Don’t rush before going into a meeting—your heart rate might go up.
Check your heart rate subtly just to make sure it’s OK.
Have a beer.
Joke.
Overprepare.
Take tranquilizers.
Many of these efforts were harmless enough over the short term—there was nothing wrong
with me joking, relaxing, or kicking back with a beer. Some could even have been helpful—in a
different set of circumstances, like trying to think more rationally or exposing myself to anxiety-
provoking situations. The problem was that the foundational message my mind was sending me
was toxic: anxiety is my opponent and I have to defeat it. I have to watch out for it, manage it,
and suppress it. My anxiety itself became my chief source of anxiety.
As I came to consider anxiety my mortal enemy, my panic attacks increased in intensity and
frequency. One day in a lab meeting I had an attack so strong that I abruptly fled, offering no
explanation. An attack on a flight to a conference made me move my seat, so that my friends
would not see what was happening . . . and then move it again. I had an attack in a department
store so strong I could not remember how to find the escalator. I sat down behind the bedspread
display and wept quietly. I scheduled films in class rather than lectures, but even then, the panic
could come on so strongly I could barely thread the film into the machine. Soon, no place was
safe. By the time two years had gone by, 80 to 90 percent of my waking hours were focused on
trying not to panic. On the outside I smiled and laughed and looked normal, even if I might have
seemed a bit withdrawn or spacey. Inside I was constantly scanning the mental horizon for signs
of the next attack.
I was like a person living with a baby tiger who had bitten my foot when hungry, and my
response was to try to placate it by throwing it chunks of steak. That worked fine in the short
term, but every day that went by, the tiger got bigger and stronger and needed more meat to be
satisfied. The meat I was feeding it was chunks of my freedom; chunks of my life. As the tiger
grew, my attention throughout the day was more focused on planning what to do if an attack
showed up. It was exhausting. Eventually, my own home provided no respite, and sleep no
refuge. I began waking in the middle of the night in a full-blown state of panic, a striking
testament to how automatic our rigid and avoidant thinking processes are. I didn’t even need to
be awake, experiencing an external trigger of some kind, in order for the vicious mental cycle to
be activated.
I had fallen completely under the iron grip of the Dictator Within. The voice in my head was
telling me more and more urgently either to avoid my anxiety or to somehow overpower it. We
all know this self-judging, bullying voice within our minds. One could think of it as our internal
advisor, judge, or critic. When we learn to tame it, it can be very useful. But if we allow it free
rein it deserves the name Dictator because it can become that powerful. Just like a real dictator,
the voice can tell us many positive things: it can boost our confidence, saying “nicely done,” and
it can reassure us that things that have gone wrong are not our fault. It can tell us that we are
intelligent and hardworking. It can just as easily turn against us, however, telling us that we are
bad, or weak, or stupid. It can tell us we are hopeless, or that life is not worth living.
Whether the voice is positive or negative is not as important as whether it dominates us. In the
name of positivity, for example, it can sell us on delusions of grandeur—convincing us that we
are so special that we are secretly envied or assuring us that we are smarter than other people and
are unequivocally right while others are just flat-out wrong. On the flip side, in the name of
supposedly constructive criticism it can steep us in self-loathing, rip our lives into shreds of
shame, or put life on indefinite hold.
What is so potentially dangerous about the power this voice can have over us is that we lose
contact with the fact that we are even listening to a voice. It is almost constantly weaving a story
about who we are, about how we compare to others, what others are thinking of us, and what we
must do to ensure that we are OK, that we’re coping with whatever challenges are confronting
us.
The dictation is so constant and seamless that we disappear into the voice; we identify with it,
or “fuse” with it. If we were pushed to say where that voice comes from, it would be natural for
us to consider the Dictator to be our voice, our thoughts, or even our true self. That is why we
call this voice the ego—which is just Latin for I. But it is really the story of I. It becomes so
entangling that we take its dictates literally.
I had done that in spades during my multiyear descent into panic disorder. The voice had
generated thoughts like I need to get a grip, I’m such a loser, Why can’t I solve this problem?, or
I’m a psychologist, for God’s sake; I need to fix it! In hindsight, I can see the “I, I, I” in every
single one of those thoughts. My “story of I” had become entangling, and overwhelming.
Virtually all of my patients have told me of similar corrosive messages from their internal
Dictator. Cognitive behavioral therapists have assembled virtual butterfly collections of such
automatic negative thinking patterns, putting them into questionnaires that can be used to assess
maladaptive thought patterns. For example, one of the earliest and best-known measures is the
Automatic Thoughts Questionnaire (ATQ), created in 1980 by two psychologist friends and
colleagues—Steve Hollon and Phil Kendall. The ATQ measures how frequently people think
thoughts like I’ve let people down, My life is a mess, I can’t stand this anymore, or I’m so weak.
Such thoughts correlate with many different kinds of poor mental and physical outcomes, but
especially depression and anxiety.
I saw the effects clearly in my clinical practice. For example, an obsessive-compulsive client
of mine could lay out in incredible detail all of the ways it might be possible for her to
contaminate others. Her worries dominated her mind, and every area of her functioning
deteriorated.
Given the negative effects of these thoughts, it is no wonder that cognitive therapists were so
focused on changing them. Obviously, ruminative thoughts about contamination were the
problem, right? And if they were, then obviously they needed to be changed, right?
This conclusion is logical, but I found that focusing on changing my thoughts as I wrestled
with my anxiety only empowered my Dictator Within. The more determined I became that I
needed to get over panic, or through it, or around it, the more I had panic attacks. What made the
notion that I had to be at war with my anxiety especially insidious was that over a period of
minutes or hours my efforts appeared to work. My anxiety quieted down for a while. But over
days, months, and years my condition only worsened. Then I had the experience that led me to
steer a new course.
We can say to a child who has learned this relational frame not only “The house is bigger than
the car,” but “God is bigger than the universe” and the child will understand. The child will also
be able to say, “The universe is smaller than God” and “Since I’m smaller than the universe, God
is bigger than me.” They can combine frames into cognitive networks.
Two-way relations and the networks they produce are the fundamental building block of our
symbolic thinking abilities. The kinds of relations we learn quickly become more and more
complex, moving beyond direct relations between words and concrete objects to abstract
relations, such as that one object is opposite to another, better or worse than another, uglier or
prettier, or more valuable. The mind is using language to understand increasingly complex
features of the world and how it works.
Without the imaginative ability to understand abstract relations, human cognition would have
been hobbled; we realized this was another major threshold of our intellectual development. It
takes a number of years for children to master. Three-year-olds tend to prefer a nickel to a dime,
because they know that coins are worth something (like candy) and the nickel is physically
bigger. Up to that point in their lives, “more” is linked primarily to comparison of physical
features, a skill many animals have. But by the time they are five or six, they will prefer the dime
“because it’s bigger.” They now understand that “more” can be abstracted from the physical
amount of something and can even be applied to something that is obviously “less” in a physical
sense. As this happens, humans enter into a cognitive world your dog or cat will never be able to
enter.
As we learn the many relational frames, we move from being able to derive relations by
observing events in the world to being able to imagine relations—to conjure them up purely in
our minds. At this point our thought processes are becoming extremely complex; we are building
ever more elaborate networks of thoughts built out of relations. A good way to appreciate why
complexity follows from knowing many different kinds of relations is to think about how
enormously complex relations are in an extended family.
Suppose I put a photo of an Asian woman in her early thirties and one of a white woman who
appears to be in her late fifties in front of you and I say, “These two people are from the same
family. Without asking any questions, can you tell me how they are related?” You’d have to
answer “no” because there are so many ways in which they might be. You might guess that the
younger Asian woman had married the son of the older white woman. But it might also turn out
that the younger woman is a stepsibling of the older woman, because she’s the daughter of the
white woman’s father from a second marriage. The Asian woman might also be the daughter of
the older white woman, by blood or by adoption. But she could also be a second cousin, the
daughter of one of the white woman’s cousins. Perhaps the two of them are married.
You don’t need to see the other people in the family who are directly linked to one another in
order to spin out these possibilities in your mind. You can work all of those possible relations out
because you understand the many types of relations that can occur in families in the abstract
(don’t we even call all of our relatives “our relations”?). This allows you to imagine the many
ways the two women could be related. And if you are told the right relation, it could impact
information about all of the rest of the family, because relations like that combine in networks.
The bottom line is that relational thought is much more complex than associative thought
because it allows us to fabricate relations in the abstract and combine them into vast networks.
With associations, we make connections between things or events because they are similar in a
physical sense, or because they occurred together in time and space. But with relational thinking,
we can connect things that have no physical relation to one another and don’t appear together in
time and place. Not only can we, but we constantly do, and the connections we make become
extremely complex.
This is why any given thought might trigger a thought about something else, such as why
having a thought about how sweet your spouse is to you can remind you of how a past
relationship ended so painfully in deep betrayal, and suddenly you will start wondering if your
spouse is faithful. You’ve connected your relationship with your spouse to that prior relationship
through the “is opposite to” relational frame. Lots of unwanted thoughts are similarly triggered
because of such embedded relations, explaining the automaticity of so much of our thinking.
Aaron and I called this new explanation of the way we learn language and higher-order
thinking abilities relational frame theory (RFT). Extensive research has confirmed that learning
relations is crucial to developing our cognitive powers, and also to developing our sense of self.
For example, in research with language-impaired children, who have not developed a normal
sense of self, we found that if we taught them how to do relational thinking, they would then
develop both stronger language skills and more normal self-awareness.
But it was the clinical implications that most stunned me. Trying to unravel these dense
networks of relations and reconstruct them, as CBT has tried to help people do, is like trying to
rearrange a vast spiderweb. It’s futile.
Trying to get rid of thoughts would just add to the cognitive networks that surround them.
Relating could be abstract: anything could be related to anything.
You can assess for yourself what I mean. Think of any two objects. Anything. Once you have
done that, how is the first one better than the second? You will find an answer very shortly. How
did the second cause the first? Think hard. Again an answer! How can you only think rational
thoughts if the very nature of thought allows anything to be mentally related to anything else in
any way at any time?
I did the math: the relations of just eight things and their names could yield over four
thousand possible relations (things to things; names to names; relations to relations; all
combinations). That meant it could take an eternity to work out the implications of all of the
possible relations any one of us already has in our head! There must be an almost infinite number
of inconsistencies in these cognitive networks. And adding a truly new thought could change all
others but in highly unpredictable ways.
These implications were sobering. Traditional cognitive ideas were based on an
associationistic theory of thought. If that was wrong, traditional cognitive therapy was
conceptually wrong, even if some of its methods were helpful. And since we cannot fully restrain
how our minds relate things, I realized we would need to focus more on how to alter the
behavioral impact of our thoughts.
There were other, more expansive implications, especially for our view of human
consciousness. I realized that the two-way street of words and objects already implied a kind of
perspective taking: from the speaker’s point of view an object is called X, but from a listener’s
point of view if you hear X, you orient toward the object. But that would mean that perspective
taking is inside every word we say, and as we speak or tell ourselves stories it could easily begin
to establish a “point of view” inside us. I wrote my first RFT paper in 1984 making this claim
and called it “Making Sense of Spirituality” when I realized this could lead to a transcendent
sense of self—the perspective of an observer within who is witnessing what is being described
from a particular point of view (see Chapter Twenty-One).
That was a guess but it turned out to be right. RFT research has since shown that it’s not until
a particular type of relation is learned that this sense of self, of being a separate being, emerges.
This type is referred to as deictic relations, which means “to learn by demonstration,” but that is
an arcane technical term, so here I will call them perspective-taking relations. All of these
require a certain vantage point to be understood, such as knowing that you are here rather than
there. A relation like that can be hellacious for kids to learn because the speaker’s “here” is the
listener’s “there” and vice versa. As a result, when you go there, there becomes here and here
becomes there! (You can almost see little kids in their frustration thinking, “Could you freakin’
make up your minds?!”) But with enough demonstrations, children do learn perspective-taking
relations. The three most critical are I versus you, here versus there, and now versus then.
Children usually learn them in that order: person, place, and time.
This magic happens somewhere around age three or four. The perspective-taking relations of
person, place, and time merge into an integrated sense of perspective: a sense of observing from
“I/here/now” appears. Metaphorically, you show up behind those eyes of yours, and at the same
moment, you know that your mother is behind hers. You have developed a sense of awareness of
living in the world as a conscious human being, with a point of view. There is a quality of
“fromness” to this kind of awareness. You not only see, and see that you see, you also see that
you see from “I/here/now.” What’s more, this sense of self is based on symbolic relations; it
emanates from the combination of perspective-taking relations.
Once the skill of taking a perspective in terms of time, place, and person is established, it
never really leaves you. Infantile amnesia falls away. This is why you can readily see again
through the eyes of yourself at age four or five, but not age one. “Self” as a form of
consciousness or perspective becomes the strand you put the beads of experience on. Everywhere
you go, there you are. And you can also imagine yourself being somewhere else, say standing on
the Great Wall of China. You can even imagine yourself being someone else, or what you will be
like when you are very old. You can tell yourself stories about other people too, imagining what
they are experiencing, even if you are on the other side of the world. In imagination, you can
move perspective-taking across time, place, or person.
Perspective-taking also supports storytelling about ourselves that is more content-based and
evaluative, and that part is hard to put on a leash. With the rise of our verbal problem-solving
ability, the Dictator Within is born, along with the need for a liberated mind. As we begin to
create our story of who we are, for example, we also start to compare ourselves to others, and to
social ideals of who we should be. Thus, the unfortunate side effect of the same cognitive skills
that allow a sense of ourselves as conscious human beings is that we often soon become self-
critical, or excessively seek to be attended to, to be important or notable based on the specialness
of our self-stories. We have begun to fashion the conceptualized self, and this imagined self
often takes on the illusion of being our “real” self. We begin to become the content of our stories,
and the Dictator comes fully into power.
The problem is not the presence of a self-story; we all need one. But when we disappear into
this ongoing storytelling—when we fuse with the story—all sorts of mental health and life
satisfaction challenges follow. This is because the Dictator becomes so preoccupied with
monitoring the story and defending it, assessing whether we are living up to it or others are
believing it.
There is something bittersweet about our entanglement with our minds. Symbolic thinking
does not come from a bad impulse. It stems from our deeply rooted inclination as a species to be
cooperative, to belong in groups of others and to get along. The three things humans are
especially good at, that distinguish us so dramatically from all other species, are our higher-order
cognitive abilities, culture, and cooperation.
Human beings are by nature cooperative. If there is a child-sized bench that two toddlers want
to move, it is natural for one to try to pick up one end while the other picks up the other. Even
our closest animal relatives, chimpanzees (who are quite cooperative . . . just not as much as we
are), rarely show such things. Evolutionary biologists argue that we developed the impulse
because we lived in small groups, in which cooperation paid off.
It is just the kind of monkey we are: normally developing human babies care about social
attachment and social cooperation. Human infants come into life with a certain amount of
“theory of mind” skills, meaning the cognitive talents that allow us to know something about
what others want based on observation rather than on being told. Even young babies have some
understanding of the intentions of others. For example, if an adult and a baby who have been
playing with toys together start to do “cleanup time” and the adult points to a toy that is out of
her reach but within the reach of the baby, the baby will put the toy in the cleanup box. If a
stranger comes in and points similarly, the baby will give her the toy. That shows how we guess
what others want and how important pleasing others is to us—just by nature.
The two-way street of symbolic thinking began with a cooperative listener hearing another
group member use a term in speech—perhaps asking for an object—and knowing to provide the
named object to the speaker. This two-way social relationship allowed an immediate expansion
of cooperation and an increase in the well-being of the group. The psychological costs came
much later as symbolic thinking became internalized and focused on problem solving. In one
sense it was a spectacular success—our problem-solving skills are unparalleled in the natural
kingdom—but it led us to view our own lives as problems to be solved. What we gained in
environmental control, we paid for in lack of peace of mind. One way this may happen is that we
become so intent on being accepted by others that we create a distorted story of how valuable
and lovable we are—but then we distrust the affection we receive. We engage in needless
comparisons between ourselves and others, which in turn leads to more entanglement in negative
self-talk and psychic pain. On and on it goes.
We can see this distorting storytelling process in action if we think about why we lie. Have
you ever wondered why you often lie about things you’ve done or said? We all do, at least
occasionally and in small ways. Just for a moment, consider lying slowly, holding the
phenomenon in your hands the way a four-year-old holds, say, an unusual item such as a kitchen
whisk. And now ask yourself: why do you lie?
Don’t answer immediately. Just consider the question, and while you do, review some of the
ways you mislead others:
You tweak details to be consistent with the image you want to present.
Learn it in one,
Derive it in two,
Put it in networks,
That change what you do.
That’s the human mind in four lines. The most important line is the last. While we can’t
delete the unhelpful relations we’ve made and their elaborate thought networks, we can learn to
change what they do. We can change how they function in our lives, what we allow them to lead
us to do.
And that makes all the difference.
• • •
Did you do it? Good. Now what happened to the sight, smell, feel, and taste of this thing called
F-I-S-H?
Ninety-nine times out of one hundred, by the end of the thirty seconds those effects of fish as
a word are diminishing or even disappearing. We stop feeling dominated by the literal meaning
of the word. Instead, we begin to feel the muscles used to make the sound of the word, or we
notice the odd sound of the word. Or we see how the end and the beginning of the word begin to
blend together. By the end of thirty seconds you may only notice its shushing sound (like a loud
school librarian, I thought).
This exercise did not remove the meaning of the word fish. You still know what a fish is. But
you also became aware of the word as a vocalization; you defused the sound of the word from its
meaning.
That shift may be a small one, but this defusion effect can be enough to help a person make
choices when their inner Dictator is calling the shots. It can help neutralize the power of negative
self-talk. I saw that powerfully when I did a study on shame at an in-patient unit for substance
abusers. Early in the study, when I asked the group in the first session what they most deeply
wanted, a very scary-looking client, covered with tattoos and wearing a leather jacket with
chains, loudly declared that the only thing important to him was not to be messed around with,
explaining with a gesture that turned his hand into the shape of a pistol that he carried a gun
everywhere he went and if you did mess with him, it was the gun that would be doing the
talking. I almost unconsciously looked for the nearest exit just in case.
In the next group session we did word repetition, starting with fish but moving on to a word
the group itself chose for a powerful impact. This same guy suggested the word loser. I can still
see his tough, heavily lined face as he and the entire group said loser over and over. It was not
even an hour later that I was asking again what they most deeply wanted, and this same
seemingly tough guy stood up and said that his family had suffered terribly through his bouts
with addiction and what he most wanted was to be a good dad to his small children. Then he
wept openly.
Just a little defusion can go a long way.
Breaking the spell of our fusion with the harmful stories we tell ourselves and the voice of the
Dictator frees us to begin consciously choosing to pay attention to helpful thoughts and dismiss
negative ones. The next step in building psychological flexibility is to gain an appreciation of
how another of our great cognitive abilities, our problem-solving talent, can be misdirected,
leading us to slavishly follow mental rules that are often toxic, such as those I self-prescribed to
get over my anxiety.
Chapter Five
T ake a problem you experience in your life. Any problem. Let’s say, for example, you’re
running late to pick up your kid from school and you know for a fact there is no way
you’re going to make it on time. Let your mind go to work on the problem, and soon
enough you’ll come up with a suitable solution—probably several of them: call your spouse or
another family member; call a friend; see if the babysitter can go pick her up; call the school and
tell them you’re running late.
All good ideas.
When we point that same analytical, problem-solving tool at our internal struggles, the
outcomes are very different. Imagine being late picking up your kid and dealing with the
thoughts it might kick off: I’m such a loser, or I’m not good enough. Your mind—almost of its
own volition—will immediately start looking for a “solution” to this other “problem” as well. It
will readily come up with logical-sounding justifications “proving” that you are or are not a
loser, you are or are not good enough, and then it will suggest ways to fix the problem, often by
trying to deny that it is a problem and involving a good deal of self-recrimination. Our minds
often argue both sides of an internal argument, and the closer we get to a resolution, the harder
our minds will pull in the other direction. Try to adopt I’m the worst loser of all!! and you will
find your mind objecting: I’m not that bad. Try to adopt It’s not my fault and you will find your
mind listing the reasons it is.
One of the most harmful ways in which our minds become trapped in our thought processes is
by learning, or inferring, problem-solving rules that we convince ourselves we must follow. The
ability to generate and follow rules is among the greatest human achievements. Using them, we
can tell others what needs to be done. We can warn our children of dangers, or plan for the
future. We can pass down what we’ve learned to others, or better remember it ourselves. But this
powerful tool has a double edge.
One of the earliest and most important insights in the ACT research program was the
realization that this enormous cognitive strength could also turn badly against us. Our remarkable
allegiance to verbal rules is a major contributor to psychological inflexibility. We follow them so
strictly that we never deviate even when they are making our problems worse—sometimes
horrifyingly worse.
My own Dictator Within was quite a rule maker, and that was a striking commonality I saw
between my therapy clients and myself. My clients had also generated rules they had to follow in
order to solve their problems, and their lives had become largely dominated by them. All of us
tell ourselves rules to follow as we go about our lives. Many of these rules we tell ourselves are
quite helpful. But the problem-solving mind does not know when to stop, and even if it did, it
does not know how.
Take a simple string of thoughts from a person struggling with anxiety, such as, There is
something really wrong with me. I have no idea what to do. I can’t stand this level of constant
anxiety. We might see these all as simple observations rather than verbal rules. But if we dig
deeper, we will see that in saying to ourselves, There is something really wrong with me, we’re
also implying, If I could only formulate my actions and their history properly and understand
what is wrong, I could use that understanding to control the anxiety better. When we say, I have
no idea what to do, we’re also saying, If I’m to control this problem, then I need a plan that will
work. Underlying the statement I can’t stand this level of constant anxiety is the rule that high
levels of anxiety are dangerous, harmful, or invalid, or maybe even the rule that if I complain
loudly and forcefully enough, someone in the universe will rescue me from this impossible
situation.
The strings of thoughts our minds generate as we seek to “coach” ourselves about how to
follow rules can be extraordinarily elaborate. This may be starkly seen in the case of people who
have obsessive-compulsive disorder (OCD). I once had a client with OCD who would provide
exceptionally complex explanations about the many unnecessary ways in which she sought to
protect her children, due to her extreme commitment to the rule that she must keep them safe. As
an example, the children were prohibited from entering her bedroom—and great energy was
devoted to ensuring that this never happened, with constant warnings and questioning when she
came home. Why should they not enter? Well, because they might go into the corner of the
bedroom.
When I asked her why that was a problem, she said that a year earlier, workers who were
painting the room moved a cardboard box into the corner. “So what?” I asked. Well, that box
contained soap bars in boxes that came in from the garage. And? And the part of the garage
where the soap supplies were kept is the same part where she had seen a caterpillar a couple of
years ago. And? And caterpillars like that were also seen on a tree outside in the yard. AND?
And that tree is the same tree that was sprayed with insecticide to get rid of the caterpillars three
years ago. So? So the corner of the bedroom might have poison in it that would severely hurt the
children.
In the name of being a good mom, her mind had become a torment to her. Perhaps worse, she
also had become a torment to her children, who will likely tell stories until their dying day of
how painful it was to be a child in her home, trying to placate a loving but terrified and
constantly overcontrolling mother.
I can never work with OCD patients without a rich mix of wonderment at our cognitive
abilities and a deep sense of sadness. My mother was clinically OCD. It was a rare day that I left
the house as a small child without a warning not to eat the leaves of the oleander in our yard, a
flowering bush common in Southern California (yes, it is poisonous). Parts of the house were
off-limits, such as a seemingly terrifying (to her) attic that had once had a poison trap for
silverfish bugs in it. At her worst, she would wash her hands so often they would bleed.
I knew what it was like to have a mom like my patient.
Verbal rules dominate our minds so powerfully that creating and maintaining some mental
distance from them can be difficult. I was hopeful that understanding the nature of their hold on
our minds would lead to insights about how to break their spell.
In launching this line of research I was inspired by a remarkable set of findings in behavioral
psychology that I had read about in the late 1970s. Some of the best-known work was conducted
in the lab of a well-known behavioral psychologist, Charlie Catania, with whom I studied for a
sabbatical year in 1985.
Charlie and his colleagues had conducted a series of experiments that had explored how
tenaciously people would cling to rules they had been told to follow in performing a simple task.
These experiments were specifically designed to see whether people would cast a rule aside once
they saw a better way to perform a task. Remarkably, humans often came across as looking
considerably less intelligent in adjusting their actions than monkeys, birds, rats, dogs, and other
animals who were essentially put to the same tests.
In these studies, the human subjects were placed before a device that would sometimes, but
only sometimes, dispense an item, such as a coin, when they pushed a button. Before they began,
they were given a rule like “Push this button to earn money.” Let’s say that you are running the
experiment, and you decide to set up the machine so that on average, people will get a dime after
ten button pushes. Sometimes it will be after eight pushes and sometimes eleven or thirteen. The
number is varied because you don’t want people to figure out exactly how many pushes will
produce the dime. That would make the task too simple for testing the effect you’re after.
People will readily begin pressing the button rapidly because the faster they go, the more they
earn. Now you change the setting so that the money is dispensed not after a certain number of
pushes but instead on the first push after so many seconds on average, say after five seconds but
sometimes after three or four and sometimes after six or seven. You are trying to discover
whether people will detect the change and adjust their rate of pushing the button. After all, now
they can do a lot less work to get the dime—just one push will do it instead of constant pushing.
Monkeys, birds, and rats easily detect a change like this, with the machine dispensing food
rather than money. They all soon slow down, pushing only once about every five seconds.
Humans, however, often just keep pushing like crazy! Hour after hour.
Behavioral researchers gradually narrowed down why humans were so inflexible. When the
experiment was run but people were not told the rule “Push this button to earn money” and were
instead simply told to interact with the machine as they chose, they were much more likely to
show the good sense of a monkey, bird, or rat when the conditions for getting a dime changed. In
these cases, people were taught how to get the reward by pure trial-and-error experience. For
example, in these studies at first a dime came out when the person’s hand was near the button,
then with any press of the button, and then gradually with every tenth press on average. When
the setting was changed, people fairly readily began adjusting their efforts and landed on the new
solution.
The result was definitive—being told the rule made the difference. The field came to dub this
intransigence of the human mind when it’s given a rule—or has inferred a rule on its own—the
insensitivity effect, referring to the resulting insensitivity to changes in the situation the rule is
meant to address.
In my lab, we performed many similar studies on the impact of verbal rules during the 1980s.
Some of the things we found were pretty remarkable. In one experiment, we explored whether
people would adjust their behavior, in the same basic setup as in the study just described, if the
change in the machine’s setting was more obvious. We stopped giving any rewards until people
stopped responding for a while (say, ten seconds); the first response after that led to a reward.
Most people still kept charging ahead, pushing and pushing and pushing and pushing, even
though they were getting nothing for their labor. As people became exhausted, most participants
finally did stop for a while, say half a minute. When they then got back to pushing, on their very
first push the clock had reset and they got the reward. Did they finally realize that they should
change their pushing strategy and that pausing was key to getting the dime? In the main, no, they
did not. They started pushing again like mad! Sometimes they would even say out loud about the
machine, “It must have been broken and now it is fixed,” and then they would say again later, “I
guess it’s broken again.”
To see the insensitivity of rule-following in action in a common daily-life situation, consider
a hypothetical case of a husband and wife. Let’s imagine that this hypothetical husband, like
many men, has overlearned the instrumental rule “If you have a problem, you need to figure out
how to get rid of it.” Suppose the wife tells her husband about problems she is having at work
with a co-worker and her supervisor that are making it hard to complete a project successfully.
Her husband immediately offers some possible solutions, and (oddly to him) she becomes
annoyed with him.
Perhaps what his wife really wants is a caring ear. What is crucial to her may be the
validation from her loving hubby of how bad she feels. His ideas for “solutions” feel
condescending, insensitive, and invalidating, so she gets annoyed. But when the husband sees
that his approach is not working, what does he do? Regardless of how many times he’s been
down this path, it may be very hard to shift strategies because underneath the advice is a
problem-solving rule. More likely he will double down with his advice, which is unlikely to
work any better. Or he might try offering the advice again, only this time a little more loudly. If
his wife begins to show that she is upset or even says aloud, “You are being insensitive,” the
husband may launch into a long explanation of why his advice might be useful and explain that
after all, he was only trying to be helpful.
Note to husband: shut the heck up!
That is easy to say (and to see from the outside), but it can be reeeeeally hard to do (and to see
from the inside) once you’ve internalized rules like “If at first you don’t succeed, try, try again”
or “The best way to convince someone of something is with a good explanation.” Really hard.
This example had nothing to do with me (ahem).
A CT had its fifteen minutes of fame in 2006 when the late John Cloud (a reporter at Time
magazine who later became my good friend and to whom I’ve dedicated this book) wrote
a story about my work titled “Happiness Is Not Normal.” I’ve never argued that, but I
know why he thought it fit. The principle that we need to turn toward our pain can seem to imply
that we must abandon hopes of feeling happy. To the logical mind the message of the need for
acceptance sounds like “You are doomed to unhappiness. Get over it.”
It’s amazing ACT ever caught on, I suppose, given how easy it is to infer that sad message.
It is the exact opposite of the true message of acceptance, which is that life can be a rich
journey, even with its sorrows. It is just that a truly joyful journey cannot happen until the “feel
good” agenda set by the Dictator Within is cast aside.
From my own experience of fighting my anxiety, I knew just how tricky coming to a place of
acceptance can be. But why? For one thing, as said earlier, we’re massively encouraged by
cultural messaging to try to deny or expunge our difficult thoughts and emotions. Some of us
heard it in the form of parental commands, such as when parents tell a crying child, “Oh, be
quiet, it’s not that bad,” or “Stop crying or I will give you something to cry about.” And of
course, self-help books, magazines, and radio and television shows are also full of this advice.
Popular books promise that we can and should learn how to feel good, manage our anxiety, or
get rid of our depression—but not so much information about how to learn from our own
experiences. Our medications are anti-depressants, or anti-anxiety, or anti-psychotics, as if the
only sensible goal is to subtract them. Our disorders are called “mood disorders” or “thought
disorders” or “anxiety disorders”—once again feeding a cultural view that is often outright
hostile to anything painful. We’ve got to put aside this unhelpful messaging to create some space
to try truly new things.
A more pernicious reason why accepting the need for acceptance can be hard is that our fight-
or-flight instincts are so strong. They were vital to survival in response to physical threats out in
the world, and they often still are. Reacting to our threatening internal experiences—our painful
thoughts and feelings—in the same way seems to have naturally developed as those experiences
became more vivid, thanks to the development of our language skills. Our symbolic abilities can
make any situation a threat. In our minds.
On top of this, our biology developed rewards for avoidant behavior. When you evade a
difficult or frightening situation, the brain activates the same areas and releases some of the same
chemicals that mark the receipt of a positive reward. “Aaaah,” your body says. “That’s better.”
While that would be true if you’d just avoided an attack by a wildebeest, what if you’d avoided
the anxiety of giving a high-profile presentation at work? That same chemical hit can come from
undermining goals for yourself.
So often, when life is not going well, it’s because we are doing things that give us smaller,
sooner benefits at the expense of larger, later ones. The instant gratification of avoidance tricks
us into trading away our future. In healthy development, our short-term gains fit with our long-
term aims. So the trick is to use our capacity for symbolic thought to choose the short-term
behaviors that will lead to the much richer later rewards that come from persisting even when the
short-term steps are hard.
Easier said than done. Once we begin to let ourselves go ahead and feel the pain we’ve been
avoiding, our Dictator will begin urging us to go back to our avoidant ways, often veritably
screaming at us.
I could see that a crucial component of developing ACT would be creating some methods to
help people first make the pivot, accepting the need for acceptance, and then build their
acceptance muscles. By the time my lab and I started to develop ACT acceptance methods in the
early 1980s, a good deal of research in psychology was showing that avoidance of difficult
thoughts and feelings is harmful to us, both psychologically and physically. Humanistic
psychology had championed this notion for decades, and some other psychological traditions had
embraced it too, such as rational-emotive therapy, which put forth unconditional self-acceptance
as a goal. What was missing were powerful enough methods for helping people stop avoiding
and a theory that linked acceptance to other key features of change.
We began crafting ways to apply defusion and self skills to coping with the fear and pain of
acceptance. Learning to defuse from the voice of the Dictator helps us keep a healthy distance
from the negative messages that pop uninvited into our minds, like “Who are you kidding, you
can’t deal with this!” It also helps diminish the power of the unhelpful relations that have been
embedded in our thought networks, which are often activated by the pain involved in acceptance.
For example, the relation between smoking a cigarette and feeling better will be triggered by the
discomfort of craving a smoke. Reconnecting with our authentic self helps us practice self-
compassion as we open up to unpleasant aspects of our lives, not berating ourselves for making
mistakes or for feeling fear about dealing with the pain. We see beyond the image of a broken,
weak, or afflicted self to the powerful true self that can choose to feel pain. We learned to help
people consciously apply their new skills as they took the plunge into acceptance, such as by
placing whatever unhelpful thoughts flared up on the leaves of the stream that carry them away.
We also found that a huge boost of motivation to accept discomfort comes from beginning to
see how we’ve been harming ourselves by avoidance. As we open up to our pain, we begin to
hear the lessons it has to offer us.
Modifying Exposure
We began rapidly honing our methods for building acceptance strength. After helping people
drop the rope, we would begin walking them through the process of exposure through the
methods you will learn more about in Part Two, which include labeling emotions; noting urges;
feeling feelings on purpose; cataloging memories triggered; and sensing what your body is
doing. Vital to the ACT exposure approach is the understanding that it is not a way to get rid of
emotions—it’s a way to create more flexibility in how we respond to them.
My team and an expanding group of colleagues began testing these methods rigorously in the
lab. One study measured how acceptance methods helped anxiety-prone people cope with the
discomfort caused by breathing in a high dose of CO2 as compared to diaphragmatic breathing, a
standard relaxation technique used in exposure therapy. The researchers exposed sixty
participants to air that was up to 10 percent carbon dioxide (the normal level in the atmosphere is
less than a twentieth of that). Within seconds, such a high dose of CO2 leads to heavy breathing,
sweating, and a quickened pulse—exactly the physical conditions that often coincide with
anxiety and panic attacks. It’s not pleasant.
The participants who had been taught the ACT methods were instructed in a short session
before the gas challenge to “watch” these sensations the way they might watch a cloud in the
sky, letting go of any attempt to control the sensations, just as we let go of any attempt to make
the clouds move slowly or quickly. The control group was taught to relax and focus on their
breathing.
All groups showed the same physiological arousal, but while 42 percent of those who did the
breathing exercise felt they might lose control of their emotions, as did 28 percent of those in a
control group, not a single person in the group who had been taught the ACT methods had that
reaction. Those participants were also far more likely to be willing to go through the experience
again.
We soon learned that even people with panic disorder responded in much the same way, and
that it could impact other aspects of their treatment. A CO2 challenge for a person with panic
disorder is really a form of exposure: deliberately producing the sensations you have avoided.
David Barlow’s student Jill Levitt showed that acceptance methods did not reduce the sensations
from carbon dioxide (shortness of breath, a racing heart), or even the anxiety. What happened
was that these symptoms bothered them less, and they were more willing to go through another
round. Acceptance made exposure more possible and more effective.
These early studies gradually led to large clinical studies, with long follow-ups (such as a year
or more). The findings were confirmed.
T he ability to do what we choose to do in order to live the lives we envision for ourselves is
the ultimate aim of ACT—it’s called act for a reason. At the end of the day, we are what
we do and why we do it. No matter what problems we struggle with—anxiety, depression,
negative rumination, self-doubt, chronic pain—they do not have to keep us from acting in a way
that brings our lives meaning and purpose.
Consider great figures in history. What do we remember them for? The cars they owned, or
the appearance of their spouses? For the rationalizations they came up with for their behavior?
Not likely. We remember them for what they did and the values those actions reflected. Some of
them certainly struggled internally. Beethoven was well known for his manic fits. Letters survive
from Abraham Lincoln’s friends that describe him as the most depressed person they had ever
known. It was what they did with those challenges that mattered.
As my team continued developing ACT methods, we began focusing on ways to help people
identify and commit to whatever behavior changes would allow them to live more fulfilling
lives. Of course, the notion that to improve our lives we must take committed action is nothing
new. The idea is built into our culture to some extent. But as with so many other aspects of
human endeavor, the message has been dumbed down to simple slogans. “Just do it!” “Be bold!”
“Show your grit!”
Pivoting toward new action is not as those mantras imply. It is not a matter of “just doing it.”
How you do it matters.
Committing to change in an open and flexible way is hard work. Even clearly seeing the new
path we want to follow can be difficult. That’s partly because attempts at behavior change tend to
lead us naturally into avoidance and self-criticism. We’re prone to anxiety about whether we’ve
got what it takes to stick to a new path, and the mind screams that this is a problem that must be
solved with lower levels of anxiety. With any misstep we make in our new journey, which is
inevitable, we further pummel ourselves. The Dictator begins taunting us: “Oh, come on, you’re
not up for this!”
The first three flexibility skills provide powerful support in staying the course. Defusion
disempowers these unhelpful thoughts. Connecting with our authentic self helps us avoid the
sway of pliance and becoming preoccupied by what others think of our progress, helping us
defuse from thoughts like “They can see that I’m still struggling with my depression; I’m not
kidding anyone, I’m a loser.” It also helps fend off telling ourselves appealing lies about our
progress, such as “I’m fine now, problem solved!” when we’ve really got a good deal more work
to do. Acceptance allows us to stop directing our attention to unnecessary problem solving about
the pain we’re feeling, instead turning our attention toward the helpful insights these feelings
offer.
As we continued to develop ACT, we realized that the three additional skills—presence,
values, action—make vital contributions to psychological flexibility, offering great assistance in
committing to a new course in life. They provide essential additional motivation and mental
agility.
Hugging a friend.
Saluting a soldier.
A ll six pivots are within close reach. You knew they mattered, even before you picked up
this book. You have this knowledge built into you, both by experience and by genetics.
I can prove this to you in less than a minute.
Think of a profoundly challenging psychological issue you face. I mean an issue that has
something to do with how you feel, how you think, what you sense, what you remember, or what
you feel pulled to do or not do. This should be a painful challenge that has to do with your inner
life. It could be the sadness of a loss; anger from a betrayal; anxiety from a challenging situation;
or any of a thousand other such agonies.
Once you have one clearly in mind, peek around to see that no one is looking and then put
your body into a posture that shows you at your absolute worst when dealing with this issue. Be
a living sculpture, so that if others saw you they might be able to guess what was going on
inside. I want your body to reflect you at your most ineffective, or helpless, or overwhelmed.
Actually, assume that position, feel what it feels like, and then take a mental snapshot of what
your body looks like. Got it? OK, go.
Now do the same with you at your very, very best in dealing with the exact same issue.
Imagine you at your most effective, in tune, or empowered with that issue. Express that with
your body. Actually do it. Don’t hold back (come on, no one is looking, after all), feel what it
feels like, and then take another mental snapshot of your body. Go.
If you are like most of us, your first snapshot showed someone closed up. Perhaps your arms
were tucked in. You may have looked down, and your eyes may have been slightly closed. Your
legs might have been pulled in, or you may have curled up in a kind of fetal position, as if trying
to hide, or slumped over as if totally defeated. Your hands may have been clenched in fists, and
your jaw and stomach may have tightened. You might even have been in a fighting posture,
poised to attack, or alternatively ready to run scared, or flailing about as if actually fighting.
In your second snapshot, you were probably in an open posture. Your head likely came up,
your eyes opened wider, and your arms and hands relaxed. You might have stood up and even
walked about confidently in large steps, ready to take on the challenge and feeling energetic and
centered.
This simple exercise reveals that you already know a good deal about what science shows is
and is not good for you as you contend with your problems. Your body assumed first an avoidant
posture and then one of flexible acceptance. You know that it does not work to hide, fight, or flee
and that it works far better to open up, to have your mental arms and hands free to embrace your
problems and learn from them.
I’ve done this exercise with thousands of people in my training workshops, and my research
team has analyzed hundreds of photos we’ve taken of people around the world doing it. So far
the results are the same whether you live in the United States, or Canada, or Iran. People assume
dramatically more open postures at their best and more closed postures at their worst.
That’s because we have the wisdom of the flexibility pivots within us. But it gets overridden
by the rules that seize control of our minds and entrap us in fixation with problem solving.
I can provide more evidence if you will give me just another minute.
This is a bit like that question I asked in the last chapter about a hero you did not know, but
this time I want you to think of the most empowering relationship in your life. This should be a
relationship with someone who lifted you up, who somehow carried you forward. It could be
with a spouse or a sibling; a lover or a friend; a teacher or a coach; a priest, rabbi, or minister; a
parent or guardian—it could be anyone. This relationship could even be a spiritual one, as with
God or another power you feel close to. And if there truly is no one who has lifted you up (sadly,
some people are in this situation), you can answer on the basis of the kind of person with whom
you yearn to have such an empowering relationship.
I am going to ask you just six questions about this (which I’ll phrase as though the
relationship is in the past, but it can also be one that you’re still in):
Did you feel accepted for who you are by this person?
Did you feel constantly judged and criticized, or was judgment somehow softened or far away?
Was the person generally present with you when you were together or were they distracted, half there,
maybe even stealing glimpses at their watch as if hoping to get away?
Did you normally have a sense of being seen by that person, as if they knew you deep down?
Could you be together in different ways that best fit the situation and what you both wanted, or was it
always only one way, determined by the other person?
Each of these six questions involves one of the six components of psychological flexibility. If
your answers are what I suspect they are, then I can say this: you have a model of psychological
flexibility available to you in this relationship. You can feel the benefit of living in an open, kind,
mentally present, and purposeful way. If you could be the same way to yourself as this person
has been to you, and would be willing to be this sort of caring, supportive person to others, you
and those you love would reap wonderful benefits.
ACT can be so powerful in part because we are developing qualities of living we already care
about and know deep down that we need. By building the flexibility skills, you will be able to
consciously bring those qualities into your daily life. To do so optimally, you must work on
cultivating all of the skills; remember, they’re really six aspects of one whole.
So that’s it; the CliffsNotes version of evolutionary science. All living things adapt based on
variation and selective retention of behavior that fits the circumstances, is in balance across key
dimensions, and operates at many levels of scale. Again, what’s so remarkable for us humans, as
opposed to all other living beings, is that we can use our cognitive abilities to intentionally attend
to all of these requirements and purposefully evolve ourselves.
The process of evolution can be guided (not just purely random) even in the lowliest of
beings. For example, if you have bacteria growing in a petri dish (a good example, because their
“generations” can be only minutes long) and you remove an essential food source from the
growth medium, the bacteria will show a massive increase in genetic variation. It is as if the
bacteria are deliberately trying to find another way forward in this now hostile environment.
Of course, bacteria can’t really “deliberate” because they don’t have symbolic thought. But
people can deliberate! We can consciously adopt the behaviors that lead to healthy evolution. We
can go beyond evolution guided by the past to evolution guided by our construction of the kind
of future we want.
This is where flexibility skills come in. They support those choices by helping us: let go of
the avoidance and fusion that narrow our alternatives (variation); specify through values work
what it means for us to be successful (selection); practice and build helpful behaviors into habits
of committed action (retention); consciously pick different approaches for different situations by
being more mindfully aware of the present moment (fit); stay aware of all the key dimensions of
our psychological being (balance); and actively cultivate our social support network and the
needs of our bodies (levels of scale).
Like most of us, you’ve arrived here having already programmed yourself up with a lot
of harmful nonsense. That’s OK. We have all done the same thing. It’s a very human
thing to do. You didn’t do anything wrong.
However, you are still the one that has to take responsibility for setting things
straight. This list can be a great help, but you cannot look beyond yourself for solutions
too often. You are the most important part of the process.
When I say nonsense, I mean the mind falsely transforming very acceptable things
into terrible things. Point is, you’ve got a lot of work to do to, so summon all the
strength you have and get ready to be very patient with the process.
Prepare yourself for ups and downs as you proceed. Your mind will definitely scream
to you that you’re off course when you’re not. Don’t believe the hype it gives you.
Don’t worry about where you’re supposed to get to. Assume that you’ll be doing this
work for life, because you probably will, and you’ll be better off for it. You’ll likely
emerge at some point into a clearing and feel the urge to pronounce yourself healed—
that you’re now “rid of that stuff.” That’s a trap, because the next little whiff of “that
stuff” has the potential to drag you right down again, and your mind can turn
ANYTHING into “that stuff” when the fear alarm is ringing.
Be OK with being a work forever in progress. Allow for a place for pain in your life.
That’s always been reality. Your mind will come up with crackpot theories about how
you can find a new life with no pain or unease at all. That’s a lie. What happens if you
buy into all that? Well, no version of reality has a chance of ever being good enough,
and your mind just keeps saying “Ahhh! Keep running! Keep fighting! We’re not there
yet!”
I beg to differ. Even now, in the midst of pain, you’re so very, very close to the
valued and fulfilling life you seek, because what you are right now is all that you truly
need. Challenge the notion that you have to get to “somewhere else.” There are things
about our habits that we all need to change, but we can start by just learning to see, to be
here, and to care.
That will take time. Though a vital life is a half step away, it’s not a step that is easy
to take. Fear and sadness and entanglement is hard to turn away from, but it can be
done.
I was deeply moved by Tim’s message. We human beings have such a hard challenge and yet
every wisdom and spiritual tradition says what I believe: we have within us the possibility of a
vital life if we can learn to cultivate it.
At the beginning of this chapter you showed with your own body that you have the power
within you. You probably already have a better understanding of some of the pain, fear, shame,
anger, resentment, or other emotion you’ve been trying to avoid, and of behavior you want to
change.
So let’s go learn how to put that mind of yours on a leash.
Part Two
INTRODUCTION: STARTING YOUR ACT
JOURNEY
P art Two is your personal workshop in learning the ACT practices. Think of this chapter as
the orientation. It also prepares you for the journey by helping you drop the rope in
whatever struggles you’re caught in. You’ll learn a powerful way to identify avoidant
thoughts and behaviors, and you will be able to apply the flexibility skills to them as you work
through the chapters.
Each chapter is devoted to helping you make one of the pivots and then continue building that
skill. I illuminate how each skill helps satisfy a deep healthy yearning we humans all have, but
that we unfortunately often try to satisfy in a toxic and inflexible way. Recall, for example, that
yearning to belong leads us to lie, resulting in disconnection from others. I try to show how
readily we can make each pivot, swinging the energy inside that yearning toward healthy living,
often using stories of those who have done so.
Next, I offer a “starter set” of exercises followed by additional exercises to do as you continue
building your skills. I recommend that you do the first set and then move on to the next chapter,
coming back to do the additional ones once you’ve worked through all of the Part Two chapters.
That way you will quickly experience how all six skills build on and support one another. We’ve
found through many years of teaching ACT that it’s best to learn a small but complete set fairly
quickly, and then to practice these initial exercises while gradually expanding your skills.
As you read these chapters, you may want to apply the insights and exercises to a particular
challenge you’re struggling with. That might be quitting smoking, sticking to a diet, dealing with
depression, coping with stress, contending with a horrible boss at work, or managing the
frustrations of parenting. If you are already engaged in a program of some kind for coping with
that challenge or are in therapy or undergoing treatment, learning the skills will assist with those
efforts. Studies have also shown that the skills help with following dieting guidelines, staying on
a physical fitness routine, and even deepening our sense of spirituality, whether complementary
to formal religious practice or outside such a tradition.
If you do decide to apply the skills to one particular challenge as you read these Part Two
chapters, you may first want to read the material in Part Three about how ACT helps with that
specific challenge. If you are looking into therapy or treatment programs and you want to
consider ACT therapists, this link will help you find them: http://bit.ly/FindanACTtherapist. But
these days many clinicians know ACT to a degree, and many programs incorporate some
elements of ACT. Ask around.
ACT is not just for dealing with specific problems, though. Flexibility skills are a method of
evolving as a generally healthier, more fulfilled person. Thus, as you read these chapters, you
will have ample opportunities to apply the exercises to whatever daily challenges come up.
Feel free to work through these Part Two chapters at your own pace, keeping in mind that
making the full set of initial pivots is best facilitated by fully engaging in the practices. Aim to
complete the chapters in about a week or two, ideally reading one chapter and doing the first few
exercises in one or two days. You could also, however, go through them faster, say two at a time,
or you could spread the reading out over a longer time frame. I strongly urge you, though, to
carve out the time to work all the way through these chapters one directly after another without a
substantial gap of time in between. I think you will begin to see some positive effects from the
practices quickly, which should help keep your motivation strong.
6. Took tranquilizers.
Your turn. Write a similar list of the ways you’ve tried to solve your problems. Actually do it.
The next step is to look hard at whether these methods have delivered results, and if so,
whether they were large and lasting or small and fleeting. You will usually find that some—or
even all—of them have helped in the short term, but that they haven’t contributed to longer-term
improvement and might even have made things worse.
Look at my list. When I was at the height of my panic disorder, how did I feel when I, say,
turned down an offer to give a talk instead of facing my fear? I felt great! I felt relieved and
calmer. Still, the noose tightened. The next time an invitation to speak came, my anxiety was
even more fearsome.
Now it’s time to look at your list.
Ask yourself one at a time whether each of the methods you’ve used has actually paid off in
the long term. If not, look long and hard at the smaller, more immediate benefits that have made
those methods appealing. Often in this exercise you will realize what they were really about.
They may have been efforts to control or evade your experience; they may have been driven by
the “have to” messages of the Dictator Within; they may have traded away a values-based
approach for the addictive short-term pop of chemical reward. Take your time, but cover every
single item.
Do not blame yourself as you consider your list. While the purpose of this exercise is to help
you “drop the rope” and accept the need for acceptance, it may ironically trigger self-repudiation.
Coming to see how ineffectual or counterproductive our efforts to solve problems have been can
be painful and lead to self-blame, and even shame. If that’s true for you, then make that harsh
treatment of yourself a target as you begin to develop the flexibility skills.
Now take a mental step back from your list and ask yourself, if you keep doing what you are
doing, is it likely you will keep getting what you are getting? You may hear your Dictator
pushing back as you contemplate the answer. Some of your methods may seem incontrovertibly
logical. But again, have they worked? Completely? Over the long run?
It’s time to answer this question: Who do you trust, that voice in your mind or your
experience? What could be more incontrovertibly logical than to cast aside “solutions” that don’t
work in your actual experience?
As you proceed through these chapters, you may find it useful to repeat this process of
writing down the solutions you’re pursuing and closely scrutinizing how they’re working short
term and long term. I expect you will be heartened that you are adding to your list some highly
effective new methods.
One last preparatory step you may want to take is to get an assessment of your degree of
psychological flexibility, which you can use as a benchmark for gauging your progress in
building the skills over time. This is what we do with the participants in studies; we have them
fill out assessments before we put them through the training and then again after the training,
sometimes doing follow-ups after several months in which we again ask them to fill out the
assessments. A general assessment is provided on my website (http://www.stevenchayes.com),
as well as a number of assessments tailored to specific conditions: diabetes, epilepsy, cancer,
substance abuse, weight loss, and many more. But you don’t have to do an assessment to get the
benefits of learning the practices, so if you’d rather not, that’s fine.
Finally, you may also want to join one of the many online communities that support people in
learning and applying ACT. The oldest is the ACT for the Public discussion list. You can access
it at http://bit.ly/ACTforthePublic. It can be very helpful to ask questions there as you read the
Part Two and Part Three chapters.
In the entire set of ACT-relevant studies (now numbered in the thousands), I don’t know a
single example of an improvement in psychological flexibility that was not associated with
beneficial outcomes. The bottom line is this: if you acquire flexibility skills, they will help you in
many different ways. So if you’re ready, let’s go!
Chapter Nine
T he defusion methods the ACT community has developed help us use our minds in a more
open, aware, and values-based way. We learn to become more cognizant of the
automaticity of our thoughts and to watch the ones that aren’t helpful from a distance, as if
to tell the Dictator Within, “Thanks, but I’ve got this covered.” The critical voice and its
commands don’t go away, but we see them more as the products of our mental mechanisms, like
the pronouncements of the contraption created by the Wizard of Oz. We don’t need to argue with
our thoughts. It’s more like putting the mind on a leash.
Defusion methods are hugely helpful as we begin to probe into the sources of our pain or fear,
because that examination provokes many difficult thoughts. We can load heaps of recrimination
on ourselves and get caught up in unhelpful rumination. As we learn to defuse from self-
judgment, we can replace it with self-kindness. Defusion also helps us turn off our compulsive
problem-solving for a while. It opens a door to our power to change, allowing us to acknowledge
our unhelpful thoughts while charting a course that goes beyond them.
It’s time to get up. No, it isn’t; it’s only 6:00. That’s seven hours of sleep. I need eight
—that’s the goal. I feel fat. Well, birthday cake, duh. I have to eat cake on my son’s
birthday. Maybe, but not such a big piece. I bet I’m up to 196 lbs. Shoot . . . by the
time I run the Halloween candy/Turkey Day gauntlet I’ll be back over 200. But maybe
not. Maybe more like 193. Maybe exercise more. Anything would be “more.” I’ve
gotta focus. I have a chapter to write. I’m falling behind. . . . and I’m getting fat again.
Noticing the voices and letting them run might be a good start to the chapter. Better to
go back to sleep. But maybe it could work. It was sweet of Jacque to suggest it. She’s
up early. Maybe it’s her cold. Maybe I should get out of bed and see if she is OK. It’s
only 6:15. I need my eight hours. It’s close now to seven and a half hours. Still not
eight.
Not only are these thoughts remarkably circuitous, but most of them are about rules and
punishment. Many of them are also contradictions of the prior thought. I’m sure you’re familiar
with that kind of mental to-and-fro. Welcome to the human race.
The old cartoon device of an argument between the devil on one shoulder and an angel on the
other is understood even by small children. That’s because arguing with ourselves is so natural.
We begin to do it not long after our language abilities have developed and our Dictator Within
has come on the scene. When we are deeply focused on a mental task our minds can enter into a
state of flow, in which thoughts, emotions, and actions are all temporarily in sync. But the more
usual state is one of mind wandering, and that is often characterized by a good deal of mental
disagreement and disengagement.
The parts of the brain involved in mind wandering are referred to as the default mode
network, because it is activated automatically when the brain isn’t focused on specific tasks.
Interestingly, neuroscience scans have recently shown that the executive network of the brain,
which is involved in decision making, is also active during mind wandering, physical proof that
when you are not watching the mind, it is often engaged in an effort to sort through cacophonous
thoughts. The open awareness encouraged by defusion helps calm the default mode network,
quieting the mind and helping it focus on thoughts we consciously give our attention. Think of
defusion skills as peace-of-mind skills. A kind of mental calm settles in when we experience the
functional coherence of a mind focused on what works.
Let me give a personal example. In a talk I gave at Stanford, I was talking about the
incredible increase in the use of sleeping medication, but instead of documenting the rise in
billions of dollars, I said “trillions.” I did not notice the error at the time, but my mind did
because in the middle of the night I sat bolt upright and cried out loud, “Trillions?!! You idiot!”
Within seconds I was pacing the room berating myself for my stupidity until it occurred to me to
do Titchener’s word repetition exercise, which I described in Chapter Four. I sat on the corner of
the bed and for thirty seconds, I repeated the word stupid. Then I was done. Within minutes I
was back to sleep. It was not worth any more of my time. I did not need to convince my mind of
that through argument—that would have only increased the volume.
To get a look at how automatic and circuitous your own thinking process is, right now take a
minute to point your thoughts in any direction of your choosing and try to track them as they run
their course. You should write down all those that you notice for long enough to capture.
After completing this exercise, repeat it two more times, again letting your thoughts run for
one minute. In round two, imagine that your job is to figure out whether each thought is literally
true or appropriate. In round three, imagine that your thoughts are like the voices of quarreling
first-graders. Adopt a posture of curiosity and amusement as you listen to them, but do nothing
else with them than to notice them. Take a minute each and do it.
In round two, you probably experienced the sense of being pulled into your thought networks.
Their loudness may have increased; a focus on content may have gone up. You might have
noticed yourself getting involved in a kind of argument with your mind.
In round three, you probably noticed more about the flow of your thoughts. Very likely, the
specific content of the thoughts seemed less important. You had a sense of being outside the
argument.
That difference explains why defusion exercises weaken the link between automatic thoughts
and behavior; our ability to step back from our thoughts grows stronger as we practice.
Imagine that you are watching a quietly flowing brook with large leaves on it floating
by. Each thought that comes into your mind, place it on a leaf and watch it float
downstream. If it reappears, that is fine—just put the second version on a leaf too. The
goal is to stay by the stream, watching your thoughts. If you discover you’ve stopped
doing the exercise and your mind has gone elsewhere, which is common, try to catch
what led your mind astray. Almost inevitably, what happened was cognitive fusion
with a thought. Something popped into your head and instead of placing it on the leaf
you started engaging with its content, and it triggered your automatic thought
processes. After noting how the “fusion trigger” worked, get right back to watching the
brook and begin again.
Bea needed to start with defusion work because she could not make any progress until she
freed her mind from her rumination. Once that was achieved, she was able to make rapid
progress, learning the other pivots and becoming productive again with her writing after only a
month. The happy result was that she was ultimately awarded tenure.
When we learn defusion skills, we can take the energy of our counterproductive yearning and
pivot it toward learning to be gently guided by our experience. We become able to prize function
over form. As we experience the benefits of focusing on helpful thoughts, we become
increasingly motivated to defuse from the Dictator’s voice, creating a positive feedback loop.
A columnist at NBC News, Sarah Watts, has personally experienced the power of defusion in
her recovery from debilitating anxiety. She described how it helped this way: “Within weeks,
after much practice, even the thoughts that once left me paralyzed—my cancer is going to kill
me, I’m going to pass another painful kidney stone—had loosened their grip on me. They were
neither true nor untrue—they were simply thoughts, and I had the power to do with them what I
wished.” As her life opened up, she concluded, “This must be how normal people feel!”
Actually, no. This is how people feel after letting go of being attached to mental form over
mental function. It is unfortunately not normal, but it is within reach.
Getting Prepared to Practice Defusion
It’s good to start by getting a basic assessment of the degree to which fusion with negative
thoughts may be causing you distress. The first step is to take the following quick assessment,
called the Cognitive Fusion Questionnaire.
Below you will find a list of statements. Please rate how true each statement is for you by circling a number next to it.
Use the scale below to make your choice.
1: never true
2: very seldom true
3: seldom true
4: sometimes true
5: frequently true
6: almost always true
7: always true
2. I get so caught up in my thoughts that I am unable to do the things that I most want to do
1 2 3 4 5 6 7
7. It’s such a struggle to let go of upsetting thoughts, even when I know that letting go
would be helpful
1 2 3 4 5 6 7
Now add up the numbers for an overall score. There is no strict correspondence of score to
the degree of cognitive fusion, but a rough guideline is that if you score below 20, you are able to
think reasonably flexibly. As your score moves into the mid to upper 20s and 30s, fusion is
becoming more dominant, and the methods introduced in this chapter will be helpful to you in
getting needed distance from your thoughts. Even if your thinking is defused and flexible,
however, it is worthwhile to practice defusion methods, for the same reason it is worthwhile to
engage in physical exercise even if you are strong. The practice will keep your flexibility of mind
in good shape.
Over time, our new awareness of our thought process helps us become more attuned to when
we’re slipping into fusion. The key signs to keep in mind are as follows:
1. Your thoughts seem predictable. You’ve had them plenty of times before, so much so
that they seem to be part of who you are. Make a note of these thoughts, actually
writing them down, and you can practice defusing from them over time.
2. You have a sense of waking up from a reverie. This means that you have disappeared
into your thoughts for a time. You may even discover that a good deal of time has
gone by and you’re now late doing something you were supposed to get done. When
this happens, as in the leaves-on-a-stream exercise, try to back up your thoughts and
identify the moment you disappeared. That will help with recognizing triggers.
3. Your thoughts become highly comparative and evaluative and begin wandering. When
your mind is just noting what is effective—seeking functional coherence—once you
notice it, the review quiets. If you find your mind going around in circles, or your
evaluation becomes self-reflective and comparative, you’re due for defusion, as, for
example, with this string of thoughts: “Can I claim that dinner as a charitable
deduction? Yes, I think I can. I’m glad I thought of that. Others would miss it, but
not me. I think even my tax advisor would have missed it.”
4. You catch your mind in overbusy mode, engaged in a wrestling match involving lots
of contradictions, self-admonitions, and rules (“You are wrong, you do not need that
donut! It will make you fat. Well, even fatter. That’s why people avoid you. Oh, come
on, it’s just a donut . . .”).
1. Disobey on Purpose
Let me start with one that I’m sure will seem perplexing. Just trust me.
Stand up and carry the book around with you while you slowly walk around the room,
reading this next sentence aloud several times. (Really do it, while walking, OK? Ready? Stand
up. Walk. Read. Go!)
Here is the sentence:
“I cannot walk around this room.”
Keep walking! Slowly but clearly repeat that sentence as you walk . . . at least five or six
times.
“I cannot walk around this room.”
Now you can sit down again.
It is such a tiny thing, isn’t it? A tiny poke in the eye of the Dictator Within; a little tug on
Superman’s cape.
This exercise was one of our earliest defusion discoveries, used in the ACT studies done in
the early 1980s. Even though it is a silly little exercise, a team in Ireland showed recently in a
laboratory experiment that it immediately increased tolerance to experimentally induced pain by
nearly 40 percent! I’m not talking about people saying they can tolerate pain. People were
willing to keep their hand on a very, very hot plate (not hot to the point of injury, mind you, just
hot enough to cause real pain) 40 percent longer—after just a few moments of saying one thing
while doing the opposite.
Think about that. Even the tiniest little demonstration that the mind’s power over you is an
illusion can very quickly give you significantly more freedom to do hard things. You can easily
build this into your life as a regular practice (right now I’m thinking, I cannot type this sentence!
I can’t!).
And we’ve only just gotten started.
Now listen to your thoughts for a bit, and when your mind starts to chatter, answer back with
something like “Thanks for that thought, George. Really, thank you.” If you speak to your mind
dismissively, it will continue right on problem-solving. Be sincere. You might want to add, “I
really get that you are trying to be of use, so thank you for that. But I’ve got this covered.” If
you’re alone, you could even say this out loud.
Note that your mind will probably push back with thoughts like That’s silly. That won’t help!
Respond again with, “Thanks for that thought, George. Thank you. I really do see how you are
trying to be of use.” You could also even invite more comments with dispassionate curiosity:
“Anything else you have to say?”
4. Sing It
This method is powerful when you’re having a really sticky thought. Turn it into a sentence
and try singing it—out loud if you are alone, in your head if you have company. Any tune will
do. My default is “Happy Birthday.” Don’t worry about trying to be clever about the wording,
like coming up with a rhyming scheme. This is not going to get you on America’s Got Talent!
Just repeat the thought to the tune. See if you can find a thought that is nagging you right now
and try it. Try different tunes; sing it fast or slow. The measure of “success” is not that the
thought goes away, or loses all punch and becomes unbelievable. It is that you can see it as a
thought, and do so just a bit more clearly.
Additional Methods
5. Backward
Take a negative word that is at the heart of a recurrent difficult thought and spell it backward.
For example, I guess I’m just stupid. . . . Say, did you know that stupid spelled backward is
diputs? Odd interruptions like that remind you that you are just thinking—and that is the point:
to back up and look at thoughts, not from thoughts. (A fun variant is to apply the old song “The
Name Game” to the word: “Stupid, stupid, bo burpid, banana fana fo furpid, fe fi mo murpid.
Stupid!”)
6. Look at It as an Object
Put the thought out in front of you and ask some questions about it. If it had a size, how big
would it be? If it had a shape, what shape would it have? If it had a color, what color would it
have? If it had speed, how fast would it go? If it had power, how much power would it have? If it
had a surface texture, how would it feel to the touch? If it had an internal consistency, what
would that be?
If after answering these questions the power of the thought is unabated, focus on your
reactions to the thought—especially your judgments, predictions, negative emotions, or
evaluations (e.g., “I don’t want that! I despise it!”). Hold those in your mind. Then pick a core
reaction that seems central. Move the first thought to the side and place the core reaction in front
of you. Now answer the same questions: If it had a size, how big would it be? And so forth.
After you’ve answered them all, peek back at the first thought. Is it the same size, shape,
color, speed, power, texture, and consistency? Often you will find that it has changed in ways
that give it less of an impact.
7. Different Voices
Say your difficult thought out loud in another voice. You can pick your least favorite
politician, or a cartoon character, or the voice of a movie star. Try out different voices. Keep in
mind, though, never, ever to ridicule yourself. The voices are to help you look at the thoughts,
not to make fun of them, or you.
T hink back to a memory from early elementary school. With a bit of effort you can go
behind the eyes of your much younger self, reexperiencing that event.
You have just touched the sense of “you,” the observer, who appears when our minds
become able to use cognitive perspective-taking. From that point on, a sense of observing from
within our mind from the perspective of an “I” is a constant in our lives. I will call this “I” that
we become aware of the transcendent self because it is always there within us, no matter where
we are, who we’re with, and what the conditions of our lives are. At the same point when we
develop this awareness, we begin to construct a story of our self—crafting the conceptualized
self—which can block our awareness of our transcendent self. We become so focused on
bolstering and defending this story we weave that we end up trying to hide aspects of who we are
and of our experiences, not only from others, but from ourselves as well.
The first two exercises provided next will help you make your initial pivot. The next few in
the starter set then help develop increasing awareness of your transcendent self and cultivate
your sense of connection with others and of belonging.
On the other side of the Self pivot, your world changes. As you emerge behind your eyes, you
begin to see behind the eyes of others. You notice people noticing you; you notice people
noticing you noticing them. You sense a kind of awareness that binds us all together. You begin
to find that you’re making more thoughtful connections with people all the time—in the grocery
store, in the elevator, at work, or at home. You will notice an old woman struggling to push her
shopping cart through the store, bravely facing her own physical limitations; a waiter taking care
to ask a customer what he wants; a child yearning for attention from you but being too afraid to
ask.
When we touch our own consciousness in a full and open way, we are much better able to
touch the consciousness of others. We see that awareness is far larger and more ancient than the
space defined by our own mind and body. In a deep sense it is boundless, timeless; it connects us
all to one another. We are conscious. That satisfies our yearning for belonging in a healthy,
nurturing way, empowering us to be more fully ourselves and yet deeply related to others. You
belong, as a birthright.
1. I Am/I Am Not
A good place to start is with this simple exercise. Following are three unfinished sentences.
Take a sheet of paper and write them down. Now complete the top two with one-word answers
that represent positive psychological attributes of yours. Don’t put in mere descriptive attributes
(e.g., I am male). Use terms that refer to your most prized personal qualities. Reserve the last for
the exact opposite. There, list in a single word a personal attribute that you fear you have or think
you have that is negative.
1. I am ________________.
2. I am ________________.
3. I am ________________.
Another way to step back is to write a brief story about yourself and then rewrite it.
Start with a couple of hundred words about something you struggle with psychologically—
something that gets in your way and has a bit of a history to it. Be sure to describe some of that
history and the internal and external ways that it interferes. Once you’ve done that, get a pen and
draw a circle around all words that are reactions: thoughts, feelings, memories, sensations, urges,
or actual behavior. Don’t circle explanations for why you reacted: just the reaction itself.
Now do another run through of the story and underline every external situation or fact. I’m
asking you to note reactions (circled) and external facts (underlined) because the mind
sometimes mixes the two, which makes the next step harder.
After those two tasks are done, here is your challenge: rewrite what you have just written so
that the theme, meaning, outcome, or direction is totally different, but every item that is circled
or underlined is included in your new story. Mind you, I am not asking you to write a better
story, or a happier one, or a truer one. It only needs to make sense, to fit well with the underlined
and highlighted material.
Here is an example of the first story written by a client of mine. The external facts are
underlined and reactions are “highlighted” here in boldface.
I was sad as a child. I felt alone and neglected—my mother seemed more interested in
her own misery than her children. I did poorly in school because I was more focused
on my fears than on learning. The other children didn’t really like me and the
teachers were as inattentive as my mother. I was frequently the object of bullying and I
thought I was stupid. It wasn’t until middle school when I realized I was smart
when I entered a team academic competition and we won the whole county. They then
tested me and sat me down to say I should be in the gifted class. All of a sudden, the
teachers saw me differently—but the kids not so much. I got the sense that even my
parents now saw me differently—like “who is this kid?” Other children seemed to
think I was strange, though. In high school the boys discovered me, and I learned I
could get a lot of attention from them, which made me feel great on the outside—but I
still felt inadequate on the inside. Somehow school success happened, but I think it
was in spite of myself. I’m surprised I could get out of my way enough to even let
that happen. Externally I guess some would say I’m a success, but with this history I
live more with my own self-doubts.
Her rewrite was a revelation to her. What shocked her was that though not a single fact or
reaction was changed, her conclusion changed considerably. You will recognize an ACT flavor
in this rewrite, which makes sense since we had been working together within an ACT model.
I was sad as a child. When I felt alone and neglected, I focused on my fears which
may have contributed to my initially doing poorly in school. I think I had initially
internalized an idea that I saw my mother pursue—when you are miserable, focus on
that, not on what you have in front of you. That cost her a lot in terms of her ability to
focus on her children and take in the love that was around her. I learned a lesson from
watching that. When I felt that the other children really didn’t really like me, or the
teachers were inattentive like my mother, or when I thought I was stupid and even
when I was bullied, I focused on what I could actually do something about. For
example, in middle school I entered a team academic competition and we won the
whole county. The decision to enter that competition had a profound effect, because
after that success, the teachers saw me differently, and I was tested. Soon they sat me
down to say I should be in the gifted class. Even my parents then saw me differently—
like “who is this kid?” That got things rolling in a very different direction, and it all
came from these little choices I was making to try to learn from my mother’s mistakes.
If some kids didn’t appreciate me or thought I was strange, I found ways to get to do
the positive things that brought me healthy attention. I think my confidence and
achievement attracted others—for example, in high school the boys discovered me. I
learned, whether I was feeling great or feeling inadequate, to focus on what I could
do, one step at a time. I’ve had a surprising amount of school success as a result—I
just got out of my own way and did what needed to be done. My mind tells me it was
in spite of myself, but I guess we all have self-doubts. Bottom line, I’m a success.
Be careful with what your storytelling mind will do with this. Again, the point is not to write
a positive story. This client ended up having a positive realization, and it’s just fine if that is an
outcome, but that is not the aim of the exercise—the point is to instill awareness that we are
always story-ing. We are creating a narrative that is but one of many possible narratives. To
heighten your awareness, you might even want to rewrite the story another time.
When we attribute our interpretations of our experiences to the situation rather than to our
own way of seeing the situation, we shove our own meaning-making out of view. It’s a form of
self-delusion. This exercise is one way of applying defusion skills to our self-story so that we can
take responsibility for the consequences that follow from the way we’ve interpreted events and
how we’ve reacted to them. This rewriting process helps us see that we have a great deal of
freedom and creativity in how we weave the story of our life situations, even very difficult ones.
One last step in this exercise really helps to drive that realization home. Ask yourself: What if
there is no one, true story, but only a variety of different stories that can be used in different
settings and circumstances to promote different ways of being in the world? Which storyline will
lead you forward to where you want to go? Which storyline seems most useful to you and under
which circumstances? Who would you rather determines which storyline gets your attention?
The Dictator Within, or your transcendent self?
Begin to regularly ask yourself the following question as you go about your daily life: “And
who is noticing that?” You can set reminders on your phone or computer to do this. Or you could
set a rule for times to ask it, such as whenever you touch your phone, or keys, or wallet. When
the cues appear, take a moment to notice your experience and touch awareness for a split second
as you ask, “And who is noticing that?” Be careful not to let the question lead to an extended
mental treatise about who you are—that is your judgmental mind trying to tell a self-story. Shut
that process down if it kicks in by using your defusion skills, such as by listening to the mental
treatise in the voice of Donald Duck, or imagining that you are a pompous professor holding
forth.
The goal is to touch the “I/here/nowness” or your transcendent self, even if just for a
millisecond. Over time you will find that asking yourself this question becomes second nature
and your connection to your authentic self keeps strengthening.
Keep practicing this set of exercises as you now move on to Chapter Eleven. You will quickly
find that you are treating yourself with more compassion and feeling more genuinely connected
with more and more people in your life. Then it’s important to keep developing your perspective-
taking skill by coming back to do the following exercises.
Additional Methods
Begin to practice perspective-taking regularly at work, socially extending this sense of “you”
to include the awareness of the awareness contained in others. Suppose you have an important
meeting coming up in a few minutes with a colleague. It could be challenging and you need to be
at your best. You are prepared but feel a bit anxious. As you wait in your office, a wonderful way
to spend those two or three minutes is just to consider this list of points and questions, which you
could copy and post by your desk:
As you notice that, don’t grab at it—just for a second touch that you are here, now, aware.
As you think of this meeting coming up, search for a memory—in childhood if you can go that young—that
is somehow related. Don’t get there by cognitive analysis. Just let any memory pop up and then notice it for
a few moments. Notice who else was there and what you were doing/feeling/thinking.
In the original memory, who was noticing these things? See if you can catch your original sense of awareness
as an experience, not a preconceived idea.
You’ve been you your whole life. Whatever else may happen in this meeting, you will notice what happens
there too. See if you can promise yourself to stand with yourself, becoming more aware of the rise and fall of
experiences in the meeting.
Picture the person coming to meet you. Imagine where they might be in this moment. Take the time to go
behind that person’s eyes and picture what they are seeing right now as they come to the meeting.
What might that person be worried about? Take a moment to notice that worry.
What does this person deeply care about? See if you can sense that.
And what might this person care about specifically in the meeting coming up? See if you can experience
these things.
Now come back to yourself here and now. What do you most care about in this meeting?
Then, as you come back into the moment, consider this: Is there a way for both of you to accomplish your
deeper purposes of meeting?
This exercise is essentially about developing empathy, as you will surely have understood. It
is an extended form of the perspective-taking practice that Trudy taught her daughter, Sam,
building your ability to connect with others not only more authentically, but with more
compassion. This is a powerful means of developing your sense of connection with others.
Close your eyes and get in contact with whatever you struggled with. Take some time to feel what you feel,
think what you think, and remember what you remember. Don’t try to fix it—try to contact your pain.
Take that noticing part of your awareness and imagine leaving your body and looking back at yourself.
Notice what you look like from the outside but realize that inside you are hurting.
Ask yourself (but do not answer . . . just hold the question in, in awareness): “What do I think of that person
I see called ‘me’? Is this a lovable person? Is this a whole person?”
Take that point of consciousness to the other side of the room, leaving yourself sitting there. Now look back
at yourself from afar. See yourself sitting there, suffering. You might notice also that there are others not too
far away (in your house or neighborhood) and for sure some of them are suffering right now as well.
Ask yourself again (but do not answer . . . just hold the question in, in awareness): “What do I think of that
person I see called ‘me’? Is this a lovable person? Is this a whole person?”
As you picture yourself from across the room, imagine that you are reading a book that asked you to look at
yourself from across the room while feeling something that was causing suffering. But it is ten years from
now and you have grown far wiser. If you could pass back two or three sentences from that wiser future
about how to be with yourself with this issue, what would you pass back to yourself?
Sit with that for a few moments and mentally write yourself a short note of advice. Then come back to your
body and open your eyes.
One of the interesting things about this exercise is that the notes people write usually conform
to the wisdom the flexibility skills teach us: just be you; go for it; it’s OK—this will pass; you
are lovable; you can let it go. I believe this indicates that our natural consciousness is
psychologically flexible, which means you have a constant ally in learning how to develop your
own psychological flexibility: you have you. The whole, complete, genuine, authentic you.
Chapter Eleven
I n Chapter Nine we learned that the first step in turning toward acceptance is admitting to
yourself that the things you’ve been doing to cope with difficulties haven’t been working
because their aim is avoidance. Now that you’ve begun practicing defusion and reconnecting
with your transcendent self, it’s time for the next steps in acceptance—turning toward your pain
and beginning to open up to experiencing it and learning from it.
The defusion and self skills are powerful aids in the difficult work of learning acceptance. As
we begin to allow ourselves to feel our pain, our fight-or-flight instinct will kick into high gear.
Our minds will begin virtually screaming at us to go ahead and take that drink or push down that
anxiety. All of the unhelpful rules we’ve been following will assert themselves (“It’s better not to
feel the pain, just numb yourself”) and our negative self-talk will flare up (“You’re not strong
enough for this” or “This is too hard” or “Who are you kidding, you’re just a failure!”). Our ego-
defending self-deceptions will call out to us, pushing back on making behavior change and
telling us we’re a victim—“Why should you have to stop smoking, it’s not your fault cigarettes
are addictive.”
Knowing how to acknowledge and then let go of those unhelpful messages empowers you to
begin tapping into the wisdom of your pain. You can begin probing into the underlying
motivations of the behavior you want to change. Just as I was able to catch that glimpse of my
young self hiding under the bed as my parents fought, by building your acceptance skills you can
begin to listen to your painful memories and cope with current distress in a less defensive,
impulsive way. You’ll start to hear helpful messages in place of the avoidant ones. You’ll also be
able to appreciate the central piece of wisdom our pain offers us—that our pain is due to a
healthy yearning.
Sometimes people try to stay partially emotionally closed as they practice exposure. That will
seriously undermine getting the benefits, and when you need to accept the most difficult
experiences, the skills will not be there.
The most common limits people set are to try to impose a threshold on the strength of the fear
or pain they’ll open up to and to rule out ever facing certain issues. An example of the first is
“I’m willing to practice acceptance as long as I’m not too anxious.” That never turns out well.
Why? As soon as anxiety ticks up a little, your mind will begin to worry that it might go higher
and cross the threshold you set. That fuels more anxiety, and voilà, you are “too anxious.”
This does not mean you can’t set other kinds of limits. You can, for example, limit deliberate
exposure by time (“I will go into the mall for five minutes”) and by the type of situations and
emotions you tackle. You can take your time and take incremental steps. There is no
speedometer glued to your forehead. Overwhelming yourself by trying to tackle your most
difficult feelings right away is counterproductive. Start with feelings, memories, and current
experiences that are less intense. Others can wait until you’ve developed greater flexibility.
We use the metaphor of taking a leap not from a cliff but from a chair, or maybe the roof.
You can control the circumstances of acceptance and therefore, to a degree, naturally limit how
much emotion you’ll expose yourself to. But that is because less is provoked, not because you’re
denying the feelings or trying to tamp them down. A leap is a leap—even if it is from a low
stool. When we choose to accept, we’ve got to go “all in” or the benefits will not flow.
Starting out with less intense sources of fear and pain does not mean that you should rule out
ever needing to face certain issues. Suppose you decide you will never face your sexual abuse
history, and then you find the love of your life and discover you cannot open up a place of real
intimacy because that place reminds you of the abuse? Suppose you decide you will never face
the death of your father, and then your mother gets a terminal illness and you can’t be there for
her? We are all forced to “receive the gift offered” inside some kind of incredible tragedy. If
you’ve worked on accepting your most difficult experiences, you’ll be much better prepared for
these shocks.
Applying acceptance methods to the most difficult experiences is best done after all of the
flexibility processes are in place, however. Your growing psychological flexibility will guide you
about when to tackle the next challenges. For this reason, in this chapter I’m providing only a
core starter set of practices for you to do now. A number of more advanced additional practices
will be introduced in Chapters Twelve, Thirteen, and Fourteen, which combine acceptance with
presence, values, and action skill building.
One last point to make is that taking acceptance to the max is often best done with
professional help, and you can find a list of several thousand therapists who do ACT at
http://www.bit.ly/FindanACTtherapist.
1. Say “Yes”
A core skill in acceptance is to be willing to have events be what they are. You can start
practicing just by looking around. As your eyes land on anything, see what it feels like to look at
it from the point of view of “no” meaning “no, that’s no good; that has to change; I want that the
hell out of here; that is unacceptable.” Simply look at a specific thing you see, and mentally
adopt a “no” approach to it, then move to another item as you scan the room and do the same,
over and over. Do this for a couple of minutes.
Now repeat the scan but this time do it from the perspective of “yes” meaning “yes, that’s
OK; that is just like that; it does not have to change; I can allow that to be just as it is.” Simply
look at a specific thing you see, mentally adopt a “yes” approach to it, then move to another item
as you scan the room and do the same, over and over. Do this for a couple of minutes.
Take a pause and see if you can sense how different the world seems inside “yes” versus
“no.” Back in Chapter Eight, I asked you to put yourself in a physical posture expressing you at
your best and then you at your worst when faced with difficult experiences. If you were like most
people, at your best your body assumed a more open posture (e.g., head up, arms out). The “yes”
and “no” ways of looking at the world tap into a similar mind-set: the open and accepting one
and the avoidant and controlling one.
A way to ratchet up this “yes/no” exercise is to add to it the physical postures exercise. This
time, when you are doing the “yes” cycle, put your body in an open position—standing or sitting
tall, palms up, arms out, head up, eyes open, legs apart—and when you are in the “no” cycle put
your body in a closed position—arms in, head down, eyes lowered, legs closed, fists and jaw
clenched, stomach muscles tightened. Notice very carefully how your experience differs.
You can move on to do this exercise with specific thoughts, emotions, urges, and memories.
Over time, you will begin to notice as you go through your daily routines that sometimes you
settle mentally and maybe also physically into a “no” posture without meaning to. Noticing the
mental and physical cues can help you catch yourself and consciously adopt a “yes” posture
instead.
2. A Caring Exercise
Pick a feeling or experience that you have a hard time accepting, one that’s leading to
unhelpful resistance. Start small. Then envision one of the following for at least one minute.
Hold your experience as you would hold a delicate flower in your hand.
Sit with your experience the way you would sit with a person who has a serious illness.
Look at your experience the way you would look at an incredible painting.
Walk around the room with your experience the way you would walk while carrying a sobbing infant.
Honor your experience the way you would honor a friend, by listening carefully even if it was hard.
Inhale your experience the way you would take a deep breath.
Abandon the fight with your experience the way a soldier might put down his weapons to walk home.
Take in and carry your experience as you would drink a glass of pure cold water.
Carry your experience the way you carry a picture in your wallet.
These metaphorical ways of treating your feelings, memories, and current experiences are
often powerful in building acceptance. That’s true even if as you consider them your mind says,
“I don’t know how to do that.” Give them a try over time with different memories, experiences,
emotions, urges, or thoughts.
3. A Wider View
Feeling something painful or difficult tends to cause us to focus our attention narrowly,
allowing pain or fear to loom large in our minds. If we bring a wider perspective to the
experience, we can more effectively open up to the gift buried inside it.
Take some time to conjure up a difficult experience, bringing it fully to mind, and then
consider these questions.
Is there a specific bodily sensation that is associated with this experience, and can you say “yes” just to that
sensation? Give yourself a minute to consider that and to see if you can. Don’t rush.
Have you seen anyone in your family struggle with something like this experience, and if so can you bring
that memory to mind with the purpose of looking at their experience with compassion? Again, don’t rush.
Extract what you can from the question and then move on.
Is there a specific thought associated with this experience, and can you say “yes” just to that thought? Think
that thought as a thought and drop any sense of struggle with it. Just notice it.
If you were to look back on your life from a wiser future, would you say there is something in this
experience for you to learn from? Pause with this question. Don’t get all mind-y. Don’t try to figure it out or
second-guess yourself. Just gently look to see, from a distant and wiser you, what might be inside this
experience that would help you on your path?
What does this experience and your struggles with it suggest you deeply care about? In your pain you find
your values: what does this painful area say about your values and vulnerabilities? What does it suggest
about what you want?
If this experience were in a book you were writing, how might the character experiencing it become wiser or
more alive as a result? In other words, if you were on a hero’s journey, and this were a challenge, how could
the hero use it to foster vitality and wisdom?
Are there other memories associated with this experience? Can you say “yes” just to one more? Give
yourself a minute to consider that and to see if you can. Don’t rush.
If you blame someone for this experience, can you think of times that you have done something like what
they did? Perhaps in a lesser way? Sometimes we hold others responsible for our difficulties. Sometimes we
even do so as a way to avoid seeing how our behavior is similar to theirs.
If someone else you care about were struggling with an experience like this, how would you feel? What
might you suggest that they do? Picture a friend with the same issue and allow yourself to connect with both
of these questions. How do you feel about them, knowing they have this issue? What would you say to them
about what they might do?
What would you have to do to let go of a struggle with this experience? You picked something you say “no”
to—what would you have to give up in order to let go of an attachment to that “no”? This is a subtle
question: don’t rush your answer. Open up all of your channels of sensing and being aware. Try to feel the
answer more than overthink it. Is there something there you are holding on to?
If you could feel this experience without defense, what would you be able to do in your life? Allow yourself
to reach out and dream. Imagine you could take the experience along with you for an adventure. If you
could, what journey would that be?
4. Practice Opposites
This is a more advanced skill that is a playful variation on the last method. Begin practicing
this exercise whenever you find your mind telling you not to do something or think about
something. This is a way of using fearful emotions and thoughts as guides to good exposure
experiences.
If I’m working with someone on exposure to being at the mall, for this exercise I’ll ask,
“Where does your mind say we cannot go?” If the person answers, “Up the escalator,” then it’s
up the escalator we go. It’s always a choice—there’s never a need to force it. You could choose
an alternative, such as taking the stairs if that’s less difficult, leaving the escalator on an action
plan list of behaviors to commit to later on. But don’t underestimate this exercise, especially if it
has a playful mood. I’ve seen clients grab back territory they’ve abandoned for many years. It’s a
bit like deciding to ride a zip line or bungee jump for the first time—often once you begin,
within seconds your fear is overtaken by a joyful sense of life expansion. Who knows? Maybe a
parachute jump is next!
Chapter Twelve
I’ m not usually chatty on planes, but on a recent flight the man next to me was, and I went
along to be polite. Soon I was fascinated. He was a commercial pilot who lived in New
Orleans and loved to sail boats competitively. He claimed spectacular success as a racer,
particularly in his hometown. “You must understand the local currents and winds,” I offered. “Of
course,” he answered a bit dismissively, adding, “but all locals do.” After looking from side to
side in a conspiratorial way, he leaned close and in a semiwhisper said he would divulge the
secret of his success. Enjoying the drama, he paused and said, “I smell the coffee.”
I looked at him a bit slack-jawed but no, he had not lost his mind. He explained his sailing
advantage with a story that I checked out soon after I landed.
New Orleans is the second-largest coffee port in the country, and there are a few industrial-
sized roasters spread along the Louisiana coast near the river. Each roaster is known for
particular beans and qualities, and for that reason, each has a distinctive aroma. When miles
offshore all he had to do was to notice the characteristic smells and voilà, he knew the wind
direction! Using his well-trained nose and knowledge of the city, he could sense small wind
changes far more rapidly and accurately than competitors who had to watch wind socks or hold
up a wet finger. He tacked into these changes before others knew what was even happening.
Sometimes his crew members would yell at him over what looked to be a totally irrational choice
of direction, only to quickly settle down as the wind change became clear.
We are all surrounded by vast and potentially important information, both inside and outside
of us, that generally sits there unnoticed and unused, especially when our attention is constrained
and rigid. How many of us would think to smell their way through a sailing race? Perhaps very
few, but a dog or cat needing to use this information would have no problem accessing it—not
only because they are better smellers but because they live more in the present, which keeps
them primed to learn by experience.
The inability to live in the present enormously reduces the information available to us. It’s as
if we’re playing tennis while wearing sunglasses with a lens that’s been rubbed with sandpaper.
We’re distracted by preoccupations that mar a clear view of the current moment.
I can show you in less than a minute how our attention becomes limited. Look around the
room for thirty seconds and find everything that is colored black. Catalog every black item and
then bring your eyes BACK HERE to these capitalized words.
Now, close your eyes and recall absolutely every item you saw that was a rectangle. No
cheating!
....
Are you back? Did you have trouble remembering rectangular items?
If I had asked you to count all the black things you’d seen, you could have done pretty well.
But though you probably saw plenty of rectangular shapes—take a look around now for them—
your attention was dominated by the rule to find black things, so your mind saw only part of
what your eyes saw. There is a lesson here: our judgmental, problem-solving minds constantly
pull our attention away from full awareness of the present moment.
Another way to demonstrate this is to look around the room and try to figure out what is
wrong with everything you see. Look for flaws, item by item. Do it now, again for about thirty
seconds.
....
I bet the journey into a “now” that you were evaluating made you feel like you were more in
your mind than in the room. You might have thought about how visitors who came recently must
have noticed all the flaws, and you might have wondered what they thought of you because of
those flaws. Maybe you berated yourself for not being more vigilant about fixing up your home,
or for not having better design taste. And while you were busy with those thoughts, I bet you
hardly noticed how your toes felt, or whether you were breathing freely, or whether the room
was cool.
If the aroma of coffee was wafting through the room, you probably didn’t notice that either.
What if, like our sailor, there was something to be learned from your present experience? Too
bad . . . you missed it.
The first three flexibility skills are all vital to empowering us to live much more in tune with
the present and the learning it affords. All of these skills support us in making the pivot toward
presence, away from preoccupation with the past and future to the possibilities of today. We can
also build a number of practices for cultivating attention to the present into our life routines. This
helps us stay on the path of living, day-to-day and moment-to-moment, in accord with our
values.
A brief period of mindfulness meditation can encourage people to make more rational
decisions by considering the information available in the present moment. Meditation
reduced how much people focused on the past and future, and this psychological shift
led to less negative emotion. The reduced negative emotion then facilitated their ability
to let go of “sunk costs” [throwing good money after bad when a poor financial
decision is made].
A Starter Set of Methods
I am going to focus here on simple methods that have proven effective. If you do not yet have a
more complicated form of practice, I recommend starting with these, each of which can be
performed in just a few minutes, which helps with doing them regularly. Consistent practice is
key to lasting results.
Ideally, you should make a few of these part of your flexibility skills toolkit, practicing them
often enough that you can do them by heart. That will allow you to call on them at any moment
when you find your attention being unhelpfully pulled into the past or future. You can make
them part of your daily life routine, whether that’s in the morning right after waking up, while in
the shower or having breakfast, or perhaps in the middle or at the end of the day. You will
immediately begin to see the positive effects on your ability to focus on the things you want to be
attending to, and that is often highly motivating in continuing with daily commitments. Consider
sticking to a daily flexibility practice as your first commitment to living your more values-based
life.
For the initial set I’ll begin with a simple meditation technique and then introduce a few
attentional flexibility exercises. Once you’ve read the rest of the Part Two chapters, you can
come back here to do the rest and then decide which you want to keep practicing.
1. Simple Meditation
A wonderfully simple method of meditating was laid out by a friend of mine from graduate
school, Raymond Reed Hardy, in his book Zen Master. What he suggests is not new—it is just
the simplest possible beginning. Here are the instructions. Sit down, back straight, eyes slightly
open, cast your eyes downward at a forty-five-degree angle, and maintain a soft focus (don’t
sharpen your visual attention to any particular point). If you are uncomfortable sitting cross-
legged, sit in a chair with your feet flat on the floor. Allow your mind to come to rest on your
breath. Each time you find your mind has drifted away, release it from that train of thought and
then allow it to settle again on the breath.
That’s it. Do it for a few minutes a day.
How can such a simple practice work? It builds your attentional muscles. Each time you
notice that your mind has wandered, you are strengthening your ability to notice and to regain
focus.
....
If you are like most people your mind did wander, but sooner or later you noticed it
wandering and brought it back. You probably also noticed things about the sole of your left foot
that you don’t usually think about: sensations, qualities, features. You may have noticed its size
or its shape or a tingling or warmth.
Now set the timer for two more minutes and do the same with the sole of your right foot. See
if you can deepen the awareness of sensations and observations this time, such as noticing even
more aspects or features. Again, if your mind wanders, gently bring your attention back.
OK, start the timer and begin.
....
What did you notice this time? Did the time seem to pass more slowly? Did your mind start
telling you there was nothing new to learn?
Now set the timer for two more minutes and see if you can be continuously aware of the soles
of both your left and right foot simultaneously. Try not to alternate, but instead broaden the beam
of your attention to allow you to see both at once. If your mind pulls you away, gently redirect it
back.
....
What did you learn? What did you notice? Did your observations and awareness come and
go? Did you find yourself sometimes focusing only on the left and then the right, while at other
times you could do both? That’s great! Directing your attention first to one foot and then the
other not only builds attention in the present, it builds flexible attention. Remember that the goal
is directed attention that is both flexible and voluntarily.
This is a version of one of the most effective and yet simplest mindfulness exercises,
developed by mindfulness researcher Nirbhay Singh. Studies have shown that it helps reduce
aggressive behavior in children or in adults struggling with chronic mental illness. It can help
people stop smoking. It can help children with a biological inability to feel full to keep from
overeating. This exercise helps focus awareness by grounding it, very much as a boat is
stabilized by an anchor. Your feet become anchors. Grounding awareness undercuts the
automatic thoughts and behavior processes that pull people quickly from anger to aggression,
from having an urge to actually smoking or eating. It opens up a tiny window of choice while
damping down emotional and cognitive reactivity. I prefer it at times over the more common
practice of following the breath. For one thing, you can use it anytime and anywhere—even
while talking (try that with a “follow the breath” approach!) For another, many forms of anxiety
involve difficulties with breathing, and focusing on breathing can be an invitation into panic.
Additional Methods
5. Getting Present with the Past
One of the most difficult challenges in focusing on the present is that our minds are so often
“hooked” by the past—memories, emotions, and thoughts are all embedded in our mental
networks and easily triggered. A helpful way of reminding ourselves of these hooks is the
acronym I’M BEAT. If you notice you are being pulled from the present moment, see if you
didn’t just get hooked by Interpretations, Memories, Bodily sensations, Emotions, Action urges,
and Thoughts of other kinds (such as predictions and evaluations). Once you make yourself
aware of them, you are back in the present! Said another way, the way to get unhooked is to
bring full awareness to the hook itself. Almost always you will find the hook inside the I’M
BEAT list (which is not a bad acronym since without awareness, these reactions will beat you
down).
Here’s a great exercise for learning to counter the pull of the hook.
Deliberately bring a memory to mind and then say to yourself, “Now I’m remembering
that . . .,” continuing the statement by briefly describing the memory in one short sentence. For
example, you might say, “Now I’m remembering that my boss told me I would never amount to
anything.”
As you do this, be on the lookout for any emotions triggered; any bodily reactions, such as a
tightening of your gut; thoughts that may arise; or an urge to do something. Also be alert to other
memories that might pop up. When you’re done with the statement of the memory, attend to
these emotions, thoughts, and other sensations one by one, saying, for example, “Now I’m
having the emotion of sadness.” If you had the thought, “That should never have happened,” you
should state it as “I’m having the thought that that should never have happened.” If you lost track
of the responses you wanted to describe, go back to the memory and restate it to capture them
again if you can. For other memories that pop up, go through the same exercise.
This simple phrasing “I’m having the thought that . . .” is a powerful means of bringing
defusion into mindfulness, creating a little distance from our thoughts and emotions and impulses
that allows us to be in the present moment with them. The thought or feeling may be about the
past, or the future too, but by these tags you are alerting your mind that this reaction is occurring
in the now. Cultivating that awareness develops a powerful habit of mind that can help us stay on
course even when the most difficult memories, thoughts, and emotions present themselves.
6. Inside/Outside
This last exercise helps build our ability to be aware of our internal experience while also
attending to whatever tasks we’re engaged in, not getting rigidly fixated on either.
While you’re engaged in some task, say gardening or a household chore, keep paying
attention to what you’re doing but also shift some focus to what’s going on inside your body.
This is very much like focusing on both your feet. Allow any physical sensation to step forward
but without grabbing all of your attention. Where do you feel this sensation? Notice the edges.
What is the quality of the sensation? Hot/cold? Tense/calm? Throbbing/constant? Tight/loose?
Rough/smooth? Remember to stay with the activity as you do this.
Now bring your attention more fully again to the task, but also continuing to be aware of the
sensation. How is the sensation related to the task? How are your feelings about the task, and
your degree of focus on it, related to the sensation?
Your insides are reacting to the task, and your feelings about the task are impacted by that.
Maybe you’re feeling deeply satisfied by seeing how well your flowers are growing and you
notice that you have a physical internal sensation of pleasure even while you are also feeling
some pain in your knees and arms. Or maybe you’re feeling bored with the task and you notice
that you’re also feeling a slight sensation of hunger. It’s important that you allow your awareness
of these interconnections to emerge from just shifting your attention around from inside to out
and that you don’t start problem-solving and giving yourself a rule—“I’ve got to find a
connection!” This exercise is one of attentional focus, not of diagnosis. It helps us keep our
attention limber so that we’re more fully present in the moment, with both our bodies and our
minds. Over time, this helps us experience the present moment more fully, staying alert about
whatever information may be presenting itself to us that can be useful, like that scent of roasting
coffee my sailor friend picked up on.
Chapter Thirteen
O ne of the greatest sources of psychological distress is losing touch with the values that are
truly meaningful to us. I had a client who, when asked about her deepest values, paused
for a long time before pushing out the words, “That’s the scariest thing I’ve ever been
asked.” After another long delay she added, “I’ve not thought about that in a long, long time,”
and began to cry.
That is the most common emotional reaction to connecting deeply with values. I’ve seen it
scores of times in therapy. I suspect it’s also why we cry at the sight of a newborn baby, and why
tears flow at weddings. It’s why sometimes our eyes tear up at a spectacular sunset. We’re
feeling connected to aspects of life we treasure.
I bring my hand out from behind my back, with my three fingers still stuck out, and I explain
to the client that usually this questioning goes no more than three rounds. By the fourth question,
if not sooner, almost everyone has answered with, essentially, “I don’t know.” This helps them to
see that they’ve been buying into the need for all sorts of culturally scripted reasons and not
really appreciating that the answer is not really all of the whys anyway. It is far closer to the truth
just to say “because I choose to.”
I recall once working on weight control with a client with diabetes who, after a values
conversation, said she was going to work on her health so she’d have a better chance to see her
daughter grow up. It rang true; I sensed that this was her authentic motivation. Just to test that,
though, I asked her why seeing her daughter grow up mattered. She wasn’t fooled. “It doesn’t,”
she said a bit flippantly, and then after a short pause she peered down at me over her glasses and
with a clipped intensity added, “except . . . to . . . me!”
Saying that we freely choose our values doesn’t mean that our choices aren’t shaped by
family and cultural influences, such as parental guidance and being taught religious beliefs. We
absorb these teachings, but as we do, we exercise our ability to choose, even if we don’t
acknowledge that to ourselves. All choices are informed by our history. But justifying our
choices with the rationale that they’re what we were taught is a way of avoiding personal
responsibility. This is a precept of all the world’s major religions. They emphasize that human
beings have the capacity to choose to live in accord with religious teachings or not. The
affirmative leap to do so is often called a “leap of faith.”
Defusion and self skills help us stop the justification process from kicking in and connect
with others in a deeper way. We learn to catch ourselves as our minds begin spinning out
compliant reasons for our behavior. They also help stop self-recrimination as we begin doing
values work. The Dictator can become quite harsh as we begin acknowledging to ourselves that
we haven’t been living in accord with our values. It will start berating us—“See I told you,
you’re no good. You’re a hypocrite, a charlatan.” We may also get caught up in excessively
evaluating whether we’ve chosen the right values, ruminating over whether they’re really our
“true values.” With the ability to disregard these unhelpful messages, values work is freeing
rather than punishing.
The following are domains of life that contain values for some people. We are concerned with your quality of life in each
of these areas. One aspect of quality of life involves the importance one puts on different areas of living. Rate the
importance of each area (by circling a number) on a scale of 1 to 10. A score of 1 means that area is not at all important.
A score of 10 means that area is very important. Not everyone will have notable values in all of these areas, or care about
all areas the same. Rate each area according to your own personal sense of importance.
2. Marriage/couples/intimate relations
1 2 3 4 5 6 7 8 9 10
3. Parenting
1 2 3 4 5 6 7 8 9 10
4. Friends/social life
1 2 3 4 5 6 7 8 9 10
5. Work
1 2 3 4 5 6 7 8 9 10
6. Education/training
1 2 3 4 5 6 7 8 9 10
7. Recreation/fun
1 2 3 4 5 6 7 8 9 10
8. Spirituality
1 2 3 4 5 6 7 8 9 10
9. Citizenship/community life
1 2 3 4 5 6 7 8 9 10
In this section, we would like you to give a rating of how consistent your actions have been with your values in each of
these domains. We are not asking about your ideal in each area. We are also not asking what others think of you.
Everyone does better in some areas than others. People also do better at some times than at others. We want to know how
you think you have been doing during the past week. Rate each area (by circling a number) on a scale of 1 to 10. A score
of 1 means that your actions have been completely inconsistent with your values in this area. A score of 10 means that
your actions have been completely consistent with your values.
2. Marriage/couples/intimate relations
1 2 3 4 5 6 7 8 9 10
3. Parenting
1 2 3 4 5 6 7 8 9 10
4. Friends/social life
1 2 3 4 5 6 7 8 9 10
5. Work
1 2 3 4 5 6 7 8 9 10
6. Education/training
1 2 3 4 5 6 7 8 9 10
7. Recreation/fun
1 2 3 4 5 6 7 8 9 10
8. Spirituality
1 2 3 4 5 6 7 8 9 10
9. Citizenship/community life
1 2 3 4 5 6 7 8 9 10
There are a number of ways to assess the results. The first is to look at all domains that have
relatively high importance scores (a score of 9 or 10) and also have relatively low consistency
scores (6 or less). These are clear problem areas, and I suggest doing your initial values work
with any one of them. Then you can move on to other areas.
It’s also good to calculate your overall score. Multiply the two numbers from the first and
second parts for each domain. So if for family, in the first part you scored it as 10 and in the
second part you circled 4, for that domain you’d get 40. Add all of those numbers and then
divide them by 12 to get your composite score. To get a rough sense of how your score compares
to those of the broad public, the average composite result is 61. Do not begin beating yourself up
if your score is lower than that. Practice some defusion from that negativity. This is a discovery
process, not a critique, and after all, you’ve embarked on this journey—give yourself some credit
for that. You’re here to embrace change.
If you scored quite a few of the domains as low in importance to you, you should consider
whether you were being fully honest with yourself about them. It is perfectly reasonable to have
some domains that are unimportant. You may not care about citizenship, or the environment, and
if you do not have children, you may not care about the parenting practices of others, and so on.
That being said, research suggests that if many of these domains are unimportant, that’s a
contributor to psychological distress. Use this assessment as an opportunity to admit your true
values to yourself.
Now, with a good idea of the values domain you’d like to start working on, you’re ready to
get going.
A Starter Set of Methods
I recommend that in this reading session you do at least the first exercise. Then you can either
read the others but return to work on them later on, or if you want to, jump to the next chapter on
committed action and come back to them. You will find as you move into committed action that
all of the flexibility processes now become relevant, but values especially so, because they
provide motivational energy to go ahead with behavior change. For example, the second and
third exercises in this chapter are great ways to start identifying actions that you want to commit
to change.
Don’t be surprised if this work stirs things up. There is a palpable sense of vulnerability that
comes from doing values work. Don’t be surprised if you find yourself getting unexpectedly
emotional over the next few days, or cranky, or anxious. If you do catch yourself getting caught
up in rumination of past difficulties and self-recrimination, go right to a little defusion, self, and
presence practice. If you feel yourself pushing back against emotions, or procrastinating, practice
some acceptance exercises. Remember, we hurt where we care, and values work is all about
caring.
1. Values Writing
I want to ask you to write about your values, answering a small set of questions I will ask.
This values writing will help you explore further, in an open and unregulated way, the story
you’ve been telling yourself about your values and how you can reconnect with your authentic
values.
Research has shown that values writing has more impact on behavior and health than just
asking people to pick their values from a list or state them in a few words. Values writing can
reduce defensiveness, making us more receptive to information that suggests changes we need to
make in our lives. It reduces physiological stress responses and buffers the impact of negative
judgments of us from others. And we know a bit about why all of this happens. Values writing is
most powerful when it leads us to care more about transcending our own ego and self-story and
helps us link our caring to the good of others. Values work helps build socially positive
emotions, like gratitude and appreciation, and the feeling that you are making a meaningful
difference in others’ lives.
If that sounds preachy, please remove any sense of “should” from it. You don’t need a
wagging finger from me any more than you need one from anyone else, including you. I’m
advocating values work because science shows that it improves our lives. It’s just the way we are
wired.
To start, take out a piece of paper and write for ten minutes about a value you care about
deeply in any domain from the list I just gave you. Really do it—ten minutes is not very long! As
you do so, address the following questions:
What do I care about in this area? What do I want to do in this area that reflects that caring?
When in my life has this value been important? What have I seen in my life when others pursue
this value, or not? What might I do to manifest this value more in my life? When have I violated
this value and has that been costly?
Try to focus your writing on the qualities of your life as you want to live it—qualities of your
own that you hold as being of intrinsic importance. This is between you and you; it’s not about
seeking approval or following a bunch of rules. You are not trying to avoid guilt or tell a self-
justifying story.
If it feels like you are beginning to write a holiday list to Santa—a list about what you want
from life or others—redirect your writing in the direction of describing the qualities of actions
you would like to manifest in your life. If you get bogged down, just rewrite things you’ve
already written until new things show up. Since this is between you and you, you cannot get it
wrong.
Don’t continue reading until you’ve written for at least ten minutes. Trust me on this. Just do
it.
....
Now we can look back at what you’ve written. But before turning to that, consider that I asked
about times in your life when this value was important, because that helps reaffirm your
commitment to it. For me, one of these times was crying under my bed as my parents fought,
which helped me see how I longed to help others in a new way. To this day, I sign off on most of
my e-mails (especially ones in which I’m trying to help others who are looking for ACT
resources and the like) with the phrase peace, love, and life.
I asked what you can do to act more in accord with this value, to help you identify specific
actions to commit to. Finally, I asked the painful question about times you’ve fallen short and
how that affected your life, because we have much to learn from the pain we inevitably
experience.
OK, now read what you wrote and see if you can distill out of it a few examples of things you
want to do in this area. Actual behavior. Next look for mentions of the qualities you want to
manifest in your actions. You might want to do things genuinely, lovingly, carefully, creatively,
curiously, compassionately, respectfully, openly, joyously, industriously, healthfully,
adventurously, thoughtfully, justly, supportively, learnedly, peacefully, humorously, simply,
honestly, spiritually, fairly, charitably, traditionally, dependably, and so on and so on. We are not
used to writing about the qualities of action, so don’t expect these exact words to show up—I’m
trying to give you a set to help you see what I mean by qualities. It’s hardly a complete list . . .
just use it as a rough guide.
With this first set of actions you’d like to take, you might want to move now to the next
chapter, to gain guidance about how to commit to them. Or you might want to do the other two
starter exercises here first. If you decide to move on now, be sure to come back to do at least
these next two exercises. They have proven very powerful for people in developing a deeper
awareness of their values and continuing to chart a course of more meaningful living.
Additional Methods
This is a slight modification of the values writing task. Before I ask you to write, though, I
want you to think. Imagine that the next year is going to be a key year in defining who you are in
your life. If you were to become more fully you during this year, while at the same time still
supporting those you care about, what would your process of “becoming more fully you” look
like over this next year? Where do you wish to grow? What kind of person are you yearning to
be? If you were writing the chapter of the next year of your life, what would the theme be?
Now that you have the set, do ten minutes of writing about the next year and what you hope
to become.
• • •
Many more ACT exercises have been developed for connecting with values, and I highly
recommend you seek them out (follow the search strategy I listed in the Author’s Note, before
Chapter One). Building your connection with your values is a journey that can last the rest of
your life, and every step will make your life more meaningful.
Chapter Fourteen
W e have reached the last step in the dance of living the life we want to live. Without this
last pivot, we’re at risk of backsliding on all of the progress we’ve made in the
previous steps. But once we commit to building values-based habits of action, we
secure our progress with all of the flexibility skills. Taking action that helps us get where we
want to go requires us to employ the other skills, reinforcing their importance. As in a real dance,
in which all of the movements you’ve practiced flow together into a smooth and seamless
pattern, committed action brings the six pivots together into a healthy, ongoing process of acting
as you choose.
Recall that psychological flexibility is really one overarching ability, not six. It can’t be
learned all at once, any more than how to dance the tango could be learned all at once.
Ultimately, as you continue working on the skills, they combine into the one skill of living with
psychological flexibility. Choosing more meaningful ways of living is the payoff that comes
from integrating the skills—I even emphasized that idea in the subtitle of this book. It is
habitually pivoting toward what matters that makes the other flexibility skills foundational. It is
hard to truly commit to a new way of living without having developed some other flexibility
skills, and all of that work begins to come to fruition once we begin making changes in our
patterns of daily living.
As we embark on committing to behavior change, of whatever kind, the key is to do so with
psychological flexibility. What does that mean exactly? It means moving forward with self-
compassion, not berating ourselves for inevitable missteps, and buying in when our judgmental
minds label them, or ourselves, as failures. It means embarking on your new course with a clarity
that you’re not doing this to impress others, bolster your ego, or conform to a new version of a
conceptualized self. Rather, you’re committing to change because doing so is helping you
connect with your deepest values from your most authentic sense of self. It means accepting the
pain and risk that is inevitably involved with change, whether that’s the physical pain of
withdrawal symptoms or cravings, or the emotional pain sure to come from opening up to
experiences we’ve been avoiding, such as rejection by someone we ask on a date, or criticism
from a difficult parent with whom we reconnect. Finally, it means keeping our attention on the
richness of making an effort and learning new habits rather than fixating on a static state of
success and how far we are from it.
The last realization needed to engage in building new life habits in this psychologically
flexible way is that we’re not going to be immediately competent in our new chosen actions. We
will without doubt stumble as we pursue our new course. We’ll backslide in our behavior and
we’ll probably grasp again at avoidance. That is OK—that is how change happens. Stumbles are
no reason to berate ourselves or to flee back into self-delusion or give up in despair.
The Action pivot moves us away from an unhealthy desire for perfection and toward a
flexible appreciation of the intrinsic satisfaction of developing competence.
I will no longer struggle with the pain of my childhood when I’m famous.
I will stop worrying about the future when I have a lot of money.
As the Dictator deflects our attention away from the intrinsic value of our current efforts,
including the learning we can gain from our stumbles, and focuses our mind on the need for
achievement, we can slip into another type of avoidance. Despite their appearances, some forms
of persistence are actually forms of avoidance, driven by fear (of failure, for example).
Workaholism and perfectionism are examples. These rigid forms of persistence carry with them
a strong negative health impact as well as leading people to ignore relationships and recreation.
The Action pivot takes the yearning for competence and directs it toward building habits of
values-based actions that are authentically meaningful to us. That undermines both
procrastination and workaholism.
SMART Goals
As we embark on committing to a new plan of action, we should develop SMART goals:
specific, measurable, attainable, results-focused, and time-bound. It does not help to set a goal
like “I will be better” because it has no increments of progress. It’s counterproductive to set
unrealistic expectations such as “I will never feel depressed again.” And setting a realistic time
frame for achievement of a goal helps to tamp down the sense of urgency about achieving it now.
If you are committed to helping veterans heal their wounds from war, you might set a goal of
obtaining a degree in clinical social work in the next three or four years, so that you can work
with them professionally. Once that goal is set, you may need to go through multiple rounds of
goal-setting to find the right program, apply for it, and finish the degree. Each of these steps is
specific, measurable, attainable, results-focused, and time-bound.
The other flexibility skills help with commitment to the actions that will allow us to achieve
these goals. Defusion allows us to distance ourselves from negative thoughts and judgments
about our progress. Connecting to our transcendent self keeps our focus on taking action because
we care, not to comply with social expectations or avoid guilt. Acceptance helps us maintain our
grit when the going gets tough. Presence helps us stay focused on the process rather than the end
goal—and how far from it we are. Connecting with our values reminds us that these difficult
actions are in the service of living the life we will find meaningful, rather than in service of
proving our self-worth or escaping from difficult experiences.
Based on a distinction between you as a conscious being and the story the mind tells of
who you are, in this time and situation are you willing to experience your experiences
as they are, not as what they say they are, fully and without needless defense, and
direct your attention and effort to creating larger and larger habits of behavior that
reflect your chosen values? YES or NO?
It reads a little like a marriage vow, and no wonder. It is a commitment. Every flexibility
process is in that question. Life asks it of you over and over and over—without end, so far as I
know. Each time you answer “yes,” your life expands. Each time you answer “no,” it contracts.
A habit of answering “yes” will likely make your life more difficult at times in the days and
years ahead; it will also make your life more vital and meaningful, even in times of doubt and
pain.
It’s OK if you’re not ready to answer “yes.” Just keep your eyes wide open. If you find
yourself stuck on “no,” commit to noticing how that plays out in your life. And then come back
to the question.
Actually, you can’t really avoid coming back to it. That’s not because there is some cosmic
imperative that you eventually “get it right,” but because life affords us the potential to take
committed action in every moment of every day. That is how it is. Just as we have within us the
knowledge about the value of the other flexibility skills, so too we have within us the awareness
that we have the power to take the actions to change our lives. We sense the possibility of our
own agency.
So, here is life, asking you the question once again.
Based on a distinction between you as a conscious being and the story the mind tells of
who you are, in this time and situation are you willing to experience your experiences
as they are, not as what they say they are, fully and without needless defense, and
direct your attention and effort to creating larger and larger habits of behavior that
reflect your chosen values? YES or NO?
The wonderful (and terrible) thing about human behavior is that it tends to support itself.
Lives fall into behavioral patterns. We do what we do, because it’s what we’ve always done.
This can become problematic for all the reasons described: we can fall into psychologically rigid
habits. But small behavioral direction changes can build to create a huge change in direction over
time. The trick is to calibrate your efforts.
Initially it’s best to make changes that are simple and quick. If you want to read more and
watch television less, start with no television after work until you’ve read for thirty minutes.
Even if the commitment you’ve decided on is small, it can help to make it smaller still. Make it
fifteen minutes of reading, or cut out a single show you think is mindless but you find yourself
watching anyway (do you really need to see more back episodes of Cupcake Wars?).
It does not matter how small it is. You’re making progress.
There are exceptions to every rule. You cannot leap across a canyon in two steps. For
example, if you’ve tried the well-established harm reduction approach to dealing with an
addiction and it did not work, it may be time to make a full-stop commitment to sobriety. That’s
a case of tailoring which methods you practice to suit your challenge. The good news is that
psychological flexibility skills help with such challenging leaps.
Additional Methods
For a month go to bed an hour earlier than usual and get up an hour earlier, just cuz.
Deliberately embarrass yourself by wearing something slightly off (e.g., a loud and unattractive shirt,
mismatched socks) each week, just cuz.
When I was walking out of panic disorder, I did longer and longer exercises of this kind: first
hours, then days, then months. One of the final commitments was to go for a year without dessert
—not because that was important, but precisely because it wasn’t! I slipped once (I put a
spoonful of ice cream in my mouth before remembering and spitting it out), but with that
exception I met the goal. I began to trust that I could do what I said I would do and that, in and of
itself, was a huge benefit to me.
Why does this help? It undercuts the tendency to slip into the judgmental frame of mind that
we must keep our commitments because doing so is important, rather than because it’s our
choice and habit. Suddenly, the judgmental voice of the Dictator begins to speak, telling us “I
have to be someone who keeps my commitment” or “I am bad if I don’t keep my commitment”
(conceptualized self) or “I will feel guilty if I don’t keep my commitment” (experiential
avoidance). Before we know it, we’re “committing” based on the usual robbers’ den lineup of
guilt, shame, self-loathing, self-criticism, compliance, and emotional avoidance. By committing
to some actions “just cuz,” we stay more aware when these other motivators are raising their
ugly heads.
5. No One Is an Island
Shared or public commitments are more likely to be maintained, as long as we don’t shift the
responsibility for our behavior to others. That is likely why certain important life commitments
(e.g., marriages) include rituals asking for the community to witness the commitment and to
support it. It’s tricky, of course: the mind can begin to claim that it is others who must now do
the heavy lifting, but flexibility skills can help keep that process reined in.
There is another reason it is useful to think of others when making commitments: our
behavioral patterns don’t only affect us as individuals. They touch the people around us. All
parents experience this challenge as they watch their children respond to—even replicate—their
most desired and most abhorrent behavioral traits. Societies and communities respond in kind. If
you change your behavior, a similar behavior change is now more likely in your friends, the
friends of your friends, and the friends of your friends of your friends. That could mean that
thousands of people have a stake in your success (perhaps thousands are looking over your
shoulder as you read this book right now!).
When you share a commitment, your friends need to see that this is part of your larger
mission, and defending against criticism or needing external control is not the point. It is sharing
and caring. It helps if your friends know about flexibility pivots and can see when you get
hooked, avoidant, or wrapped up in a self-story, helping you with gentle nudges to stay on
course. Those are the benefits you’re looking for.
Part Three
INTRODUCTION: USING YOUR ACT TOOLKIT
TO EVOLVE YOUR LIFE
K nowing the moves and how to make them happen is not the dance of psychological
flexibility. In actual dancing, we really start having fun when we creatively combine
moves, fitting them to those of our dance partners in the moment. So too, the true joy of
learning the flexibility skills comes from combining them in an ongoing way to rise to the daily
challenges of our lives—to pivot toward what matters . . . to us. That is the dance of flexibility.
The exercises in the preceding chapters have given you some personal experience with how
the skills help contend with certain challenges. If you’ve applied the exercises to one pressing
issue, you can keep that up now, continuing to practice the skills. You may have also already
begun applying them to other challenges and found yourself calling on them in a daily way as
issues arise. Encouraging you to continue building the skills and applying them to more areas of
your life is the purpose of this part of the book.
Sometimes psychological flexibility training leads to major progress, and because people feel
they have “solved” the problem that inspired them to try ACT, they stop working on the skills.
That’s a great shame because if you keep practicing the skills and consciously applying them to
new domains of your life, you can keep evolving your life in accordance with your chosen
values.
You have to keep practicing because rigid ways of thinking and acting will always keep
sneaking up on us. I experienced an example this morning. I have a coffeemaker I used to love
that makes fresh coffee one cup at a time. After a few years of great coffee, in the last six or eight
months it had not been working well. The coffee was too weak for my taste, even if I filled the
coffee strainer to the brim and pushed the “bold” button. I tried different types of coffee; I
packed it in tighter. Nothing worked.
My wife heard my complaining and kindly bought me a new one. The instruction book was
right there as I unpacked the box, so even though I knew how to use the coffeemaker, I decided
to skim it. I soon discovered something I’d forgotten (if I’d ever read about it before). The
pamphlet cautioned, Do not fill the strainer with coffee! If you do, the coffee will be weak
because the water will not go through the coffee but will flow out of the overflow tube. Especially
do not pack the coffee.
Aaagh! The coffeemaker was fine! I’d let the commonsense rule “for more, use more” take
over my behavior, and it never even occurred to me that maybe the right rule was “for more, use
less.”
That’s fusion. That’s a lack of variation. That’s weak coffee and the unnecessary purchase of
a shiny new coffeemaker! Not exactly a tragedy, but a good example of how the skills can help
with all of our endeavors, whether big or small.
Assembling Your ACT Toolkit
To make practicing your skill-building a habit, it’s helpful to create a set of your own preferred
exercises. Here is an example, comprising some of my favorite metaphors and exercises selected
from those I’ve presented. Don’t be thinking this is the best set—this is just an example of a
sensible initial set. Fill in a grid like this with your own favorites.
For the next few months at least, largely limit your practice to playing around with your
initial set until they are so familiar that they come naturally to you as you need to call on them
day to day. At that point, begin adding one more method at a time. There is no need for you ever
to get bored with any given exercise, as a huge number of alternatives are available online and in
the scores of ACT books available. See how what you added works, and if it’s not helpful,
jettison it and move on to something else.
Applying the Skills Broadly
Research has evaluated the effects of ACT in contending with a vast array of difficulties. In
addition to those already discussed, these include recovering from eating disorders; coping with
performance pressures, whether in school, at work, in the arts, or in sports; dealing with stress;
facing the fear of cancer; dealing with prejudice, and many more. ACT training has helped
people win Olympic gold medals, manage Fortune 100 companies, play a better game of chess,
and foster artistic talent.
The mind says that what you learn in one area transfers to others. Well, that can be true, but it
is not automatic. You have to consciously work on applying the skills to more and more areas of
your life. The chapters in Part Three share insights gained through both research and ACT work
with clients about why the flexibility skills are so helpful for specific types of challenges. I
explore aspects of the challenges covered that make them so difficult and show how certain of
the flexibility skills are especially useful in coping with those. An example is that in trying to
recover from substance abuse, shame is a difficult issue, and defusion and self exercises undercut
its grip. I also provide some additional exercises that have been effective for certain types of
challenges.
As you choose new challenges and life domains to apply your skills to, follow a basic process
like that used in the workshop conducted with people who have chronic pain described in
Chapter Eight. Recall that the first step was for people to write about what they wanted their life
to be like in each of the domains in the Life Compass, and then to identify the barriers they felt
were getting in their way and the difficult emotions and unhelpful thoughts holding them back.
We can add to that process now by doing a deeper dive into the yearnings that motivate human
life before culling the steps you might take.
The domains we covered in Chapter Eight were work, intimate relationships, parenting and
children (you don’t have to be a parent or have kids to care about those issues), education, the
environment, friends, physical well-being, family, spirituality, aesthetics (such as art or beauty),
community, and recreation. Once you pick a new domain or specific challenge, remind yourself
of what might be at stake there by considering this diagram. These are the six yearnings. Keep
each in mind as you unpack what is going on, watching for barriers that pop up when you touch
the deeper needs and yearnings that show up in this area.
Let’s say that you are feeling unhappy at work. Some of the reasons may be obvious, such as
if you have a highly critical boss or you’ve got too much work assigned to you. But you might
also be having trouble putting your finger on what is wrong. Catch what reactions you can.
Suppose you feel like a cog in a machine, unseen and uncared for. Maybe you feel stuck, and the
work you are doing is empty.
See if the issues contain within them some or all of the six basic yearnings we all have.
Feeling unseen and uncared for probably reflects a yearning for belonging. A sense of emptiness
or feeling stuck suggests a lack of self-directed meaning. Feeling like a cog in a machine
suggests a lack of freedom to create your own areas of competence.
As you consider what you yearn for, allow the barriers that stand between you and satisfying
those yearnings at work to come to the fore. Some of the issues may be internal, psychological
ones, but some may be external. This mix of external and internal barriers is true of most of our
difficulties in life, so it’s vital to always consider both. Write down all of the barriers you
identify, and for those where the reason why you’re having difficulty isn’t clear, think about
what might be underlying your dissatisfaction.
An example of an internal barrier about work might be that you have thoughts like I’m not
good enough that stop you from reaching out and connecting with others, undermining your
sense of belonging. If you’re feeling stuck, for example, that may be because you don’t feel the
work you’re doing is meaningful. It’s not in line with the values-based way of living you aspire
to. But maybe that feeling of being stuck also leads to daydreaming that takes you away from
what you are doing. If so, you might want to add to the yearnings that are involved in this
problem because perhaps you are also losing a sense of orientation at work.
For those where the reasons for your discomfort seem obvious, such as that critical boss, dig
deeper and think about why the criticism is so hard for you to take. You might realize that it’s in
part because your mother or father also often criticized you when you were growing up and it
kicks off an old critical voice within. Add that to your list of barriers.
Now write down the set of solutions you’ve been trying for coping with the barriers. The list
might be quite long, but I’ll just give a few examples here:
Working hard to make sure you get all high marks on your next performance evaluation
Forging a relationship with a co-worker who also likes to talk about the problems and problematic people at
work
Now it’s time to use your flexibility skills to see if the solutions you’ve been trying are likely
to work. The first two solutions in the preceding list are clearly avoidant. They offer short-term
relief from negative feelings and thoughts, but at the cost of being able to participate, which
likely only amplifies a sense of invisibility and lack of belonging or competence and may be
undermining your reputation with your boss and colleagues. Trying to ensure a perfect
performance evaluation may be fine, but it’s important to consider whether the motivation is in
part a fear of criticism, rather than intrinsic motivation to achieve. If avoiding criticism is a
driver, it’s important to realize that this may be self-defeating, since the process generally
requires managers to offer at least some critical feedback. What about the friendship with a co-
worker? Having work friends is awesome, but constantly discussing with those friends how
unhappy you are may be a form of rumination, especially if the co-worker now reciprocates with
all of the reasons why the work environment is awful, leading you to do more of the same. You
think it’s helpful to vent, and it does soothe the yearning for belonging, but it could intensify
your unhappiness by creating a work-related echo chamber full of judgment. Not a good idea.
Even dogs don’t pee in their own beds.
It is worth noting the thoughts and feelings you’re having as you consider your problem.
What negative messages has your Dictator been berating you with? What emotions are you
trying to escape? What memories come up that are haunting you? These may include painful
thoughts such as My colleagues don’t respect me, or I can’t do anything I care about in this job,
and a deep-down core of Maybe I’m not good enough. You may also be feeling anger linked to
the sense of invisibility.
OK, you’re ready to start applying your toolkit. Maybe start with a presence exercise or two
to get into a mindful perspective. You could next do some defusion work to distance from those
negative thoughts. Do a values exercise to clarify how the way you’re working is out of
alignment with your chosen values. You might realize that all of that commiserating with your
colleague is in conflict with a value of being forthright, and that you would be better served by
discussing issues with your boss. As difficult emotions are triggered while you do this work,
apply acceptance practices to them. Do a self exercise to soften the self-story and to touch on the
part of you that knows how to connect with others. Maybe you’ll find that you’ve been accusing
yourself of being incompetent, or spinning the tale that no one really cares about you at work
because you’re not interesting or charismatic. Maybe finish this deep dive by committing to a
small action you’ll take the next day. Let’s say you commit to speaking up and sharing a
suggestion in a meeting that’s scheduled. That’s all six skills applied!
Now begin applying the learning you’ve done to more and more experiences at work as
they’re happening. If you’re in a meeting and you start feeling that no one is interested in your
input, do a quick defusion exercise in your mind. If your boss makes a nasty comment to you,
when you’re alone for a moment, do an acceptance exercise, and if your Dictator is assailing you
with some negative message because of that criticism, apply your defusion talent to that.
In a focused session at home, perhaps after a week, you could continue with some presence,
defusion, self, values, and acceptance work, and then take some time to look carefully at what
concrete steps you might take to improve the situation, setting forth more small SMART goals
that comport with your values. Maybe those would include talking to friends about how best to
carry the criticism; asking the boss if you can take on an additional responsibility that would be
meaningful to you and inviting him to give you guidance and critical feedback (essentially
defusing from the punches a critical boss will likely deliver, while allowing you greater self-
determination); exploring the possibility of a transfer within the company; or beginning to
research getting a new job by visiting a job recruitment website.
As you work through this process, you may discover that for this challenge, you need more
work with some of the skills than others. For example, you might notice that you can apply
defusion very well to thoughts like I’m not good enough, but that negative emotions, such as the
reemergence of the pain of criticism you felt as a child, knock you over sideways. In that case,
you ought to work on relatively more intensive practice with acceptance skills. You might
attribute that to being afraid of what might happen. But you should also look again at whether the
goals are truly in alignment with your values. You might realize that you’ve become quite
disconnected from a sense of what your authentic values regarding work are, and in that case,
you’d want to do more intensive values exercises. It’s important, though, to also continue
applying all of the skills to the challenge.
Progress with some challenges may take more time than with others. That’s perfectly fine;
don’t get discouraged. You’ve started dancing. You are moving with increasing flexibility.
Always keep in mind that value-based living is not about reaching goalposts, it’s about moving
in your new chosen direction.
A large study that analyzed the effects of all the known risk factors for poor health, such as
exposure to pollution, an absence of clean water, and high blood pressure, recently
produced a shocking finding. Nearly two-thirds of all poor health is due to behavior. Not
infections, toxins, or genetic predisposition. What kinds of behavior? Smoking, drinking, eating
an unhealthy diet, failing to exercise, not taking care of your teeth, and not getting good sleep,
just to name a few.
Meanwhile, for every dollar spent on healthcare, less than a dime is spent on helping people
change their unhealthy behaviors. Physical interventions, such as medications or surgery, are the
go-to method for health problems in Western medicine, even though they usually carry their own
risks and for some problems have limited effects. Proven psychological interventions are vastly
underprescribed. But we as individuals can take charge. Let’s face it, we pretty much know what
we should be doing. The problem is that adopting new routines, and especially sticking with
them, can be daunting.
4. Does it seem solid, like an object, or does it shimmer, flutter, shake, or move?
5. Where does it live in your body? Do you experience it in your head? Your belly?
Somewhere else?
6. Are there any emotions that are connected to this craving? Do you feel anxious,
stressed out, sad, angry, or something else?
Now, imagine you can reach out and touch your craving. At first, you might give it a
sympathetic pat on the back, so to speak. See if eventually you can actually embrace the craving,
figuratively cradling it in your arms like you would a child. Feel empathy for it, noticing how
much it wants, how hungry it is for attention.
You can do all of this without acting on the craving. In fact, you can take this craving with
you while you engage in any action of your choosing. In time, the craving may fade. But if it
doesn’t, you can carry it as long as it needs. It’s not you—it’s a part of you.
Always take the stairs if you have time and it is safe. Always.
When grocery shopping, grab a gallon of milk in a plastic jug with a handle and, while you shop, slowly do
curls or triceps presses to the point of muscle exhaustion (a count of eight up and four down is about right—
yes, there has actually been research on this!). If you ever see me in an airport, chances are you will see me
doing this with my briefcase. People will look at you funny, but do you care?
Do push-ups every other night before going to bed, having the goal of doing as many as your years on the
planet (yes, I can do seventy of them).
Sleep
A great irony of having insomnia is that some of the difficulty comes from awareness of how
important getting good sleep is. One of the biggest predictors of poor sleep is entanglement with
repetitive negative thoughts and worries, including worry about getting to sleep. I’m sure poor
sleepers know the problem well. You find yourself lying in bed worrying about some event
you’ve got coming up, or caught up in problem solving or planning, and then, because you’re
failing to fall asleep, you begin worrying about that too.
Trying to make ourselves go to sleep is one of the most frustrating things we can ever
experience. And we’re not wrong to make the effort. The toll from lack of sleep is atrocious.
A wealth of research has revealed a wide range of unhealthy effects. People with poor sleep
patterns incur healthcare costs that are 10 to 20 percent higher than those who get good sleep.
Inadequate sleep also impairs cognitive functioning, such as working memory and problem
solving, and it can cause or worsen depression and anxiety and lead to irritability, which can all
undermine the quality of our relationships. On top of these consequences, there are the costs to
individuals, companies, and society at large in terms of missed workdays and poor decisions that
may have costs for others as well, such as bad medical decisions by sleepy healthcare providers.
ACT studies in chronic pain and depression have documented that better sleep can come
along as a kind of good side effect of flexibility processes, and pilot studies of ACT for insomnia
are producing good outcomes. But this is an area where large controlled scientific studies of
ACT have not yet been done. The best-supported treatment approach is cognitive behavioral
therapy for insomnia, or CBTi, and most consumers should start there but with an eye toward
using flexibility skills as well. Let me explain.
CBTi is generally administered in a series of therapist-guided sessions, usually between five
and eight, that focus on good sleep hygiene, such as avoiding smoking, consuming caffeine or
alcohol late in the day, or exercising right before bed; establishing a regular sleep schedule; using
the bed only for sleep and sex (no reading, texting, or watching TV); and strictly limiting the
time spent lying awake in bed, so we don’t come to associate being in bed with insomnia. For
example, often people are advised that if they still can’t go to sleep after twenty minutes, they
should get out of bed. The treatment also involves restructuring of catastrophizing thoughts (for
example, “I have to go to sleep or else I’ll blow that meeting and get fired” might be changed to
“It would be nice to go to sleep, but either way I can handle it”). Often relaxation techniques are
also taught, and people are cautioned to avoid consciously trying to sleep.
While the approach works well for many, for some it’s ineffective. One reason may be the
problem with cognitive restructuring we’ve considered before. Changing your thoughts in a
given direction means taking their content seriously. You have to notice them and evaluate them
in order to try to change them, which may actually strengthen their hold over your mind and
wake you up.
To address this problem, researchers tested a combination of ACT training and a modified
form of CBTi with a patient who had initially seen good effects from CBTi but had relapsed into
insomnia. He was first put through three new sessions of CBTi, which was modified by
instructing him not to do cognitive restructuring of the thoughts that were keeping him up. He
was also given six sessions of ACT training, in which he was taught to accept those thoughts as
well as the feeling of fatigue his lack of sleep was causing. This included doing the “leaves on
the stream” exercise with the thoughts and imagining that his fatigue was an object, describing
its shape, color, and size, as well a defusion exercise, like those given in Chapter Nine. He also
did values work, committing to activities he had avoided but loved such as nighttime reading
(he’d been afraid it would make his mind active) or scheduling weekend activities with his
family (he’d been afraid he would be too tired to do them). By the end of the therapy he reported
feeling more energy as well as coping better when he was fatigued, and he said his relationship
with his family was improving. So while I do not advise using ACT as a first treatment instead of
CBTi, if CBTi isn’t having good enough effects for you, try adding ACT methods to it this way
and not doing the cognitive restructuring.
One ACT-based exercise to try that I’ve found helpful when I’m struggling to get to sleep is a
variation of the “open focus” presence exercise discussed in Chapter Twelve. Purposefully put
your mind into a mode of broad and dim attention. It may help to think of this as a slow, fuzzy,
dispassionate form of mindful observation, gently noting any mental activity that stands out but
without excessive interest. Just passively be with whatever shows up in your mind, the way you
can “be with” hot water when you sit in a soaking tub. Don’t focus as much on your thoughts and
other experiences as in the typical presence exercises; more gently notice what shows up, notice
the empty spaces between them, and then do nothing with these experiences and spaces. It may
help to think of this as putting your mind on a kind of temporary unemployment status; it has no
work to do. While your body knows how to sleep, your problem-solving mind does not, and this
helps to convince it that it doesn’t have any work to do for you.
Finally, you may also want to consult The Sleep Book, by Dr. Guy Meadows, a psychologist
in England who runs an “all ACT” sleep clinic. He has developed a detailed ACT approach to
sleep therapy, which is presented there.
Chapter Sixteen
MENTAL HEALTH
M ental health conditions have been characterized in the popular media and even in the
loose talk of researchers as diseases, as though depression, OCD, and addiction are
comparable to cancer or diabetes. They are not. To qualify as a disease, a condition has
to have a known originating cause (an etiology), be expressed through known processes (a
course), and respond in particular ways to treatment. Mental health conditions don’t meet those
criteria. The medical community actually refers to them as syndromes, and they are rather
roughly diagnosed through lists of symptoms. People are said to have a condition if they display
a little more than half of the list.
The group of psychiatrists and psychologists tasked with creating the latest set of names for
syndromes know that full well. An article from the developers noted that treating syndromes as if
they are equivalent to diseases “is more likely to obscure than to elucidate research findings”
because research based on them may “never be successful in uncovering their underlying
etiologies. For that to happen, an as yet unknown paradigm shift may need to occur.” I and my
colleagues agree and have been attempting to create a shift to a more process-oriented approach
to an understanding of mental health conditions.
The popular understanding of mental health has been pushed too far in a medical direction.
An example is the idea that mental health conditions and addiction are fundamentally determined
by genes. Now that we can map the entire genome of hundreds of thousands of people, we know
that entire gene systems account for only a small fraction of any given mental health or addiction
condition. Environment and behavior are big influences. Indeed, no clear biological marker has
been found for any common mental health condition.
An example of how genes and environment interact is provided by family risk studies that
show that depression, anxiety, and substance abuse tend to “hang out together.” So, if your father
had alcoholism, as mine did, you might be vulnerable not only to alcoholism but also to
depression and anxiety. Some of that is due to genetically determined differences in how readily
the nervous system links previous events to psychological pain. If you are “high strung” and can
easily connect neutral experiences to later bad events, you are genetically prepared to be hit
harder by psychologically painful events. If you have that tendency but are raised in a family
with a high level of nurturance and secure attachments (solid and safe relationships), all may be
well. Even when bad things happen, if your parents do not model experiential avoidance,
problems may not result. But take a person who is genetically primed to react to negative events;
mix in painful or abusive experiences, especially in the absence of security and nurturance; and
add a dollop of family traditions of avoidance and inflexibility, and voilà, you have the formula
for mental health problems.
A wealth of studies show that learning psychological skills can lead to notable improvements
in coping with mental health challenges, often with better long-term outcomes and fewer side
effects than with medications. Mental health conditions are often characterized by excessive
amounts of behavior that may be adaptive in some contexts. For example, thinking through how
to learn from past mistakes is not a bad thing—but allowing that pattern to cycle into outright
rumination predicts depression. Flexibility skills motivate us to consider thoughts and behaviors
that break the hold of a narrow repertoire of unhealthy ones and to focus on what works. That
naturally leads to better balance, which is essential to evolving on purpose.
If you are struggling with mental health conditions, you should view reading books like this
one as a supplement to professional help, not a replacement. Getting treatment when you are
struggling is vital, and too many people fail to go for it. A major reason for this omission is,
unfortunately, stigma. Research indicates that across the world, as many as one in five people
will experience a common mental health condition during a given year, and that as many as one
in three people will experience some form of mental health challenge during their lifetime.
Nonetheless, many people hold judgmental views about these conditions. Many see mental
struggles as a weakness of character. People with mental illness are tagged as incompetent,
dangerous, or irreparably “broken,” leading to discrimination in hiring and social distancing.
The result is that people with such conditions often hide their symptoms, even from loved
ones, and avoid treatment or support. In fact, only about one in five will seek assistance from a
mental health provider. That is a tragedy, especially because scientifically well-established
treatment is available. In other words, there is help.
Stigmatization can also be internalized in the form of self-blame and even self-loathing.
Misguided cultural messages like “just think positive thoughts” only encourage more avoidance
and make it worse. ACT helps people cope with the pain of stigma and defuse from unhelpful
messages.
If you do seek treatment, ACT skills will complement those efforts. ACT is familiar enough
to the professional therapeutic community that you may be able to engage your therapist in a
conversation about how best to do so, and you could supplement that by online searches of your
own about how ACT and flexibility processes are in accord with the concepts and approaches
your provider is using. Or see if any ACT therapists are nearby: http://bit.ly/FindanACTtherapist.
At this point in the book you likely appreciate why ACT is helpful with mental challenges: it
strengthens a different mode of mind that is more observant, appreciative, and empowering, and
less critical and mindless. Flexibility skills lessen the impact of unhealthy self messages and help
people come into the present; opening up, noticing, and naming difficult emotions that echo
forward from our history. That lays the foundation to focus instead on our authentic values and
to take steps to make them central to our lives.
The action exercises provide assistance in following prescribed steps, whether those are
SMART goals you set for yourself or ones recommended by a therapist or a program. ACT
practices can support other established programs for coping with mental health issues, such as
AA, peer support groups, or online programs.
A good general approach to applying ACT to mental health struggles is to once again start by
considering the internal barriers that are contributing to the difficulty you’re experiencing and
making a list of the strategies you’ve been trying for coping with them. Often you will see
obvious ways to begin practicing the exercises in your toolkit with these barriers as your targets.
All of the flexibility skills are relevant, but some will be especially helpful for some
conditions. For example, because of the prominent role of rumination in depression, the power of
defusion exercises to free you from its grip can be especially helpful. For anxiety, exposure
exercises are helpful, and acceptance and values work will help make exposure both more
possible and more useful. For substance abuse, acceptance helps greatly in dealing with the
psychological and physical discomfort of cravings as well as with the emotional pain people are
so often trying to numb out. Experience itself will help you focus more on the skills that you find
most helpful, but it is best to work with the other tools in your toolkit too because they’ll
reinforce your progress.
Now, here is more specific guidance about common conditions.
Depression
If you have depression, you probably know that it’s quite common. But you may not know just
how common. Depression is now the leading cause of disability in the world—about 350 million
people around the globe are wrestling with it, including one in twenty Americans over age
twelve.
Antidepressant medication is helpful for severely depressed people over the short term, but
many fail to respond. The effects for most are not large, and long-term or high-dose use carries
the risk of a long list of side effects, including sexual dysfunction and an increased risk of
relapse. Psychotherapy has been found comparably effective for depression over the short term,
with notably lower side effects and more benefits after treatment is stopped. Researchers are still
trying to figure out if there is an advantage to combining therapy with medication for truly major
depression, but the combination for lesser depression is not significantly more effective. As long
as the jury is still out, it’s important to check out the current research as best you can before
agreeing to any course of treatment.
You may already be in therapy, or may be considering what sort of therapy to go for, so let
me offer some guidance about ACT vis-à-vis other options. The leading form of therapy
prescribed for depression for many years has been traditional CBT, and many studies have
shown that it can lead to good outcomes. But why traditional CBT works is still confusing. As
discussed earlier, many studies have indicated that the benefits of CBT are largely due to the
behavioral elements, not just restructuring thoughts. Meanwhile, dozens of randomized trials
have measured ACT’s effects on depression, and so far ACT has been found just as effective as
CBT. In addition, we know more about why it works—because it develops psychological
flexibility, which gives people a clearer focus on the immediate targets of change.
For example, as noted, rumination is a leading contributor to depression. ACT research has
uncovered part of the reason. Researchers studied people who had experienced a major loss to
see if rumination led them to become depressed; the answer was yes, but only if they were
ruminating to avoid difficult emotions. If your mind simply returns to the loss repeatedly,
without efforts to avoid the pain, the rumination will eventually diminish and not cause much, if
any, harm.
Suppose you have experienced a major loss such as the suicide of a close friend. All of us will
wonder, “Is there something I missed?” or “Why didn’t I call her and ask how she was doing?” If
you are reliving the past to avoid the pain of the loss, however, you will be unable to connect
fully with the love you felt toward your friend; you will be less likely to reach out to other
friends for support. You are risking getting “stuck” in that state we call depression.
ACT is linked to the CBT tradition, so many CBT therapists are willing to draw on ACT to
complement the elements of CBT we know are helpful, especially the behavioral elements.
Flexibility pivots can easily be combined with virtually any well-validated method. An example
is provided by one of the best types of therapy for depression, Behavioral Activation (BA). Great
results have been found in research that combines it with ACT.
BA was developed by the late Neil Jacobson, a good friend who overlapped with me as an
intern. He combined acceptance practices with methods for helping patients do more of what
they care about, focusing on replacement behaviors. If someone is sleeping late in an effort to
escape depressive feelings, a replacement behavior of going for an early-morning walk might be
recommended. A schedule of positive replacement activities is generally created to help move
toward goals. Emotional avoidance is discouraged.
BA and ACT agree about the futility of trying to directly change the content of thoughts that
are contributing to depression, and also about helping people see the negative effects of
avoidance strategies. ACT adds defusion, self, and presence practices and emphasizes that
actions should be in the service of valued living. These skills help people commit to replacement
behaviors. If you’re in BA therapy, talk to your provider about how to add ACT into it.
I can’t let this section close without a brief shout-out to Neil, since he was one of the early
supporters of ACT. Neil called me as his second large study on BA, which showed that BA was
better than traditional CBT, was winding down. He told me it was time to stage a “contextual
revolution” combining my early ACT methods with BA and other new CBT methods that had
recently been developed. I excitedly agreed and booked a flight to Seattle for a few weeks later
to plot the revolution. But Neil tragically died of a heart attack days before that flight. I
eventually declared the arrival of the Third Wave of CBT (with ACT as a foremost example) on
my own, but the Third Wave would surely have benefited greatly had this science warrior lived!
Anxiety
About 12 percent of people around the world will experience some form of anxiety challenge
during any given year, and as many as 30 percent of us can expect to grapple with an anxiety
condition during the course of our lives. The good news is that research has shown ACT to be
highly effective across the many different kinds. Here I’ll introduce some of the results and
highlight a few specific guidelines about tailoring ACT to coping with anxiety.
The standard of care for anxiety, as for depression, is CBT, and ACT has proven either
comparable or somewhat more effective for anxiety than traditional CBT in many studies. One
well-done study comes from a research team at UCLA supervised by psychology professor
Michelle Craske—one of the best CBT researchers on the planet. Participants were given twelve
hour-long sessions of individual counseling, one session a week, which was either ACT-based or
CBT-based. Both groups showed great improvement by the end of the sessions, but in a follow-
up with them twelve months later, the ACT group showed much greater improvement. They
were moving on in their lives and engaging in significantly less avoidant behavior and negative
thinking. The defusion and acceptance skills were found to account for the difference.
The ACT community has discovered some key ways the flexibility practices can be tailored
to anxiety. These concern how one engages in exposure to triggers of anxiety, which is a main
component of traditional treatment for phobias, social anxiety disorder, and OCD. ACT
therapists have learned that rather than starting right away with some exposure work, it’s best to
begin by building defusion and acceptance skills and doing values work and then start doing
exposure. For example, in one study that produced strong results, exposure exercises weren’t
introduced until the sixth session out of twelve. The first five sessions were devoted entirely to
the flexibility skills. This was so that participants could draw on their ACT learning as they
began facing the discomfort of exposure. Defusion and acceptance help with difficult thoughts
and feelings, and several studies have shown that it is easier to do exposure if the activities are
meaningful to people. Say that you have social anxiety and an activity recommended to you is
attending a cocktail party. That kind of socializing may not be of interest to you. Instead you
could use values work to identify activities that you’ve been avoiding that you’d really like to be
doing. Maybe that would be attending an exercise class.
Another modification to traditional exposure is that patients are instructed to start with
activities that are relatively easy to manage and work up to the most challenging ones. ACT
doesn’t put a premium on the amount of discomfort the activity provokes. The ACT approach is
that you are free to choose whichever activities you prefer, because they’re of value to you,
whether they are easy or challenging.
If you discover that you weren’t as ready for exposure as you had thought, and you have to
stop, or maybe you even had a panic attack, don’t let your Dictator beat you up. Walking out of
an anxiety struggle is a journey that will inevitably involve some trying times. Since my last
panic attack twenty-three years ago I have sometimes been very anxious, but I have been able to
keep doing anxiety-inducing activities, such as giving lectures to large crowds, by using my
skills whenever anxiety starts creeping up on me. To be honest, writing this book is an example.
If it is hugely successful, who knows? Maybe Oprah will call.
Aaagh!!!
One exercise that I’ve found helpful as a regular practice is the reverse compass trick I wrote
about earlier. I used the example of assigning myself the task of rubbing my hands over my face
if I have an obsessive thought about cleanliness when leaving a restroom. To apply this to your
own anxiety, make a list of activities that can be anxiety-provoking that you avoid and start
picking them off, one by one. For example, perhaps you’ve noticed your mind telling you that it
is too scary to ride a roller coaster, take a dance lesson, take a trip by yourself, agree to talk to a
church group, sing at a karaoke bar, ride a zip line, tell a friend how much they mean to you, or
any of a hundred such things. Try to do at least one new anxiety-provoking thing from your list
every week, and during the exercise itself, work on your mindfulness skills, including presence,
acceptance, defusion, and self.
I’ve learned never to say never about anxiety, and about life. I hope and pray I will stand with
myself even if Oprah dials me up!
Substance Abuse
Flexibility skills will complement whatever approach to recovering from substance abuse and
addiction one pursues, whether that’s a twelve-step program, residential treatment, individual
counseling, use of agonists and antagonists (e.g., methadone for opiate addiction), motivational
interviewing, contingency management, or any of several others. Controlled studies have verified
that ACT training enhances outcomes during treatment programs and in staying abstinent after
treatment. The skills will also help with seeking treatment, which is a huge barrier for so many
people who are experiencing any problem.
One of our earliest large studies on ACT for substance abuse assessed the effects of the skills
used in conjunction with methadone maintenance for people struggling with opiate addiction. At
a six-month follow-up assessment, 50 percent of those in the ACT group were clean, as
measured by urine tests, as compared to 12 percent of those getting methadone and standard drug
counseling alone.
In the years since, there have been over a dozen decent quality studies on ACT for substance
abuse, and they have shown that it appears to help across a wide range of specific types. We’ve
learned a lot about why. For one thing, substance use is often motivated by avoidance. While
some people just stumble into it because initially it’s fun, or because all their friends are using
and then their use escalates, many people are drawn to taking harmful drugs and drinking
excessively because they’re seeking to numb difficult thoughts and feelings, whether they’re
fully aware of that or not. By stressing the power of acceptance and the harm caused by
avoidance, ACT training helps undermine the power of substances to fool the person using them.
We have a phrase we like to use: “ACT—we take the fun out of addiction!” Yes, it’s a joke, but
the point is serious. Real avoidance works 100 percent only if you do not know you are doing it.
At the point that you know that you are using substances as an avoidance mechanism, you have a
chance to choose a different direction. Of course, the process is challenging.
Recovery involves both the physical challenges of withdrawal and the psychological
challenges of abandoning deeply ingrained habits. In addition, substance abuse is one of the most
stigmatized problems anyone can develop, and internalizing that sense of stigma is a powerful
predictor of poor outcomes. That internalization is pushed deeper by psychological inflexibility
but can be alleviated by learning flexibility skills.
Acceptance skills help in coping with the physical and psychological distress of withdrawal.
The many ways in which the body and mind inveigh against efforts to stop are a challenging
aspect of substance abuse, with cravings and other withdrawal symptoms often motivating
relapse. Acceptance can help stay the course of abstinence and break the negative feedback loop.
ACT skills can also help people move beyond compulsive thoughts about using and tamp
down the effects of deeply embedded psychological triggers. Recall that RFT explains that dense
networks of relations become fixed in our minds, and that thoughts embedded in them can be
triggered at any moment. Neuroscientific research on addiction has shown that precisely this
process is at play. All sorts of cues that have been related to substance use can trigger thoughts of
using. Some are obvious, like seeing a beer commercial or catching a whiff of marijuana, but
others may be totally outside our awareness.
Therapists know this, which is why a standard component of most substance abuse treatment
programs is avoiding triggers. The problem is that the degree to which we can control our
exposure to them is limited because the networks of relations in our minds are so elaborate. For
example, a relative we don’t see often might be related in our minds to drinking, because on
occasions when we do see him, there is always some drinking going on. Maybe we hear someone
say something this relative once said. Our brain may immediately call drinking to mind. Even
our efforts to abstain become related in our minds to using, as when I noticed that having the
thought I’m calm and relaxed kicked off my anxiety. Likewise, thoughts about using can
themselves trigger a physical reaction similar to actual using—albeit a more moderate one. For
example, people with a history of using cocaine respond to videos of people using cocaine by
experiencing a release of dopamine into their brains similar to the one they’d get if they were
using themselves.
ACT gives us another route forward: reduce the impact of triggers when they occur.
Eradicating all subconscious cues and cravings is unrealistic, but building up acceptance and
commitment skills creates room for those unwanted thoughts and impulses to roam through our
minds without compelling us to act on them, gradually reducing their impact. They assist with
what a friend and colleague, the late alcoholism researcher Alan Marlatt, referred to as “surfing
the urge.”
ACT learning also disempowers the harmful negative self-talk that those who struggle with
substance abuse so often inflict on themselves. Intense self-recrimination contributes to the pain
of addiction, further fueling the impulse to avoid by using. Recrimination after relapse can be
especially brutal. In addition, the pain of stigma and the shame it induces are powerful
impediments to seeking assistance. So many people delay until the problem is acute or they’ve
hit bottom. Learning to distance oneself from the inner voice of shame and blame and to see
oneself again as a whole person who is so much more than the sum of addictive behaviors makes
room for self-compassion.
Values work helps by reconnecting people with their aspirations for their lives, enabling them
to see past the powerful allure of the transitory relief of numbing the pain and commit to
behavior change.
Finally, substance abuse is a common companion to other mental health challenges, such as
depression and anxiety, which ACT is also so helpful with. So strong is the link to mood
disorders that people who have one are twice as likely to be substance abusers, and the link is
especially powerful if people are psychologically inflexible.
If you are in treatment or want to pursue it, which I strongly advise if substance use is a
problem, you can include ACT exercises to complement those efforts. Indeed, ACT is largely in
sympathy with the twelve-step treatment process popularized by AA and incorporated into the
approaches of so many treatment centers. The twelve-step approach shares the ACT emphasis on
accepting what we can’t change and bringing one’s life into alignment with one’s values through
committing to specific actions. The famous Serenity Prayer, which is featured in slightly
modified form in the AA program, asks for the serenity to accept what we can’t change, the
courage to change what we can—our behavior and the situations influenced by it—and the
wisdom to know the difference. ACT has used science to help guide that wise distinction.
We recently tested applying ACT training specifically to shame for people in treatment for
substance use, compared it to a standard twelve-step program, and verified that it enhanced the
effects of the in-patient treatment. What’s more, while initially both groups improved
comparably, in follow-up the clients exposed to ACT kept improving, doing better than those in
the twelve-step facilitation alone.
Because ACT is evidence-based, combining it with a traditional twelve-step program also
addresses the objection some raise about the AA approach: that it is not scientific. In addition,
for those who are drawn to the twelve-step approach but are turned off by some of its features,
such as its strong emphasis on spirituality, my former student Kelly Wilson, who is in long-term
recovery from heroin addiction, has written a book, The Wisdom to Know the Difference, which
walks the reader through a twelve-step approach that is written entirely from the ACT
perspective.
The bottom line is that whatever prior or current approaches you or a loved one may have
been taking to beat substance abuse, building psychological flexibility skills will help.
To start the process, I advise focusing on values work and revisiting that work regularly as
you work on the other skills. This is because when one sees clearly how substance use is
preventing one from living in accord with one’s true values and life aspirations, that is a
powerful motivation to persist through the pain of the process.
To gauge how much of a role avoidant inflexibility may be playing in your substance use, you
can take the assessment designed for measuring flexibility regarding substance abuse available at
my website (http://www.stevenchayes.com).
Kelly Wilson distills the ACT message for addiction down to a single question: In this very
moment, will you accept the sad and the sweet, hold lightly stories about what is possible, and be
the author of a life that has meaning and purpose for you, turning in kindness back to that life
when you find yourself moving away from it? It is a courageous journey, a hero’s journey, to
walk out of an addiction. That question is like a map for how to do so: at each choice point it will
help those in recovery find their way home.
Eating Disorders
Perhaps the first thing to say about eating disorders (EDs) is that some of them are extremely
serious medical conditions and that professional treatment should be sought out immediately
once signs of a disorder are detected. EDs are among the most difficult mental health conditions
to treat, with high rates of failure and of relapse after initially successful treatment. While EDs
have tended to be viewed as a female issue—they are more common in females than males—the
diagnosis of EDs in males has been on the rise. About twenty million women and ten million
men in the United States will experience a clinical ED during their lives, and the first decade of
this century saw a 66 percent increase in diagnosis of EDs in men. As is true with all mental
health conditions, the causes are complex and still not well understood, involving what appears
to be a wide range of genetic, neurobiological, psychological, and social factors.
One thing known for sure is that emotional avoidance is relatively high in people with EDs.
Self-starvation, binging, and purging are motivated, at least in part, by the desire to avoid
difficult thoughts and feelings, whether about body image or other life issues, such as fear of
intimacy or of failure. People with EDs often actively use thought suppression as a form of
experiential avoidance, and the more they do that, the worse their symptoms become. This helps
to explain why many people with EDs are also dealing with depression and anxiety, which are
both also strongly predicted by avoidance. Rumination, in the form of negative self-talk about
body image and obsessive thoughts about eating and weight, has also been found to contribute
significantly to the development and persistence of EDs. ACT helps counteract all of these
factors.
One of the toughest aspects of treatment is that people with EDs are so often ambivalent
about, or outright opposed to, getting treatment. ACT values work helps them see how they have
subverted other life aspirations in their pursuit of weight control and then make an authentic
commitment of their own to realigning their lives with their values.
In addition, extreme allegiance to elaborate food-related rules is a major feature of ED
behavior, and a relatively high number of people with EDs also struggle with OCD. Defusion
helps them break the grip of those rules.
Self work can help people with EDs find a place where they are OK even with thoughts like
I’m too fat or My body is disgusting. A transcendent sense of self gives people with EDs a
foundation for wholeness.
ACT also helps with the anxiety that is a common problem for people with EDs. Psychiatrist
Emmett Bishop, who has developed an ACT-based ED treatment program, explained to me that
EDs are so hard to treat in part because food restriction gives people significant relief from
negative emotions that have tormented them, with anxiety being core to that turmoil. Research
shows that about two-thirds of people with EDs also have an anxiety disorder. Emmett says that
they attain “an adaptive peak of experiential avoidance” and compares the effect to that of anti-
anxiety medications, known as anxiolytics. ACT, he says, helps people “get off the peak and deal
with the resultant anxiety.” He says, “Our patients are lost in a tangle of anxious details.”
Flexibility training helps them create a healthy coherence in their minds focused on their values
instead of on preoccupation with moment-to-moment monitoring of how well they’re following
their elaborate eating rules.
CBT is still the gold standard for psychological treatment of eating disorders, so perhaps the
wisest course is to add ACT skills to support traditional CBT approaches. A recent study did just
that with an Internet program that combined CBT with ACT. The CBT elements focused on
achieving early change and stabilizing healthy eating patterns, noticing overevaluation of body
shape and weight, and working on such core issues as interpersonal difficulties or perfectionism.
ACT values work was added to motivate change, and acceptance and mindfulness work was
used to help let go of perfectionism and rigid thinking. The study found that nearly 40 percent of
those who used the website were helped, versus only 7 percent for those who were not given
access to the site.
The power of adding ACT training to a program for treating EDs was also empirically
assessed in a study at the Renfrew Center in 2013. One group of people with EDs were given the
center’s standard treatment, which involves common methods like regular weighing, exposure to
feared foods, and the normalization of eating habits. Another group was given the standard
treatment as well as the choice of attending eight nighttime group training sessions, each of
which combined instruction in a number of the ACT skills. Anyone who attended at least three
was counted as having completed the training, so engagement with the practices was sometimes
limited. Nonetheless, the study showed that those who got some ACT training showed
significantly less concern about their weight and greater intake of food—by almost twice as
much—as the non-ACT group. At a six-month follow-up, fewer of those in the ACT group had
been rehospitalized.
Successes like this have led a number of ED treatment programs around the United States to
use ACT as a main approach. Emmett Bishop’s program is one example. He founded the Eating
Recovery Center, which has locations in a number of states. One of the things I like about
Emmett’s program is that he carefully collects data from all of the patients he treats, and he
periodically publishes it. That is as rare as it is honorable. He recently published results from six
hundred of his patients and found that about 60 percent were significantly helped by his largely
ACT-based treatment program, and that changes in psychological flexibility strongly predicted
the improvement.
The measure of eating-related psychological flexibility Emmett uses is a modification of one
that a former student, Jason Lillis, and I published years ago. It asks people to rate statements
such as the following:
I need to feel better about how I look in order to live the life I want.
You can take the full assessment to determine your own degree of flexibility at
http://www.stevenchayes.com.
When I asked Emmett to sum up the wisdom he’s learned from his work with thousands of
people with EDs, his bottom line resonated deeply with me: “Don’t get mired in anxious details
of the moment, but identify the overarching values of your life and follow them in an open,
curious, and flexible way.” Every one of us could benefit from this advice, and if you or a loved
one have an ED, I hope it will point the way to healing.
Psychosis
I do not want this chapter to end without mentioning psychosis. The late Albert Ellis, a friend
and the developer of rational emotive behavior therapy (REBT), liked ACT but once told me to
my face, “Steve, ACT is for———eggheads” (if you knew Al, you know he threw in several
cuss words in the———part). I asked for clarification and he said, for example, it would never
work for people with hallucinations or delusions.
We promptly did a study to see.
If you’ve seen the movie A Beautiful Mind about the Nobel Prize–winning mathematician
John Nash, you’ve essentially seen what we tried to teach. In that film, Nash became so
entangled in his delusions that he was about to lose his family and his academic job. Instead he
learned to watch his symptoms from a bit of a distance psychologically instead of fighting with
them or complying with them. That distancing allowed him to focus more on what he really
cared about (his family and his work). That is the core of the ACT approach to coping with
psychosis.
We now know that even three to four hours of ACT can lead to a significant reduction in
rehospitalization over the next year, and we know why: it changes how hallucinations and
delusions affect a person. Building flexibility leads to less distress from them, less belief that
they are literally true, and lower behavioral impact from them. The depression that commonly
sets in following a psychotic break is diminished as well. The work is still young, but it is
unfolding nicely to a drumbeat of studies and programs worldwide.
I disagree with my late friend. Flexibility processes are not for eggheads, they are for us all,
regardless of the kind or severity of the experiences we are struggling with. People with
psychosis experience intense stigmatization. They tend to be seen as having a brain disease or a
genetic flaw that makes them seem profoundly “other.” It is not true. As with all mental health
conditions, we do not yet know why people have these hallucinations or delusions, but hearing
voices (for example) is not in and of itself crippling any more than chronic pain, or anxiety, or a
painful loss. People are people, pure and simple, and a growing body of research suggests that
inflexibility processes increase the impact and perhaps even the emergence of hallucinations and
delusions. People who hear voices and others dealing with these experiences are not “other.” We
all have within us some of what leads to severe mental health issues. Mental health is not a
“them” issue, it is an “us” issue, and I hope that over time we can all learn to bring the same
compassion that ACT teaches us to direct toward our own mental struggles to those who face the
most profound challenges.
Chapter Seventeen
NURTURING RELATIONSHIPS
W hen I ask my clients or workshop attendees to closely consider their values, I know one
thing I will see—the importance of people to people. Our relationships with lovers,
spouses, children, parents, friends, and co-workers are central to our well-being. We
know it, and our values show it.
We are built to bond with others. Just looking into the eyes of someone you care for releases
natural opiates, as if your neurobiology is saying, “This connection is good for you.” But, of
course, healthy bonding also requires thoughtful nurturing. What pulls you even closer to people
is being able to share what you care about, and your thoughts and feelings, in an open and honest
way, as well as listening attentively and with openness, rather than judgment or defensiveness,
when they do the same. Yet we so often find ourselves hiding our true thoughts and feelings
from those we care about, as they do from us.
Consider romantic relationships, and the ways that anger or hurt can encourage us to close
down rather than risk losing our composure and provoking conflict. We may worry that our
partner will erupt at us if we share that we’re angry or hurt by something they’ve done, or not
done. Or we might not want to seem vulnerable or may fear that our partner will defensively
distance from us.
That is all understandable. But here is a simple formula about relationships to keep in mind:
in a context that maintains a secure connection, intimacy = shared values + shared
vulnerabilities. Psychological flexibility allows us to stay focused on nurturing intimacy even
when we are angry or hurt. It helps us weather the stresses that are inevitable in any close
relationship.
When engineers want to build an earthquake-safe house, they add flexibility to the
foundation. Just so, the flexibility skills provide a strong foundation for our relationships. They
help us contend better not only with our own difficult thoughts and feelings about relationships
but with those of the people we care about, as well as the behavior of theirs we find upsetting.
The skills also help us foster flexibility in our loved ones.
Why are they so helpful?
Defusion helps us step back from unhelpful thoughts and feelings about others and how
they’ve treated us and consciously reject negative behavior they can trigger, like lashing out in
anger. People appreciate this forbearance, and it tends to inspire them to be less negative and
reactive as well. That opens up room for thoughtful, caring communication that does not threaten
withdrawal or termination of the relationship.
Attachment to a conceptualized self creates distance between us and others. We often
inadvertently pressure our family and friends to support that self-image, even though, because
they know us well, they can see it’s distorted. Connecting with our transcendent sense of self
undercuts this tendency, helping us bring our whole, true selves into relationships and recognize
the wholeness of others.
Acceptance helps us be honest with ourselves about pain we’re feeling in a relationship,
which in turn allows us to articulate those feelings to others, rather than covering them up or
acting out in ways that are unhelpful such as threats to withdraw in the service of eliminating
pain. Of course there are times to withdraw based on safety or self-care, such as from an abusive
relationship, but acceptance of the pain of doing so will help there too.
Presence keeps us from slipping into rehearsing past wrongs in our mind or imagining future
pain and disappointment, and instead helps us focus on the potential for connection and healthy
attachment in the present. Others perceive that we are looking to make the most of the
opportunities of the moment, and that encourages them to do the same.
Doing values work helps reorient us toward how important relationships are to us, and to
build our relationships on a basis of shared values, and, as the case may be, acceptance of some
differences in values. Research has shown that the ability to choose one’s values is related to the
capacity for healthy attachment to others, probably because it is easier to own and make real our
yearning to attach and belong when it is a choice we make rather than feeling as though it is out
of our control.
Caring for others is not only a matter of feelings, of course; we must take actions that nurture
relationships, such as initiating needed conversations or committing to constructive changes in
our behavior, even if we don’t feel like doing so. Commitment practice helps with these actions,
which can be quite difficult, such as forgiving, letting go of conflict, and doing small loving
things in an active, consistent, and thoughtful way.
Applying flexibility skills to relationships involves not only directing them toward our own
behavior, thoughts, and feelings—it means applying them to the behavior, thoughts, and feelings
of others. Consider defusion. The focus thus far in the book has mostly been on defusing from
our own harsh messages about ourselves. But we can also use defusion to step back from our
harsh judgments of others. This allows us to show them more understanding and kindness. In
addition, they will sense that we are doing so, and that, in turn, gives them more space to look at
their own thoughts and behavior more openly, because they become less defensive. We can also
use defusion to step back from harsh judgments others have of us, which we tend to internalize
and then inflict on ourselves. That allows us to be less defensive in our interactions with others.
In extending self-work to others, we can apply the same lessons we learned about how
unhelpful our self-stories can be to appreciating that we also weave stories about others. We
make assumptions about what they are thinking and feeling and why they’re behaving as they
are, often without asking what’s going on for them. We’ve probably all experienced this being
done to us and haven’t liked it one bit.
To stop ourselves from doing this, we can use the same I/here/now perspective-taking
practices we used in Chapter Ten to gain awareness of our characterizations of others and
consider alternative explanations of their behavior, putting ourselves in their shoes and looking
through their eyes.
The social extension of acceptance is, in part, showing compassion for others, even when they
may be causing us pain. Acknowledging that they are feeling their own pain helps us avoid the
traps of lashing out in response or breaking away from them. Extending acceptance also involves
being willing to share with them about the pain they’re causing us, despite the fear we may have
about doing so. All too often, we assume that people understand they’re causing us pain, when,
in fact, they may be largely unaware. Sharing about it in a nonaccusatory way can be difficult,
but it can also lead to breakthroughs.
Extending values work involves sharing our values with others and learning about theirs,
discussing values with them in a respectful way rather than making assumptions. We build
mutual appreciation of one another’s life aspirations and learn how we can help one another
fulfill them.
Committed action is extended by cooperating with others to find more effective approaches to
solving problems and pursuing goals together. One of the great sources of frustration, and rancor,
in relationships is that we tend to want to change some behavior in the other person that annoys
or hurts us. They often resist this change, and we become even more irritated. When we connect
with others based on shared values and vulnerability it is much easier to set SMART goals and
agree on compromises that will work for both parties.
You can apply most of the exercises presented in Part Two to any relationship you want to
nurture. Say that you are feeling really resentful toward your spouse. To defuse from the
negative thoughts you’re having about him or her, you could write them down and then practice
the “look at it as an object” exercise from Chapter Nine on them, in which you ask questions
such as if the resentment had a shape, what would that be, and if it had a speed, how fast would it
go? You could also create a pack of cards with those thoughts written on them, carry them
around with you, and apply whichever of the defusion exercises you’ve found most helpful.
If you’ve woven the story that your spouse is totally inconsiderate, you could apply the
exercise of rewriting your self-story to your story of your spouse. If you go back through the Part
Two chapters you will see that applying the exercises this way to relationship issues is really just
a small step, and in fact, it’s one that many people who learn the skills take quite naturally.
Instigate, Model, and Reinforce it, From, Toward and With It!
I love that formula, and not just because it’s so helpful, which it is. I also love the fact that the
acronym that it spells out is:
If it is painful to see your child’s painful struggle, can you start with owning and sharing that fact?
That is instigating. It is inviting her daughter to notice her own pain in a way that might lead
her to have more openness and curiosity about it.
Can you ask her some open questions about her feelings without moving quickly to “helping” or to
“changing” but instead just listening with openness and curiosity?
Can you have this discussion without the hint of a suggestion that it is your daughter’s task to rescue you
from pain or self-criticism you’re feeling about her pain? Can you show her that you are OK with your
emotion? For example, would it be OK to tear up?
Can you tell her that you will stay with her in her moments of pain, no matter how hard that is for you?
All of that is modeling; in this case modeling the skill of acceptance, which invites her
daughter to let herself feel her own emotions.
The actual dialogue might proceed this way:
Mom: It hurts to see you suffer in a struggle against fear. It just stabs me through the
heart. I’ve been in what I think are pretty similar situations and I remember how
helpless and hopeless I felt at the time—almost as if it weren’t OK to be me. I think I
believed I needed to be fixed before others would want to be with me. Is what you’re
going through anything at all like that?
If the daughter then does open up and share, the mother should use the moment to deepen the
connection and caring between them. For example, suppose the daughter says she is afraid fear
will overwhelm her. Her mother might respond by saying:
Thank you for sharing that with me, for trusting me with it. I feel closer to you when I
know what you feel, even when what you are feeling is hard for you to share and hard
for me to hear.
The more you work on this approach to helping others cultivate their own flexibility, the more
natural the process will become. This is a powerful way to strengthen the bonds in your
relationships, creating more interpersonal flexibility, which becomes mutually reinforcing.
In addition to these general guidelines about applying the skills to relationships, some specific
findings about flexibility in particular kinds of relationships are important to know about. Next, I
discuss a little more about parenting, then address some special issues about romantic
relationships, including the problem of abuse, and I conclude with a discussion of how ACT can
be applied to countering prejudice.
It’s not my purpose to lay out a detailed program for relationship health in any of these areas.
These discussions are meant to open a door to insights from ACT. If you are struggling with
serious relationship problems, I encourage you to seek help from a professional. Common
therapy approaches for relationships that are easy to integrate with ACT include emotion-focused
therapy, the Gottman Method, and integrated behavioral couples therapy.
Parenting
It’s hard to be a parent.
I should know. By the time little Stevie goes off to college, I will have been raising children
in the developmental period continuously for fifty-five years (Guinness Book of World Records
—take note).
Parenting involves such a roiling mix of emotions. As with the mother dealing with her
daughter’s struggle with social fears, it’s difficult to watch our children suffer, to be rejected, to
make mistakes, to stumble and fall. But it’s wonderful to watch them overcome obstacles, to step
forward and find the courage to be more fully themselves, and to discover their own sense of
purpose in life.
Researchers have found that psychological inflexibility makes it hard to interact with our
children in a healthy way, especially when we are feeling vulnerable or stressed. Conversely,
psychologically flexible parents are more able to learn good parenting skills and to deploy them
when needed.
One of the trickiest aspects of parenting is that we are constantly modeling, instigating, and
reinforcing either flexibility or inflexibility with our children. We can’t avoid that impact. When
children see our own flexibility or inflexibility, they internalize it.
That matters.
Parents’ inflexibility significantly predicts their children’s anxiety, their acting out, and
whether they will develop actual trauma if bad things happen. For example, if there is a nearby
school shooting or a destructive storm rolls through town, you can predict which kids will have
an especially hard time. It’s not those who were especially anxious; it’s those with especially
inflexible parents.
A recent study done by ACT researchers in Australia followed 750 children and their parents
over a six-year period from middle school to the end of high school. The children of parents who
did their parenting in a rigid and authoritarian way, which was low in warmth or emotional
sensitivity and high in control, showed decreases in psychological flexibility during the course of
the study. Making matters worse, as kids became less flexible, parents tended to respond by
becoming yet more authoritarian, plugging into a feedback loop from hell.
Of course, flexibility can be difficult when it comes to parenting, for a couple of key reasons.
For one, as parents we must set some rules for our children, and doing that without being overly
rigid about them is a delicate balancing act. After all, the rules we give children are aimed at
protecting them and helping them become responsible, caring, and competent beings. It’s scary,
not to mention infuriating, when they disregard our guidance.
The dance of flexibility in parenting is to support your child’s autonomy and freedom to make
their own discoveries, and their own values choices, while also setting age-appropriate and
reasonable limits and monitoring and disciplining them in ways that are consistent and
reasonable. This is what parenting experts have called authoritative parenting, a term that points
to another tricky issue in guiding our children. They tend to want us to be authorities.
When our children are young, they expect that we have all the answers about life (of course,
they usually grow out of that before long). We can easily slip into the role of all-knowing
advisors rather than nurturing our children’s awareness that there is no one “right” answer to
many of life’s questions, which means they will inevitably face challenges in discovering their
own answers. Affording them the latitude to go through those struggles can be difficult. The one
thing I ask my twelve-year-old almost every day is “What did you do today that was hard?” I
want him thinking of his own skills in doing hard things.
Let me give an example, using one of the most challenging questions a parent can face, to
show how ACT learning can help. I’ve had to field it from all of my children.
Between ages eight and fourteen all four of them have shared somewhat suicidal thoughts
with me, asking, each in their own way, what is the purpose of living if you are only going to die
anyway? As a psychologist, I benefited from knowing that such thoughts are common even in
children and adolescents—most high school students agree with the statement I have had
thoughts about killing myself but did not actually try. Such thoughts easily lead children to think
that they are alone, isolated, and different from other people. Insight from ACT helps us
understand that suicidal thoughts reflect the mind trying to “solve the problem” of feeling bad
inside—even if it kills us. They’re not indications that people are broken, but rather that we need
to go beyond that problem-solving mode of mind to begin to learn how to carry emotional
distress.
My son Charlie asked me a meaning-of-life question in the most initially provocative way of
all of my children. He was almost demanding that I prove that life isn’t empty and meaningless
(with a tone that suggested “and if you can’t, then why shouldn’t I kill myself?”).
I knew the idea that life has to prove itself to be meaningful is dangerous: our judgmental
minds can work around anything we give them. Meaning matters when it comes as a choice, and
trying to offer him proof would move choice over to a logical decision. It is a natural impulse but
could actually feed a dangerous idea. It was a tricky moment.
What I said stopped Charlie in his tracks. “We all have thoughts like that,” I said. “Me too! I
still have them.” Charlie’s eyes widened just a bit. “So, let’s go with it. ‘Life is empty and
meaningless. That is the secret of life. Whatever you do, in the end it’s all meaningless because
you are going to die anyway and in the end the sun is a big iceball.’ Let’s just take that as a
given.” He looked a bit stunned. He’d been ready for an argument, not for agreement. “And,” I
added as I leaned closer after a pause, “I love you, and I know you love me. Whatever else our
minds have to say, that is also true.”
Years later, Charlie told me that conversation was something of a turning point in his young
life. He saw that he could choose what was meaningful to him, and he didn’t need to win an
argument with his mind to validate his choice.
The current data on how best to address suicidality fits well with the insights of ACT:
normalize, validate the distress, frame the issue as an effort to deal with pain and purpose, and
encourage active steps that will help do that in a healthy way. If it becomes evident that your
children are struggling with thoughts that are persistent, highly distressing, entangling, or
focused on concrete deadly plans, it is time to seek professional help. You can look for ACT-
trained clinicians, who will help you and your child walk through the “normalize, validate,
reframe, activate” sequence.
For the more regular, daily stresses of parenting, to keep yourself on your toes about being
flexible with your children, whenever you are feeling frustrated with them or have the impulse to
harshly lay the law down, take a moment and quickly swoop through these steps in your mind:
1. Show up and check in. Start with what’s going on for you. Are you angry? Is that
because you’re afraid? Or insecure? Maybe you’re just tired and feeling worn down. Or
maybe your child’s behavior is reminding you of things in your life that were
traumatizing, such as an accident. Take a moment to open up to what you’re feeling
with curiosity and without harsh judgment. If what you see there is hard, acknowledge
that difficulty to yourself before shifting your attention to how to support the flexibility
of your child in this situation.
Why is this the first step? Because parenting with flexibility will be only play-acting if you’re
fused and avoidant. Your kids will see through that in an instant.
2. Take perspective. Spend another moment to see if you can put yourself in your
child’s shoes with a sense of empathy and compassion. We tend to treat our children’s
behavior as we would a math problem. Instead, look at your children as you might a
beautifully told story—with an attitude of appreciation. You and your children are
about to write the next lines in that story. What is your child yearning to write? What is
he or she afraid the next lines will be?
3. Check in with your values. Focus on how important it is to you to behave with
flexibility toward your child. Remind yourself that we’re all on a journey when it
comes to values, and progress is more important than perfection. Consider what you
can do right then and there to foster greater openness, awareness, and values-based
action in your child.
That three-part formula will help carry you through the rocky parts of parenting with your
values and your relationship to your children intact. You need to combine these steps with
specific skills (consistent and reasonable discipline, good monitoring, positive rewards, and other
actual behaviors any good science-based books on parenting skills will walk through), but these
three steps will help with the most important parenting feature of all: nurturance.
1. Take ten minutes for each of you to do some values writing as you did in Chapter
Thirteen. Do it about any shared domain, such as raising children, having fun, working
together, handling money, or creating a home. Don’t write about complaints and what
is wrong about your partner or relationship: write about your values. What are they?
Why are they important to do? What happens when you forget that?
After you’ve written for a while, take turns reading what you’ve written out loud. Listen to
your partner using “mindful eyes and ears,” and ask that they do the same for you. Be sure that
you are fully present, orienting your body toward your partner and looking at your partner rather
than listening with head down, for example. Do not comment, or correct, or challenge. Just
listen, carefully. After you have heard what your partner wrote, restate it to your partner (who
then also adopts “mindful eyes and ears”) and see if they think you’ve got it right. If what you
say is not quite what was meant, your partner can clarify. Then you should restate what they’ve
told you until your partner says you really understand. Then it is your turn to share your values,
and to go through the same process.
After each person has had the chance to be heard, it is time to share your feelings and
thoughts that came up during the exercise. Be careful not to be drawn into a round of criticism.
Keep the “I’m RFT With It” formula in the front of your mind, doing this exercise from, toward,
and with your skills. Hang on to your purpose: a safe and secure zone in which each of you can
be more fully yourself.
2. Do a version of the “Social Sharing and Defusion” exercise in Chapter Nine with
your partner (it is the last of the “additional methods” at the end of the chapter). Each
of you should write down on a card, in just one or two words, an internal barrier you
are ready to let go of, such as a fear of sharing irritation with a partner, or anger about a
past hurt. Make sure it is not a secret criticism of your partner. Then each of you can
turn over your cards.
Each person should then state in two to three minutes what this barrier feels like; share
thoughts about where it originated (e.g., when you were a child, expressing irritation would only
provoke a big fight); and consider how avoidance of that barrier, or entanglement in thoughts
about it, has been costly. Then commit to actions to move beyond that barrier. Be sure to use all
of your defusion and acceptance skills as you go through this (e.g., “I have the thought that . . .”).
Then the listener should share (in the following order) an emotional reaction to hearing this, a
point of appreciation about how your partner addressed it, and finally at least one area that is
similar or overlapping. This is a way to share your vulnerabilities in a context that feels safe, so
that you are unlikely to withdraw or threaten abandonment.
Combating Abuse
Across the planet, 30 percent of women age fifteen and over have experienced violence from an
intimate partner during their lifetime, either physical, sexual, or both. Men are abused too, but
less frequently. Abusive relationships have a strong negative impact on mental and behavioral
health, and the flexibility skills can help combat this.
People who are abused often struggle with shame, self-blame, and anxiety, and as we’ve seen,
flexibility skills help us cope with all of these. Flexibility also helps us protect ourselves from
future abuse. The risk of becoming a victim again rises considerably if abuse survivors are
psychologically inflexible. We need our feelers out to seek out partners who are good for us,
which is hard for experiential avoiders.
ACT helps with taking the difficult actions to get out of abusive relationships. All too often
people experiencing abuse are simply told “just leave,” as if that is easy. It can be a herculean
feat, and flexibility skills help survivors acknowledge what is hard even while emphasizing the
commitment to change. That is self-validating and empowering.
One study that showed how effective ACT training is in helping people recover from abuse
was conducted by colleagues and my wife, Jacqueline Pistorello, using an online program based
on a book she and Victoria Follette wrote for trauma survivors. Of the twenty-five participants,
96 percent had been sexually assaulted, 84 percent had been raped, and 60 percent had
experienced physical abuse. Intimate partners had inflicted the abuse in half of the cases. The
participants were provided six sessions of online video introduction to the flexibility skills, along
with exercises. By the end of the study, nearly half were recovered from their trauma according
to the magnitude of the changes in symptoms they reported, while another third had improved
significantly.
There are other good programs for trauma. Exposure therapy and cognitive processing
therapy are among the best, and both of these currently have more data than ACT, so I
recommend them. But these programs are helped by openness and connection to one’s values
too, so flexibility skills will likely assist with whatever approach is chosen.
Overcoming Prejudice
Prejudice is hard to talk about; we tend to think of it as something other people—bad people—
have in their hearts and minds. The sad truth is that it is inside us all. The good news is that ACT
provides a powerful new way to combat this deeply entrenched social plague.
Prejudice is due in part to cultural learning, from our parents, our schools, and pervasive
prejudicial messages and depictions in the media. But prejudice is ingrained in us so easily
because of our evolutionary heritage. Human beings evolved in small groups that formed strong
social identities. Unfortunately, while that group identification was good for bonding and
cooperation within groups, it also resulted in competition with other small groups. We divided
ourselves into ingroups and outgroups, and as we developed distinctive cultures, we created
“otherizing” stories about outgroups.
We have come a long way from living in small tribal groups crowded around campfires on
open savannas, in danger of attack at any moment by competing groups. But our minds still think
in terms of “us versus them.” Researchers have shown how strong this drive is by dividing
people into two groups according to the flip of a coin. Even though the participants were aware
their division into groups was random, they still readily began to consider their group as better
than the other group.
This instinctive otherizing is horribly outmoded. We are all one people, and that is not a
matter of mere moralizing. Genetics research has shown how deeply and completely the same in
our biology all humans are. Think of it this way: we all had the same parents not so very long
ago. If only that knowledge were enough to stop us from otherizing, but alas, research has shown
that the tendency is built deep into us.
Many social scientists have argued that continuing social diversification will inexorably
combat prejudice, but the change process is more complex than that. We should have known
that, even without research, since gender bias is ingrained in all of us, and men and women have
been closely interacting ever since humans have existed or we wouldn’t be here.
In 2007, Harvard political scientist Robert Putnam published a major study of the impact of
diversity on community life. He found that the more diverse a community was, the less people
trusted others, even within “their own” groups. Fewer people voted, volunteered, gave to charity,
and worked on community projects. In other words, he concluded, as diversity grew, people
withdrew from many of the processes of community formation. It’s not enough to live in a
diverse world—to take advantage of that diversity we need also to live in the space provided by
flexible minds.
That is because the core of the problem is that prejudice is deeply embedded into our thought
networks. Voluminous studies have been done on implicit bias—negative stereotyping and
otherizing that we are not consciously aware of. If you ask people their views regarding
stereotyped groups, they tend to give answers that fit with what they want to believe they
believe. RFT methods currently provide the world’s best tests of people’s implicit biases, and the
results show that most people do harbor negative stereotypes of those they see as being in
outgroups.
Prejudice easily digs into us, whether we like it or not, so if we’re going to combat bias more
effectively, we need to change how our minds deal with it. We need to create modern minds for
this modern world we’re living in. I have been deeply gratified to find that ACT can help. Since I
was a young child, I’ve been pained by the brutality of prejudice and how it impacts us all,
including myself. I’ve also learned how profoundly it shaped the fortunes of my Jewish
ancestors, and I’ve witnessed it directed at my children.
I knew I had witnessed something important the day I sat next to my mother as a
kindergartner watching our small black-and-white television set as a funny-looking man with a
small mustache barked out incomprehensible staccato German words, pausing only for the roars
of an unseen crowd. My mother suddenly leapt forward, spit on the television screen, turned it
off, and ran from the room.
I did not know then that the funny little man had started a brutal war that had ended less than
a decade earlier. I also did not know that my mother had been told by her own German father, as
he became swept up in fervor over the fatherland, never to tell anyone that she had “tainted
blood.” I did not even know my mother’s name. It was actually not Ruth Eileen Dreyer, as she
had always claimed—it was the telltale Ruth Esther. It was several more years before I learned
that truth and discovered that half of my mother’s maternal aunts and uncles had died while
crowded into “shower rooms” meant not to cleanse them, but to cleanse the world of them.
I first encountered raw prejudice in my childhood friend Tom. He constantly spewed venom
about “niggers,” and “spics,” and “kikes,” which he learned from his dad, who was even worse.
It bothered me. I even got into a fistfight with him once trying to make him stop. It just felt
wrong.
At the time about all I could have said was that my mother would not like it. His slurs didn’t
land on me personally. Or so I thought. I didn’t know yet that I myself was a “kike,” nor that I
would go on to marry two Latinas, nor that I would adopt an African American daughter. I didn’t
know I would eventually be connected to all three of his favorite groups to hate.
Most frustrating of all, his slurs sank into my mind regardless of my contempt for them. I
learned that by seeing how my mind could leapfrog decades of family experience and instead
give voice instead to a cruel moment when we were kids.
Tom, another friend Joe, and I had ridden our bikes to the bowling alley. As we set up for our
game, Tom strangely commented, “It looks like rain.” He and Joe smirked at each other and
giggled. I had no idea what was going on. You couldn’t even see outside from the lanes, and it
had been cloudless when we rode there. “It looks like raaaain,” Tom repeated loudly as they both
tried to repress laughter. Finally, I noticed a black man within earshot walking toward us. It
clicked. A black cloud was rolling in. Rain. Get it?
I was horrified and felt slightly sick to my stomach. But then the thought also flittered into my
mind that I was damn glad it was not me they were making fun of.
Flash forward a decade. My Hispanic first wife and our three-year-old African-Hispanic-
American daughter (Camille was born to my wife before we were married, and I adopted her
later) were at a private club pool in Salem, Virginia, in the summer of 1973. Our host, a member
of the club, had gone home early, leaving us to swim a little more. Not long after he left, a prim
woman with puffed blond hair walked gingerly toward us wearing the kind of pressed cotton
dresses Southern women wore back then. She was smiling, but it looked forced. After glancing
back and forth at all three of us, she announced that she was the social secretary of the club,
adding, “Your baby is rather brown.” At first I thought she was concerned about Camille getting
sunburned, but a rictus on her face that Batman’s Joker would be proud to display quickly made
me realize what was happening. We were being thrown out of that pool because of our mixed-
race daughter. We, or at least she, was not welcome here.
I remember no sense of anger—only shock and disgust, and then an anxious feeling that I
would not be able to fully protect my sweet little girl from things like this.
Jump ahead another dozen years. My then teenaged daughter is dressed to the nines for a
school dance, looking absolutely wonderful. As I watch her approach from across the room, and
I see her beautiful brown face, a voice bubbles up inside my head, unbidden and unwelcome.
The auditory equivalent of a smirk, it’s Tom’s voice, saying very clearly, It looks like raaaain.
Tom was in my head, now smirking and sneering at my own family through my own mind. It
did not matter that I had repeatedly seen and loathed racial injustice, up close and personal. I
would not be given a pass on that basis. The casual cruelty of those racist slurs were in me.
Just last year I told the story of Tom’s voice popping into my head that day to my daughter.
Camille was so sweet and pure in her response: “I love you, Daddy,” she said. “We all have
burdens like that to carry.”
Yes, we do.
Prejudicial cultural messages have been embedded in all of our minds. Perhaps we’ve heard
an AIDS joke, or witnessed gender bias. Negative ethnic stereotypes pervade the media. Even if
you hate them, or are the victim of them, you know them; they are in your cognitive network.
And that means they are perpetually available to do mischief even when you are not looking.
If we are brutally honest with ourselves, we know that in some of the thousand forms that
funny little man with the mustache knows to take, he lurks inside us. Every one of us. If you look
closely you can see him leering back from the mirror. If you go to the rigid, defended,
frightened, angry, judgmental parts of your own heart, you will see that he resides there.
But you can learn to use that recognition and apply it to shrivel down the harmful impact of
that part of you, and thus to reduce just a bit the likelihood that your own invisible privilege will
hide the ways you pass it to others despite your best intentions. By applying the ACT practices to
an investigation of your implicit biases, you can become more aware of them and bring your
actions more in line with your conscious beliefs. Whereas if you try to suppress prejudiced
thoughts, you actually foster implicit bias, because mindful defused awareness allows prejudicial
thoughts to become less dominant. Research shows that it helps us do more as well, committing
to positive actions to combat prejudice.
Why exactly does psychological flexibility help?
My lab researched this. We studied the many forms of prejudice: gender bias, bias against
people who are overweight, bias based on sexual orientation, ethnic bias, and many more. We
expected that underneath the superficial differences we’d find a common core, and our research
confirmed this. We found that all forms of prejudice can be largely explained by authoritarian
distancing. This is “otherizing” due to the belief that we are different from some group of
“others,” and because they are different, they represent a threat to us that we need to control.
Said another way, prejudice involves interpersonal inflexibility.
When my lab examined what psychological factors lead some people to settle into
authoritarian distancing more than others, we found three key characteristics: the relative
inability to take the perspective of other people; the inability to feel the pain of others when you
do take their perspective; and the inability to be emotionally open to the pain of others when you
do feel it—in other words, experiential avoidance. If these three processes are flipped in a
positive direction (called flexible connectedness), not only does prejudice go down, but
enjoyment of others goes up.
Drawing on these findings, we developed ACT interventions that have been found to
significantly reduce prejudice, with successful studies done regarding biases about weight;
sexual orientation; HIV/AIDS; racial prejudice; and people with mental health problems,
substance abuse problems, and physical health problems. Doing something about it within
yourself always requires a first step: looking and listening.
In some ways the most costly and difficult-to-eradicate forms of bias are invisible because
they are based on privilege. A man can believe he is absolutely without gender bias and still talk
more in meetings, or readily assume that he should lead the group because of his abilities, not
being aware that these very actions are a form of gender bias. The white person who honestly
and somewhat pridefully says “I don’t think about race” may not be aware of how much that
models privilege when a black neighbor has to send her teenaged son out into the world every
morning knowing he is more likely to be arrested or shot at because he is black, and thus has to
think about race.
It is unfair and irresponsible to ask those who bear the costs of privilege to do all the heavy
lifting to correct it, so the first step has to be to dig in. You can safely assume that you host bias
you cannot see in most or even all of the major areas (why wouldn’t you?), so learn more about
the indirect indicators of bias that will help you catch it in yourself (I just gave you two in the
area of gender, for example). Indirect indicators will help you begin to catch bias in all of its
forms—even in forms that are initially invisible.
Once you are doing that, it is time to ask people who are close to you and have experienced
bias to help you note your own invisible forms. For example, when I start mansplaining, my wife
gives me a little look. Do not expect this to feel good. Personally, I feel like putting a paper bag
over my head when I leave the house because as I turn up the mental lights, I see more bias in
me, not less. No matter. It’s a worthy journey and it helps me take steps to change.
After you’ve done that work, you are ready for a simple exercise that we’ve found is
powerful:
1. Own. Stand back and notice your own tendencies to judge others (or yourself), or to
enact bias based on privilege, and bring as much self-compassion and emotional
openness to that awareness as you can. When do prejudicial thoughts or biased actions
like this pop up? Let go of any tendency either to buy into them or to make them more
important by avoiding awareness of them or by criticizing yourself for hosting them.
These are thoughts, feelings, and invisible habits. They are yours. You are not to blame,
but you are responsible. Just note their existence, consciously increasing your
awareness of the heavy negative cultural programming we all carry.
2. Connect. Deliberately take the perspective of those your mind judges, feeling what
it’s like to be subjected to stigma and enacted bias, sometimes even without any
conscious awareness by the person doing harm. Do not run from the pain of seeing that
cost or allow it to slip into guilt or shame. The goal is connection and ownership. Allow
the pain of being judged or being hurt without awareness by the person doing harm to
penetrate you. As you do so, bring your awareness to how causing anyone that pain
goes against your values.
3. Commit. Channel the discomfort of ownership and the pain of connection into
motivation to act. Make a commitment to concrete steps you can take that will alleviate
the impact of stigma and prejudice on others, including the invisible forms. That could
mean learning to listen more; it could mean speaking out when jokes make light of
prejudice; it may mean responsibly sharing what you are owning; it could mean
stepping back so that others can step forward; it could mean joining an advocacy group;
it could mean making friends who are members of groups your mind judges. Make a
plan to take some of the actions you come up with, and follow through thoughtfully and
mindfully, not to erase what you are carrying, but to channel the pain inside it toward
compassion and human values.
You can practice this exercise regularly. As you undercut the grip of your implicit biases with
flexible connectedness, you will find that your enjoyment of being with people of all sorts
increases, no matter how different they may have seemed to you before.
The sad fact is that if we’re not helping to solve the problem of prejudice, we are helping to
perpetuate it. If we do not learn how to catch our invisible privilege or the subtly prejudicial
thoughts as they course through our minds, we will inevitably be somewhat complicit in
stereotyping and dehumanizing others based on them, unwittingly supporting underlying bias
and passing it on to yet another generation. It is hard to admit to ourselves how complicit we
have been, and it’s hard to diminish the impact of implicit biases. But with work, we can do it.
Yes, my beloved Ruth Esther with her “tainted blood”; yes, my hate-spewing childhood
friend Tom; yes, my beautiful brown daughter; yes, Steve in the mirror; yes, yes, we can.
Chapter Eighteen
H uman beings naturally yearn for competence. Good thing. From infancy forward we have
things to learn, mountains to move, games to play, and races to win. The flexibility skills
are of great assistance in all these endeavors. Here I’ll first discuss how they help with
general performance challenges, whether in school, at work, in the arts, or in sports. Then I’ll
take a special look at how the skills can be applied to our work lives, including how they can
make managers better leaders and how companies can tap the power of flexibility. Finally, I’ll
address how the skills help with a set of typical problems with sports training.
Let’s begin with the role of values work. One of the ways that ACT training helps with
performance in any of our undertakings is reminding us to be values-focused in our pursuits.
When it comes to performance, this can be quite difficult. For one thing, we’re under intense
social pressure to achieve. We’ve probably all heard the old maxim “It’s not whether you win or
lose, but how you play the game.” And we’ve probably all rolled our eyes about it. Oh, yeah?
Tell that to my boss (or coach or parents)!
We’ve discussed how important intrinsic motivation is in values-based living. A problem in
staying intrinsically motivated when it comes to performance is that so many extrinsic
motivators are thrust at us, and crude or improper use of them can interfere with the development
of values-based motivation. In school, a healthy desire to do well can turn into the feeling that
we need to score high or else. Avoidance of mental threats soon overwhelms intrinsically
positive motivations to learn. In addition, in many schools, children face testing regimens that
push aside time for creative and effective forms of exploratory learning.
At work, many of us are given specific goals, and our performance is measured through
annual evaluations tied to bonuses and pay increases. We’re often incentivized in a crude
transactional way, with the carrot of monetary rewards or the stick of the threat of admonishment
or being let go. In professional sports, there is the imperative to please fans, as well as the reward
of large salaries. Even in amateur athletics competitions, music performance, theater, or dance,
medals and trophies send the message loud and clear that participating is all about achieving.
External rewards are fine—few of us would work for a job that paid us nothing. The trick is
to use your flexibility skills to direct your focus to the intrinsic benefits of performance, allowing
concrete rewards to facilitate rather than to substitute for values-based actions.
Start by taking some time to consider the negative self-talk you’ve been engaging in about
whatever performance issue you’re struggling with. The Dictator can become an absolute demon
in driving us to achieve the outward signs of success. “If you don’t get an A in this class, you’re
a total loser.” “You haven’t had a promotion in three years; what is wrong with you?” Write
down any such messages and practice your defusion exercises on them. That will help you be
aware of them whenever they start jabbering at you, and you can say, “Thanks, but I’ve got this
covered” to them. Maybe write them on a pack of cards that you carry with you and touch the
cards whenever you hear one of them jabbering at you. You’ll get better and better at catching
them and letting go of an interest in them.
There is nothing wrong with wanting to succeed, as long as the achievements you’re pursuing
are in line with your chosen values and not in the service of avoiding fears and doubts. Values
and self work will help greatly with staying focused on the intrinsic rewards of achievement.
Taking some time to reflect on how your hard work is serving your life aspirations can help you
see course corrections you should make. Maybe you should leave work earlier to spend more
time with loved ones or to pursue other passions. Or perhaps you’ve let achieving some goal in a
sport undermine the joy of playing and refining your skills.
With any given performance challenge, write down the values that your devotion to it is
serving. Hopefully you will find that some of them are authentically meaningful to you, like
supporting your family and bringing joy to others. But you may also find that some of them are
primarily about social compliance and propping up an image of yourself, like impressing co-
workers or making enough money that others have to treat you with deference. Use your toolkit
exercises to explore whether your self-story might be too tied up with certain outward indicators
of achievement.
The flexibility skills also help with the many emotional stresses involved with performance.
These include performance anxiety, the fear of failure—and fear of success—and the pain of the
disappointment and shame that comes with inevitable failures. There is also the sting of self-
recrimination about missteps; the pain of criticism from a teacher or boss; the anger over
impediments put in our way, such as needless bureaucratic paperwork; and the stress from being
tested constantly in school or being assigned too much to do at work.
Practice acceptance exercises to cope with these emotional challenges. You can
systematically apply your toolkit acceptance practices to them. For example, pick out a specific
performance area or situation that’s difficult for you and write down the difficult emotions it
provokes. Then do the Say “Yes” and Caring exercises introduced in Chapter Eleven with them.
In the heat of the moment, as these emotions and negative thoughts flare up, call on your
defusion practices. Presence exercises will also help, redirecting your attention from your inner
battle to the task at hand. If you can get some privacy, do the Simple Meditation exercise
introduced in Chapter Twelve. In any situation, you can quickly go through the practice also
presented there of shifting your attention to the soles of your feet. By regularly practicing these
and other presence methods, you’ll find you can call on them even in the most intense moments.
Presence and defusion practices are also helpful with one of the most pernicious effects of our
worries about performance, the phenomenon known as choking. It is common in sports. We’re
so distracted by worries about how we’re doing that we flub a shot or take our eye off the ball.
Choking occurs in school and work too, such as in taking a test we’re anxious about or giving a
presentation. If this is a problem for you, start calling on your favorite defusion and presence
drills whenever you’re feeling the heat, and over time, you will become better and better at
returning your focus to the action of the moment.
The ACT message about performance can be summarized in a sentence. High-level
performance is best pursued not out of fear, judgment, and avoidance, but with mindfulness,
commitment, and love.
Tackling Procrastination
A common impediment to performance is procrastination, which is a form of emotional
avoidance, and for this reason, ACT skills help counteract it. ACT research has shown that
procrastination is predicted by psychological inflexibility. The stress and anxiety of an
assignment is diminished briefly by delay, but that smaller, sooner reward can lead to major
performance failures. Even if you’re able to pull off a good job with a project once you do finally
dive in, developing a reputation as a procrastinator can hold you back, especially in work.
ACT programs for procrastination have been developed. They teach people to follow three
steps when they become aware that they’re stalling on a task: (1) insert a mindful pause and
recognize current thoughts and feelings, (2) accept and defuse, and (3) choose to act based on
values.
If you want to try this approach, for the next week, every time you become aware you’re
procrastinating, in that very moment practice a presence exercise or two for a few minutes. This
is like dropping an anchor of attention into your body. A good strategy is to envision touching
the pull to procrastinate and then observe the sensations in your body. As you identify each one,
breathe into it as if to embrace it consciously. If you are feeling your stomach tighten, for
example, direct your breath there. Then do the same for thirty seconds or so with the emotions
and thoughts you become aware of.
If any unhelpful thoughts and feelings show up, use your defusion and acceptance methods to
observe them.
Next, review which of your values you will be acting on by doing the task. Then consider
this: what has it been costing you not to live up to that value?
Finally, with that inspiration to break free from your procrastination, craft a small set of
SMART goals that will get you moving. Begin with some behavior, no matter how small.
Drive Time
Q: [When coming up on a red light] If red were green and green were red, what should
I do now?
A: Go
Q:If corrugated were bumpy, and smarmy were the opposite, which road would you
choose? Smarmy or corrugated?
A: Smarmy
Q: [When coming up on a green light] If red were green and green were red, and in
front was in back and in back was in front, what should I do now?
Here are some other exercises that you can do to increase your cognitive flexibility and to
begin to see useful options that might otherwise be missed.
Opposite Day
Write a series of sentences that express an opinion of yours, but use words that are opposite to
your views. For example, to state the opinion that you love nature and it should be preserved,
you could write, I hate artificial things and they should not despoil nature.
Keep Learning
One of the leading causes of job dissatisfaction is feeling stuck in the same old routines; we feel
that we’re not learning and growing. We can all take the initiative to teach ourselves new skills.
This can seem like a daunting prospect, but we can direct our flexibility skills to committing to
it. And a plethora of online courses and training programs are available.
This proactive skill building can also help with the widespread anxiety these days about the
future of jobs. Specialists on the future of work have warned that automation will be taking the
place of many employees and that learning how to work with the new technologies, such as
artificial intelligence and machine learning, or how to move from office and factory work into
human services work, are ways to “future-proof” one’s career. Applying flexibility skills to
continuous learning is a great way to prepare for this brave new world of work.
1. In the area of work, what are the things inside you that you would most want to walk
toward? I’m thinking of things like the joy you get from being helpful to customers
and being kind to co-workers, the satisfaction of being honest and genuine, and the
thought that you are making a positive difference in the world.
2. What are the things inside you that most move you in the opposite direction at work?
I’m thinking of things like the resentment you feel about being overlooked, fear of
being shown to be stupid, and uncertainty about your own abilities.
3. When you are moving away from the things you want to walk toward, what are you
doing? I’m thinking of things like being silent in meetings, gossiping, and deliberately
avoiding responsibilities.
4. When you are moving in your chosen direction, what are you doing? I’m thinking of
things like coming to meetings prepared, making suggestions, and actively listening
to the ideas of others.
5. The final step is not a question. Look at the figure and where the two lines intersect and
notice who is noticing the answers you’ve written. Think of that connection as linking
your transcendent observing self to the “now” of these pulls toward and away. Remind
yourself that you can choose which direction you’re going.
Once you’ve filled this figure in, revisit it regularly until you’ve planted it solidly in your
memory. Then, in the trying moments at work when you want to call on your skills, quickly
bring it to mind and swoop your way mentally around the quadrants, updating it as you go with
tweaks that fit the current situation. Then notice who is noticing, and see if this swoop around the
Matrix provides you some support and guidance.
Sports Performance
Everyone who has played a sport knows how the voice of the Dictator can hobble performance.
We get entangled in thoughts about what we should be doing. Psychological flexibility helps
with quieting all that messaging so you can put your focus where it should be—being in the flow
of the game. This approach not only leads to lower levels of distress among athletes, it leads to
better performance as compared to traditional sport psychology interventions such as
psychological skills training, consisting of goal setting, relaxation training, attention training, and
anxiety management.
Research has shown that ACT helps not only for physical sports, but other types of sporting
competition or performance situations. For example, the ranking of internationally visible chess
players was improved in randomized trials of ACT training. The benefit appears to come from
tamping down the emotional effects of mistakes and reducing impulsive moves. Likewise,
musicians, actors, and others have used ACT successfully to deal with performance anxiety that
interferes with their art.
ACT helps to correct for a good deal of advice given to athletes, even by professional coaches
and consultants, that is badly misguided. For example, athletes are often taught to do mental
training in which they envision their competitor’s moves in order to plan for them. But what you
imagined may not be what your competitor does. The better mental preparation is presence
practice, to build up one’s acuity of observation about what a competitor is actually doing, in the
moment of play.
Similarly, athletes are commonly taught to distract themselves from pain, thinking of
something pleasant instead, or to focus just on their form. Both of these common forms of
coaching have notable limits. A student of mine, Emily Leeming, recently studied competitive
CrossFit athletes as part of her dissertation. CrossFit is a program of constantly varied functional
movements performed at high intensity. Think of it as boot camp for Olympic athletes who are
training for several sports at once. At the competitive level, these folks exercise so hard they
practically sweat blood. She had them hold a two-pound weight away from their body at a
ninety-degree angle until they couldn’t do it anymore. (It just takes a few minutes. Try it. Hold a
quart of milk out there and see what happens.) In one group, she had them focus on their form,
keeping their arm at ninety degrees; in another she told them to think of something pleasant so as
to distract themselves from distressing feelings; and in a third group she advised them to focus
on their acceptance of discomfort. Even in this elite exercise group, coaching about acceptance
significantly increased their ability to persist (up nearly 25 percent in some comparisons), while
the other two approaches produced no benefits. It’s important for athletes to be mindful of the
degree of pain they’re feeling and respond in a well-calibrated way. Otherwise they are at risk of
injury. Flexibility processes foster such openness. Research has also shown that if athletes do
suffer injury, they are more likely to go through rehabilitation successfully if they are
psychologically flexible. The effect appears to be due to better adherence to rehabilitation
requirements.
If you want to apply your ACT skills to your sports performance, a good place to start is with
any training exercises that are difficult, boring, or painful. Cycle through applying the flexibility
skills to your practice of them, maybe one skill per day of your exercise sessions, such as the
following:
Defusion day. As you’re working out, watch for thoughts that are intruding on your
engagement with the work, such as This machine is killing me or I hate sit-ups, and sic
your favorite defusion methods on them.
Acceptance day. When you feel difficult sensations that you know are not dangerous but
that are urging you to stop, bring your attention to the sensation and tell yourself, I am
willing to feel this, it’s OK. Imagine that you’ve created the sensation on purpose, which
is a way to get out of your defensive posture about it and be the author of your
experience.
Now day. Practice attentional flexibility as you work out and see if you can sense which
attentional strategies most empower your training. For example, if you ride a bike for
exercise, bring your attention to all of the sensations in your body, and then move it to
the scenery around you. Then bring it back to your body, focusing on the feeling of
pushing down the pedals and then noticing your breath. Try to pay attention to things
you do not usually notice while you’re working out, like sounds around the room or the
air drying the sweat on your skin.
Perspective day. As you start to feel discomfort or are getting bored, ask yourself: What
would you say to yourself if you were watching from across the room? What advice
would you give yourself from a distant, wiser future?
Values day. Call to mind the qualities you most want to show in the way you engage
with your training. For example, maybe you want to be friendly to the other people
working out around you rather than closed in and just focusing on yourself. Or maybe
you want to show gratitude to your trainer. Find ways to act accordingly.
Commitment day. Try making some modification to your routine that will enhance your
training, such as adding even a few more of those dreaded sit-ups, or doing some work
on a machine you’ve been avoiding.
Performance in sports inevitably involves some pain and failure. But just as developing your
physical flexibility helps you optimize your performance while also minimizing the toll it takes,
so too will cultivating your psychological flexibility.
Chapter Nineteen
Practicing Perspective-Taking
Recall that we develop our sense of self when we learn the three perspective-taking relations: I—
you; here—there; now—then. I’ve already introduced a number of exercises for heightening our
awareness of our observing self. I’ve asked you to look back at yourself from a wiser future; to
mentally cross the room and look back at yourself; and to view yourself through the eyes of an
admired friend or advisor. In each case I asked you to slide your focus from one end of the three
perspective-taking continuums—now/then; here/there; I/them—to the opposite. Imagining a
wiser future moves awareness from now to then. Mentally going across the room and looking
back moves consciousness from here to there. Imagining an advisor looking at you from their
perspective moves awareness from I to you. In other words, the first of these exercises fosters a
transcendent sense of time. The second cultivates a transcendent sense of space. And the last
builds the sense of transcending the boundaries of self and connecting with others in that realm
of spiritual oneness.
In my first article about ACT I speculated why. I speculated that a characteristic of intense
experiences of transcendence is that we are able to experience perceiving from both ends of all
three of these perspective-taking continuums, all at once. It’s as if we are seeing through the eyes
of both I and you, are in both the now and the then, and are both here and there all at once. We
have entered a mental realm that is not characterized by those divisions. We feel as though we
are participating in a larger, all-encompassing consciousness, a consciousness of “everyone,
everywhere, always,” because our minds have somehow been opened to a both/and way of
perceiving, rather than the conventional either/or. Research on transformational experiences of
many kinds backs this up, having found that divergent both/and thinking is central to these
experiences.
In a sense, consciousness itself provides the seeds for spiritual experience. Understanding the
cognitive foundation of consciousness leads to methods of intentionally investing our day-to-day
life with this feature of spirituality. Here are two exercises to practice on a regular basis.
The first exercise combines perspective-taking and acceptance to foster compassion toward
oneself and others. Compassion is a hallmark of spiritual well-being; if we are interested in
expanding consciousness it’s a great place to start.
It’s best if you record yourself reading this exercise slowly, out loud, and then go through it
from the recording, so that you can do it with your eyes closed. Insert a short pause after each
sentence, and where I’ve put ellipses, you should pause for a handful of seconds.
—
Get yourself in a quiet and comfortable place where you will not be disturbed. Begin by
noticing your senses with your eyes open—notice something you can see and look at it, seeing
your seeing. Then notice something you can touch, and reach out and touch it, noticing how it
feels. Then allow your eyes to close and notice something you can hear. As you notice yourself
noticing these things, touch just for an instant that you are the one noticing. Sit inside that
awareness for a few moments.
....
Then gently bring your attention to a painful emotion you’ve felt in the last day. As you open
up to that experience, see if you can do so with a sense of warmth and wisdom, as if you are
expanding your awareness, your simple ability to notice, so that it totally surrounds the emotion.
Notice your breath and with each breath out, expand that sense of kindness and strength a little
more, as if gently wrapping this emotion in compassionate awareness. Expand until you are
feeling every nook and cranny of that feeling on purpose: gently, kindly, compassionately.
....
Now realize that there are other people in other places and at other times who are feeling
difficult emotions exactly like that. Imagine that you can reach across space and time and bring
your expanding sense of compassion to them, as if to guide their awareness to do what you were
just doing. Others are hurting, often through no fault of their own. Imagine a person who is
suffering in that way—they have a difficult emotion to feel and they do not know how. You do
not have to know them personally. In your mind, guide this other person to expand their sense of
self-kindness and awareness, much like guiding another person’s hands to hold something
gently. Notice your breath, and with each breath out, mentally reach out and imagine that both of
you are gradually wrapping this emotion of theirs in compassionate awareness, together. Keep
expanding around the emotion until the two of you are feeling every nook and cranny of that
feeling on purpose: gently, kindly, compassionately. It does not matter if your mind says you do
not have these qualities . . . simply imagine them and be aware gently, kindly, and
compassionately.
....
Finally, imagine that as both of you find that place of self-kindness and awareness, your
painful emotion can be added to the mix. Both of you are gradually wrapping each other’s
difficult emotions in compassionate awareness, together. See if you can allow yourself to be a
receiver of compassion, as well as a giver. Set down your needless defenses against receiving the
compassion of others. Allow your awareness to wrap the pain—yours and that of the suffering
person you imagined, and of everyone who is suffering anywhere—in the power of human
kindness.
....
Sit inside that space quietly until you decide to come back to the room and then open your
eyes.
—
The second exercise helps with developing your both/and perspective. It may seem a bit odd,
but stay with it and just see what shows up.
Doing this exercise requires that you record yourself and then listen to the recording. Read the
script slowly and in a gentle, relaxed voice; pause for a moment at the end of each sentence, and
add a handful of seconds at each ellipse.
Begin with an open scan of your sensory experiences. What are you touching right now?
What are you hearing?
Now notice who’s noticing those things. Catch, just for a moment, that you are here and
aware. There is a person behind those eyes of yours.
....
Now remember looking into the eyes of somebody you know very well. It could be a good
friend, a spouse, a lover, anyone. Perhaps in real life you did not look into their eyes for very
long, but in this exercise we will imagine that it is OK to do so. Picture those eyes and look at
them.
As you remember looking into those eyes, notice that not only were you seeing someone
else’s eyes, but also you could see them as they were seeing you.
To experience what that is like, just for a moment imagine moving over into their awareness
and looking back at yourself from the other person’s eyes. Take a moment to notice what your
face looks like, and then see your eyes looking.
But those eyes you are now looking at, your eyes, are aware too. Your eyes are seeing the
other person looking at them. See if you can actually see that awareness in your eyes. The eyes
you are imagining are not just objects called “eyes.” You are seeing eyes that see. See if you can
see that. And when you see that, move back over to where you started. Now you are “yourself”
again, looking at someone else’s eyes looking back at you.
....
Finally, for the next minute or so, keep shifting perspective in the same way you just did.
Each time you can become clear that you (or in imagination, they) were being seen, breathe into
that experience as if to note it gently and then shift perspective. Slowly and calmly move back
and forth between these two perspectives. As you do so, watch for a sense that the two of you are
not entirely separate. In consciousness, the two of you are interconnected . . . as if the boundaries
between the two of you are softening and there is a both/and or a we quality to awareness, not
just an either/or or a me quality to awareness.
—
This exercise is deeply spiritual because it develops our sense of cosmic connection with
others. I’ve done variants of it many times and whenever I have, I touch a sense of we. Recall
that RFT argues that developing this sense of we was essential to creating the two-way street of
symbolic relations that led to our advanced consciousness. We are the social primates.
Connection with others is good for us and is part of what makes us human.
Once you’ve practiced this exercise a bit, I think you will find that you begin carrying this
sense of we into your daily life, becoming more aware of the consciousness interconnection we
all have with one another with just a second’s glance or a moment’s consideration. You will
more keenly see people seeing you and you will see them more keenly, feeling the bonds of
consciousness that interconnect us all in our humanity.
Cultivating Forgiveness
Combining perspective-taking with defusion helps you foster another aspect of intense spiritual
experiences—the desire to forgive. Forgiveness is a powerful force for connection, allowing us
to cast away all past grievances and forge ahead on a new path of life without that debilitating
baggage. You don’t need to record yourself doing this exercise, so I haven’t included ellipses for
pauses. Be sure not to race through this, however. Pause at each step and proceed only when you
feel you’ve completed that part, which requires some reflection.
—
Allow your mind to settle on someone in your life whom you tend to judge. They may irritate
you. You may disapprove of them. Perhaps they hurt you in some way. You may hold them to
account for a wrong.
Whatever it is, just for a moment allow your judgments of that person to float to the surface.
Don’t buy into them and justify them, but don’t try to get rid of them either. See the judgments
as something you are doing—not as something being done to you. Be careful not to judge your
judging. The goal is just to take responsibility (you could write it response-ability) for the
judgments. Let them be there as they are and treat yourself kindly. Even if there are facts behind
the judgment, see if you can notice that the judging goes beyond those facts—this is something
you are doing.
When you are clear on the kinds of judgments this person pulls from you, let your mind settle
on other people you have judged in similar ways. Who else irritates you for the same reasons?
How old is this pattern? When do you first remember making judgments of that kind? Were they
present in childhood? Were they in your family? Again, don’t judge the judging: just notice it
and notice that you are doing it.
Now see if you can find something about your behavior that you judge others for. If you are
quite critical of someone because they seem manipulative, look to see if there are times you seem
manipulative, perhaps even manipulating yourself. If you are quite critical because someone
seems full of themself, look to see if there are times you seem to be full of yourself.
Be careful if shame shows up, with its hidden message of I am bad. Defuse from that self-
judgment by looking at your own experience with dispassionate curiosity: Look at that, I did X
and my mind judged me.
Now comes a choice point. Are you willing to give yourself the gift called forgiveness?
Would you be willing to move ahead from here as a whole person without having to either
invalidate that judgment of yourself or cling to it? Could you instead allow yourself a fresh start?
Could you take yourself off the hook?
Finally, come back to the person whom you tend to judge. Could you give that same gift to
them? Do not answer right away—just sit inside the question.
This does not mean that you will no longer see the other person’s harmful actions as wrong.
It’s vital that you not invalidate yourself or change facts to forgive. What forgiving does mean is
that while you still see the actions as wrong, at the same time you are willing to take the person
“off the hook.” You will no longer seek to keep proving the point that they’ve wronged you. This
is the gift of a fresh start, not based on any kind of denial of truth, but on the choice to let go of
anger and pain. You can defuse from your judgments, and their effects on you, by just allowing
them to be there as judgments. Put them on leaves and let them float by.
It’s also helpful to say the following statement, ideally out loud, though if that’s not possible
because you’re not in private while you read this, say it to yourself in your mind.
“I choose to forgive, even though I will not forget. I am willing to let go of entanglement with
my judgments . . . both of myself and of others. I am ready to give myself more of what was
there before these experiences led me to judge myself and others. I am ready to fore-give.”
—
I put these exercises in the order I chose for a reason: we tend to have a hard time forgiving
others until we’ve done so with ourselves. The word forgiveness derives from the Old English
word forgiefan—which itself was a combination of the Proto-Germanic fur meaning “before, in”
and giefan meaning “to give.” I find that this helps me keep in mind that forgiving is a gift we
also give ourselves—a gift of some of what was there before. As we take others “off the hook,”
we can slide off that hook as well, leaving behind not ignorant innocence but experienced
innocence, the aware and knowledgeable choice to begin anew.
—
That story is a moving testament to the role of spirituality in promoting both physical and
mental health. Spirituality is a natural feature of human life that we would all do well to foster.
We are all on a spiritual journey in the broadest sense of that term. I have been delighted to find
that the flexibility skills can help people progress in that journey, nurturing their ability to
commit to living a life of awareness, meaning, and compassionate connection.
Chapter Twenty
I f you or a family member have faced a serious disease or chronic condition, you know how
psychologically difficult they can be, not only for the person who is sick but for caregivers
and friends and family witnessing a loved one struggle. Yet many healthcare providers attend
only minimally if at all to the psychological side of these challenges. Worse, the information
provided about how to cope is often misguided, encouraging people simply to think positively, or
to try harder to comply with medical advice.
My wife and I encountered this when she was diagnosed with gestational diabetes while
carrying little Stevie. The regime of diet and exercise initially prescribed proved insufficient to
control the problem, and insulin shots were required. We were given a wealth of information
about the condition and how vital it was to manage Jacque’s blood sugar levels. The primary
approach to motivating us was the ominous warning that if we didn’t carefully follow the
instructions, our baby could be harmed. To help us cope with the anxiety about our son’s health,
a small set of materials encouraged not only positive thinking but also “by the book” cognitive
reappraisal—we were advised to try to think rationally, and to detect, challenge, and change
negative thoughts.
Even in expert hands (never mind from a pamphlet!) this kind of classical cognitive
restructuring and reappraisal is difficult to implement properly, and, perhaps because of that, it
has limited benefits when the results of all of the relevant studies are combined. Cognitive
flexibility? Yes. That is helpful, and encouragement to explore other thoughts can be useful.
Detect, challenge, dispute, and change? Not so much. It is too risky and too likely to lead to poor
outcomes.
Had we not known that, we might have followed the classic cognitive challenge advice and
blamed ourselves if it was not helpful. Instead, we drew on flexibility skills. They helped us stay
focused and persist in taking the glucose readings, accepting the fear when the meter kicked out
poor numbers and channeling that fear into finding just the right combination of medication, diet,
and exercise to keep the numbers where they needed to be. It was not emotionally easy, but we
stuck with it and Little Stevie was born happy and healthy; then Jacque’s gestational diabetes
rapidly resolved on its own.
Jacque and I were horrified that the advice and informational materials we received were so
limited psychologically speaking, and yet entirely in line with the standard of care for diabetes
generally. We had been given materials approved by the American Diabetes Association (ADA),
as are most patients with diabetes. Had Jacque continued to be diabetic postpartum, we would
probably also have been referred to an educational group for several hours of training in how to
manage the disease, conducted by a certified diabetes educator. In other words, the healthcare
system would have given us all of the medical information we needed to know. I agree—that is
vital. But that is not nearly enough; people need to be given effective psychological tools as well.
That is why ACT is one of the most widely used models in primary care. My good friend
Kirk Strosahl, a co-developer of ACT, and his wife, Patti Robinson, have developed the Primary
Care Behavioral Health Model to put psychological flexibility and related methods into normal
healthcare systems. In part as a result, much of the research on the value of ACT training has
been focused on helping people contend with illness and disability, with impressive results
overall.
Consider, for example, a study conducted with over four hundred survivors of colorectal
cancer. In order to prevent recurrence, these patients needed to increase physical activity and
make major dietary changes. One group of patients received the usual education about what they
needed to do, including brochures and newsletters, while the other group received ACT training
in the form of eleven telephone calls over six months along with written materials and a
newsletter. At a one-year follow-up, those receiving ACT training were 44 percent more able to
meet their exercise goals than those in the usual care group and had made better improvements in
their eating habits.
That is to be expected, perhaps, but more surprising was that significant improvement was
also seen in the ACT group with what is called post-traumatic growth—the positive
psychological change that sometimes follows adversity. This was measured by asking the
patients to respond to a series of quality-of-life statements, such as about their relationships (e.g.,
I have a new sense of closeness with others), seeing new life possibilities (e.g., I developed new
interests), improving their view of their personal strengths (e.g., I know I can handle difficulties),
positive spiritual change (e.g., I have a stronger religious faith), and greater sense of meaning
(e.g., I have a greater appreciation for the value of my own life). People in the care-as-usual
group saw no significant change in any of these areas, but on average, the patients who received
ACT training saw significant post-traumatic growth in all of them—about a 15 percent
improvement at six months, which was maintained at one year.
Studies have shown similarly promising results in post-traumatic growth with people who
have multiple sclerosis, cardiac disease, pediatric cerebral palsy, brain injury, epilepsy,
HIV/AIDS, and a number of other conditions. Flexibility skills also help people become more
resistant to the development of health problems in the first place.
A study showing this was done in Switzerland with over one thousand participants in a rare
representative sample, meaning that the results can be reliably generalized to the entire country.
The researchers confirmed the well-known fact that daily stress and poor social support predict a
wide range of physical and mental health problems. They also found that the degree to which
these factors affect health is strongly related to psychological inflexibility. For example, for
people who scored low in tests of flexibility, their depression levels increased by 60 percent as
daily stressors intensified to a high level. But for people with high flexibility scores, depression
increased less than a tenth of that as stressors went up!
Flexibility skills also help with the inevitable emotional and physical difficulties of aging. In
modern Western culture, we receive little training in how to age in a psychologically healthy
way. The culture is rife with ageism. As a result, aging is often feared, and many people work
furiously to try to fend it off with untold billions of products and services. Staying healthy as we
age is a wonderful mission, but trying to deny aging and the inevitability of losing roles, friends,
or functions is unhealthy. We are all going to be old if we live long enough.
Research has shown that elderly people who have great flexibility skills experience less
depression and anxiety in long-term care as well as at the end of life when they are in palliative
care. They experience less anticipatory grief about facing death. Flexibility also improves
people’s acceptance of help from caregivers and the ability to compensate as they lose areas of
functioning.
These and a host of additional research results leave no doubt that learning flexibility skills
should be seen as a key component of healthcare for everyone. You can apply them to the
management of virtually any physical ailment you may experience, and as a complement to
virtually any treatment protocol you’ve been prescribed. Let’s examine a few examples.
Chronic Pain
Across the world, an epidemic of chronic pain has baffled medical researchers. It is not just that
chronic pain is increasing enormously, it is that countries with some of the best healthcare
systems and most ergonomically sensible worker protection laws spend a staggering amount of
their gross national product on disability, mostly linked to chronic pain. Scandinavia is an
example. On average from 1980 to 2015, Scandinavian countries spent 4.3 percent of their gross
domestic product (GDP) on the cost of disability and incapacity, most of it work-related.
Actual disability claims have not reached those levels in the United States (the United States
spends 1.1 percent of GDP on disability and incapacity), but it is still not cheap. The medical
cost of chronic pain is between one-half and two-thirds of a trillion dollars. In 2012, over half of
the U.S. population experienced pain over the prior three months—a largely silent epidemic that
affects more people than cancer, diabetes, heart attack, and stroke combined. Meanwhile, the
United States has led the world in trying (unsuccessfully) to treat chronic pain with opiates. That
approach may indeed have kept down costs but not because it has solved the problem—it has
shifted the burden to patients and their families and has led to the public health crisis of
widespread opioid addiction.
Why has this happened all of a sudden? Is the modern world now much more likely to visit
physical harm on people than before? Hardly. The change is in part due to how we talk about and
treat pain itself.
In the United States about twenty years ago, physicians were encouraged by the hospital
accreditation body and others to start treating pain as “the fifth vital sign,” as important in
assessing a patient’s health as measuring temperature, blood pressure, respiratory rate, and heart
rate. The intention was to provide people with more assistance in coping with pain, which was
long overdue. The problem is that the primary means of assisting them has been the prescription
of pills in order to eliminate pain, not to manage its psychosocial impact in the short and long
term. Psychological approaches have received much less support from the medical system, in
part because pain treatment is stuck in the wrong model. That is a terrible shame, because
research shows that ACT training (and other psychosocial approaches) can help people
considerably in coping with the distress of chronic pain and in avoiding the development of
chronic pain in the first place.
The great challenge with chronic pain is that unlike acute pain from an injury or surgery, it
appears to be deeply ingrained in a neurobiological system called a persisting aversive memory
network. It is pain, but it is not pain coming from acute sensory processes in injured body tissue.
Consider the experience of people with chronic pain in their limbs, such as their hands.
Sometimes people beg to have their hands or limbs removed to stop the pain. That is logical but
a very bad idea: fully 85 percent of those who have a limb removed still feel pain in the limb
even though it’s gone! This is not because the removal of the limb damaged nerves—it is
because the pain was no longer primarily in the limb in the first place. It had moved to the central
nervous system, embedded in our brains, much the way our memories are.
If pain has persisted for three months (the usual criterion in considering it to be “chronic”),
there is nearly an 80 percent chance it will persist four years later, and if the criterion for
“chronic” is raised to six months or a year, the statistics get even worse. In adults, at least, ACT
for chronic pain does not work primarily by eliminating pain (nor does any other evidence-based
psychological intervention, such as traditional CBT). Where ACT is powerful is in lowering the
level of distress felt about chronic pain, thus reducing its life interference. That helps people
continue with their regular life activities with the pain, not in opposition to the pain.
If an ACT message were part of the general approach to pain, would it reduce the
development of chronic pain? It is still early, but some work with children who have chronic
pain has suggested that ACT training can help prevent pain from becoming permanently
ingrained. Several world-class pain centers, such as the Karolinska Institute in Stockholm (where
the Nobel Prizes are given), use ACT extensively with children. That work has shown that ACT
appears to reduce felt pain more noticeably with children than adults, perhaps because pain is
less dug in neurobiologically and psychologically with children. New evidence suggests that the
same might happen with adults if we deploy ACT at the right time in acute pain situations,
before they become chronic (e.g., using ACT before back surgery).
Encouraging people to develop acceptance skills for coping with their pain should in no way
be construed as, in effect, telling them to “buck up and deal with it.” Acceptance can be a loaded
word for people who have chronic pain. Telling people they should accept their pain can sound
like a way of saying, “Please don’t talk about your pain—it is too disturbing to me.” That is not
humane, and it is not helpful.
ACT acceptance is in no way a denial, or belittling, of pain. It helps create the flexibility to go
from living with pain, to LIVING with pain by combining acceptance with defusion and
committed action. One learns to take pain along for the ride in getting back to the business of
living in alignment with chosen values.
In Chapter Eight, I described an ACT intervention for people with chronic pain, and you can
follow that approach using your favorite exercises. Then you can keep adding more exercises to
your practice. You should also try the following one, which I’ve found helpful when dealing
with pain if there is nothing to be done about it. I use it with one of the most frustrating effects of
pain—interfering with sleep.
After doing some presence work—I usually do some mindfulness meditation, focusing on my
breath, for two to three minutes—I turn my attention to the part of me that is noticing my breath.
In other words, I touch base with me as an “observing self.” From there I gently direct my
attention to where I feel the pain. As I do this, I try to “drop the rope” on the urge to control the
pain, or distract myself from it—no flinching, controlling, distracting, just observing. With each
sensation I notice, I try to get to “yes,” meaning that I can open myself to feeling what I feel with
a sense of equanimity. If negative thoughts intrude, I practice defusion on them until they fade.
Then I return my attention to my breath, notice the observing part of me again, and go back to
focusing on the pain and finding my way to “yes.” When the sensation has lost its punch, I look
to see if there are other sensations elsewhere I’m struggling with, and if so, I do the same thing
there.
Diabetes
The limits of the standard approach to the treatment of diabetes are clear in the data about
outcomes for patients. Over 8 percent of the population worldwide will develop diabetes, most of
it type 2, which is an acquired resistance to insulin. In the United States, the figure rises to more
than 10 percent, and that is an underestimate, as it’s known that many cases of type 2 diabetes
are not diagnosed. It is a huge and rising world health problem, driven in part by the spectacular
rise of obesity.
Fortunately, in most cases the disease can be managed through changes in diet and exercise,
along with medications, but much too often, patients do not stick rigorously to the appropriate
regimes. The complications that result from unregulated diabetes are severe, including
cardiovascular disease, loss of limbs, and blindness.
In the hope that ACT training could help patients manage their disease better, a student of
mine, Jennifer Gregg, conducted a study with me and other colleagues in which she tested the
results of six hours of ADA-approved education against a program that cut the ADA curriculum
almost in half and replaced it with three and a half hours of ACT training. The ACT sessions
involved walking patients through how to defuse from frightening thoughts about their condition
and the anxiety involved in properly managing it, as well as working on values to help them
commit to the necessary behavior changes.
Jennifer and I developed an assessment of psychological flexibility specific to thoughts and
feelings about diabetes. We had all of the participants fill it out before the training, and then
again afterward. We found that the psychological flexibility scores of those who got diabetes
education alone actually decreased by about 3 percent, while the scores of those who also got
ACT training improved by nearly 20 percent. The result was that the number of patients in the
ACT group who were in diabetic control by the end of a three-month follow-up was significantly
higher than the number in the education-only group. Being in diabetic control means that you’re
keeping your blood glucose levels low enough for long enough that most complications of the
disease can be avoided (it’s measured by hemoglobin A1c—a biomarker for average blood
glucose levels). For patients in the education group, the percentage in diabetic control actually
decreased slightly, from 26 percent to 24 percent, while in the ACT-trained group, it nearly
doubled, from 26 percent to 49 percent. If that degree of change were maintained, it would
predict nearly an 80 percent reduction in loss of limb and blindness over the years.
When these results were published in 2007, they caused a stir in the field of diabetes research
and care, and some researchers questioned the study. But the results were fully replicated in 2016
by an independent research team in an even larger study. I’m sure there will be some hits and
misses in the future as we learn how to dial in on this problem, and I’m not saying ACT is a
cure-all for diabetes management. But it seems that a focus on psychological flexibility can add
an important component.
If you are dealing with diabetes, you should apply your full toolkit of exercises to your
difficult thoughts and emotions regarding your condition and to committing to the behavior
changes you and your doctor have agreed are needed. Write down all of the barriers you’re
struggling with in making these changes. Drop the rope on them and get to work applying your
ACT toolkit.
Here is an additional exercise you could try, which I’ve seen is very helpful for people in our
diabetes work. We have them do it in a group workshop. You can do it with friends you trust, or
family members.
Commit to an action or set of actions and the chosen values or purpose they reflect. Then with
your group assembled, stand up and state how you want to be in relation to your diabetes. What
do you want your actions to reflect? Why and how is that important to you? What has happened
when you’ve forgotten that? Next, state your commitment to the actions you’re going to take. Be
specific enough that you’re sure they know what you are going to do. We use the phrase taking a
stand for expressing a strong commitment to something; well, this exercise is taking a stand for
your health.
Cancer
Nearly 40 percent of the population will be diagnosed with cancer at some point. While the
medical community has made great strides in developing more effective detection and treatment
methods, even the National Academy of Medicine worries that attention to the psychological
challenge of cancer has lagged. About 30 percent of patients with cancer experience depression,
anxiety, and stress, but often they’re prescribed little or no therapy.
People with cancer commonly blame themselves for contracting the disease (especially
smokers with lung cancer) or for failing to promptly seek medical diagnosis despite experiencing
symptoms. Social messaging that they should stay positive makes it hard for patients to talk
about the stress of their diagnosis. Friends and family can feel awkward discussing the fear and
pain of their loved ones. Withdrawal from life activities is common—some due to the fatigue
that is a pervasive symptom of cancer (as well as its treatment), but also because patients do not
want their loved ones to see them doing badly.
What’s more, the challenge of battling cancer is by no means over once treatment is
completed—even if treatment is successful. Fear of recurrence can persist for many years. Many
survivors experience long-term disabilities, and some may not be able to return to their jobs,
which can not only cause economic stress but contribute to a widely reported feeling of a lack of
meaning and purpose in their lives.
Training in the ACT skills has been shown to significantly improve people’s ability to cope
with these myriad challenges. This is especially true for coping with the common symptoms of
depression, anxiety, and fear of recurrence.
A helpful description of tailoring ACT practices to the specific challenges of cancer was
provided by psychologists Julie Angiola and Anne Bowen, who wrote in detail about one
patient’s experience. This fifty-three-year-old woman had stage IIIC epithelial ovarian cancer,
which had recurred twice after her initial treatment. Her sessions with an ACT counselor began
two months after the second recurrence, and she had told her oncologist that she would have to
think about whether to have additional chemotherapy, as was suggested. She reported to her
ACT counselor that she vacillated between feeling numb and engaging in “nonstop worrying,”
and that she was so fatigued that she was having trouble getting out of bed. She also said that she
was ashamed about how she was behaving, and that although she would have liked to spend
more time with her husband, she didn’t want to be a burden to him and had moved into a guest
bedroom.
The counselor began by asking her what type of life she wanted to be living, helping her
consider what valued living meant to her, and then had her identify the barriers stopping her
from living accordingly. She also took psychological flexibility and values assessments, which
showed that she scored high in avoidance but also in values, specifically valuing spending time
with family, socializing with friends, engaging in recreation, and experiencing physical well-
being. As the assessment helped her see, she was not, however, acting in accord with them.
Given her strong values score, the counselor had her first do a good amount of work linking
values to actions she could commit to. The therapy then progressed to helping her with
acceptance, walking her through many of the defusion, self, acceptance, and presence exercises
that were introduced in the Part Two chapters. She was able to significantly improve her quality
of life and reengage in the activities she valued.
You can tailor your work with flexibility skills to the discoveries you’re making about the
problems you’re having. For example, if anxiety or ruminative thoughts are problems for you,
then it might be best to begin with defusion and presence work. If self-blame and shame are
difficult issues, then self would be a good beginning.
Tinnitus
I learned the value of the flexibility skills in coping with chronic health conditions from personal
experience. Tinnitus is a name for incessant ringing in the ears. It can be quite disabling. The
most common treatment is tinnitus retraining therapy (TRT), which uses counseling to interpret
noise benignly (as a neutral signal) and noise machines or other sound devices to habituate
people with tinnitus to the ringing. The idea behind TRT is that the brain falsely perceives subtle
neural stimulation in the ear as noise but would not do that if the general set point for sound were
higher. It is sort of like how the noise of an air conditioner would be awful in a quiet room, but in
a noisy bar it would hardly be noticed.
I used to love to listen to punk rock and those tatted bare-chested singers roaring like aircraft
engines. Now, decades later, tinnitus is the result. I was not impressed with the studies on TRT
(the effects are weak), so I opted just to ignore the noise, hoping it would go away. I wore
earplugs to prevent further damage. But it steadily grew louder. And louder. And louder! This
gradual slide into more and more distress took about three years. It was not until I caught a
thought in my mind that the sound would stop if I shot myself that it even occurred to me to
apply ACT.
I went on a long walk and fully applied my acceptance, defusion, and attention skills. By the
time I got home I knew it would work. The effect was virtually immediate. Within two days, I
felt no distress about the ringing at all. None. And it has never returned.
The noise did not go away. But it became like the noise of the ventilation system in a hotel—
who is interested in that? Now several years later the ringing is still there (louder!), but it never
bothers me. I rarely even hear it, unless I am talking about it or (as in this moment) when I’m
writing about it. No matter: I have respectfully declined my mind’s invitation to care about it one
way or the other.
Such quick acceptance was only possible because I’d been practicing flexibility skills for
decades, and I’m not suggesting that such immediate effects will come right away for new
practitioners of ACT. But given my positive outcome, I reached out to Swedish researcher
Gerhard Andersson, perhaps the world’s leading expert on psychological approaches to tinnitus.
Together we created the Tinnitus Acceptance Questionnaire, a twelve-item measure of
psychological flexibility regarding tinnitus, and sure enough it strongly predicted tinnitus
distress. We now know that psychological inflexibility turns the loudness of the ringing into the
negative life impact of tinnitus, even after anxiety and depression symptoms are taken into
account.
Gerhard and his team then conducted a trial with sixty-four patients who were divided
randomly into two groups assigned to receive either TRT or ten approximately one-hour sessions
of ACT training. At a six-month follow-up, 55 percent of the patients who received ACT training
were significantly improved in the degree to which their tinnitus was adversely interfering with
their lives, such as preventing sound sleep or causing anxiety or depression. That was nearly
three times as many as the 20 percent who reported improvement after receiving TRT.
The Swedish team invited me in to help them determine if increased psychological flexibility
explained that difference. It did. Furthermore, you could see it happen in how patients began to
change the way they talked about their problems after a few sessions of ACT! We tracked the
frequency with which patients made statements that suggested they were using flexibility skills
when thoughts and emotions came up about their tinnitus. For example, if a person said, “I had
the thought that the noise was distressing” instead of a more entangled statement like “The noise
was distressing,” they were significantly more likely six months later to experience less distress
and interference from tinnitus.
There is no leading treatment for tinnitus yet, but this is a great start. My own experience with
it suggests that sometimes acceptance should have this form: I don’t care and you can’t make
me. I have nothing left to learn from the noise. (Note for my next lifetime: Do not stand near
thirty-foot-tall speakers when punk rock is blasting. OK. Got it.)
I think a lot of life events (phantom pain, permanent loss of functioning, and so on) can
eventually get to that point. Yes, acceptance means to receive the gift that is offered. But after
you explore that thoroughly, the final form may be more like “this is too boring to care about” or
like Mark Manson’s book The Subtle Art of Not Giving A F*CK, even “I don’t give a f*ck.”
Terminal Illness
ACT methods have been shown to help people with a diagnosis of terminal illness cope with the
fear and sadness of facing death. The flexibility skills help people feel less distress and direct
their energies to more meaningful end-of-life activities. For example, one study was done with
women who had late-stage ovarian cancer. Nearly 85 percent of those in this condition will die
within a few years. One group of these patients was assigned to a commonly prescribed
treatment of twelve therapeutic sessions that included relaxation training, cognitive restructuring,
and guidance on how to solve the problem of facing the inevitability of death. The other group
was given twelve sessions of ACT skills-building work. The sessions were held wherever they
could be arranged given the intensive treatment participants were undergoing, such as in
chemotherapy rooms, infusion rooms, and exam rooms.
Those put through ACT training improved significantly more in a number of outcomes. They
engaged in less thought suppression and had significantly lower anxiety and depression. In
addition, while the patients who got CBT coped with their anxiety in ways that looked more like
distraction, such as watching more TV, the ACT group took more meaningful action, such as
calling their children, deciding how their possessions might be distributed when they died,
making sure their will was in order, and writing letters to friends and family.
Flexibility skills can also help us come to a place of acceptance about the death of loved ones
and to spend the time we have left with them more meaningfully. I learned this the hard way.
My family was highly avoidant about facing death. My dad died when I was twenty-four and
in graduate school at the other end of the country, and after my sister called me with the news,
my mother soon called and actively encouraged me not to come to the funeral. I was poor, she
reminded me. She could not help much financially, she said.
I was only too happy to take that guidance, using the expense as my excuse. I’ve deeply
regretted that decision ever since.
When my sister, Suzanne, called me a couple of years ago and told me my ninety-two-year-
old mother’s pneumonia had taken a turn for the worse, I immediately got on a plane from Reno
to Phoenix. By the time I got to my mother’s bedside, she was no longer speaking or opening her
eyes, but her head moved slightly when Suzanne said, “Steve’s here.”
Surrounded by my sister and her grown children, Adam and Meghan, I sat with my hand on
my mother and watched over a period of hours as her breathing slowed and her feet turned black
as her body shut down. My mind drifted to the last time I saw her.
She’d forgotten I was coming—her mind could not hold new information well anymore. In a
frail voice, she had exclaimed, “Steven! My son!” as I entered the dayroom in the extended-care
facility she was living in. “He’s a famous man,” she proudly told a woman sitting next to her in a
lowered voice, and then catching her little mom brag, she quickly added, “He’s a psychologist,”
and then, turning to me, as if to remind her beloved son what was actually important in life, she
concluded quietly but firmly, “He helps people.”
My mother exemplified values-based living, and she had worked, to the very end, to guide
her children in doing what was right, not what was superficially appealing. What had always
mattered most to her was what kind of people we were. As her life came to a close, I was so
grateful that we could be together, experiencing our sadness and our appreciation and love for
one another fully for every precious last moment.
I will go to my own grave savoring that good-bye. We say that the death of a loved one is
awful, and it is, but these sacred moments are also full of awe, if we open our hearts to see it.
Love and the pain of loss is a sandwich and it does not come any other way.
I hope that as you face the loss of loved ones, the flexibility skills you have will help you
experience a sense of peace and the fullness of love that lies within your sadness in their passage.
Chapter Twenty-One
SOCIAL TRANSFORMATION
W e are in kind of race against ourselves. If you read between the lines in our
communications with each other, everyone is wondering if we can develop
psychologically and culturally fast enough to forestall disaster. The particular disaster
varies with the tweet, Facebook post, blog, or column, whether about warming the planet beyond
repair, fostering a killer epidemic, or simply creating a hellacious world in which our children
cannot be happy.
This book helps explain what that race is really about. Can we human beings learn how to be
at peace with ourselves and act wisely, even though human language and cognition is seemingly
creating an endless series of barriers to doing so? Science and technology, the product of those
skills, is wonderful but also mindless. The Internet connects us, but it also overwhelms us with
difficult information and challenging judgments. Airplanes connect us, but they also add more
greenhouse gases to our atmosphere than any other device. We have the capability to make the
world virtually unlivable or even uninhabitable, and in a world like that we can no longer trust in
a “me” focus—we need a “we” focus that allows us to cooperate with others to meet such
challenges.
What we have been lacking is the development and use of evolution and behavioral science
knowledge that can match the needs of the modern world. We see the cost of that absence in the
rise of mental health issues, chronic pain, and substance abuse problems, and the miserable mess
we have created by trying to medicate our way out of them. But we see it also in our inability to
foster healthy behavior, rise to the challenge of physical disease, solve the problem of prejudice
and stigma, or soften our politics. We see it in our homes, schools, and work sites.
The theme of this book is that we do have a way forward, once we realize the nature of the
challenge we face. Using principles of evolution and behavioral science, we can consciously
evolve ourselves, becoming better able to contend with life’s challenges and to transform our
homes and societies. Many of the skills we need are known and can be taught, to children and
their parents and teachers, to workers and managers, to medical practitioners and their patients,
to social services workers and those seeking services. And I believe that if we develop these
skills broadly, they can be helpful in tackling the many social, behavioral, economic, and
environmental ills that plague individuals, communities, and whole countries.
This hope may sound grandiose, but I’d like to share a story that inspires me to believe in this
potential. It’s a story of using ACT training to help people in a devastated community open their
hearts and minds to adopting a radical change in behavior in order to save lives.
If any nation on Earth were the least likely to cultivate psychological flexibility it might be
Sierra Leone. Nearly three-quarters of the country’s population of 6.2 million live on less than $1
per day. The country’s health-care system is weak, and mental healthcare as it is understood in
the West is virtually nonexistent. As of a handful of years ago, it was home to a single PhD-level
psychologist and one retired psychiatrist. I do not think that sad situation has changed.
On top of all that, the country was riven by a decade-long civil war, which ended in 2002,
leaving fifty thousand dead, a ruined infrastructure, and approximately twenty thousand
amputees. The future of the country is now in the hands of citizens who as children had been
recruited to be soldiers and to kill villagers with machetes, or who had been raped or maimed,
sometimes in front of their families.
With so much trauma already to contend with, in 2014 Sierra Leone suffered again. The
Ebola virus struck early in the year, and soon more than eight thousand people were infected and
almost four thousand had died. The WHO was struggling to contain the outbreak, which had
likely spread to Sierra Leone from neighboring Guinea and Liberia.
Hundreds of contagious-disease experts from around the world flocked to the countries, and
millions of dollars were sent in from the developed world. Expensive clinics were built (many
only to be completed after the crisis was over). Military experts helped contain civil unrest while
forcing compliance with epidemiological recommendations to stop the spread of the disease. But
mental health experts were not sent.
Why would psychotherapists be helping in fighting Ebola? Because it’s not just the disease
that is infectious, it’s also the fear of being infected, which makes fighting the virus vastly
harder. We saw that in Guinea in a horrifying way, when some of the locals in infected
communities were so terrified by healthcare workers arriving in the required protective plastic
moon-suits that they killed the intruders with machetes. They also hid sick relatives from the
authorities, or allowed them to escape to surrounding villages, where they spread the disease.
We saw the spread of fear in the United States as well. Health workers returning from other
parts of Africa (countries without Ebola infection) were put in quarantine for extensive time
periods for no logical reason. A single case of Ebola in the United States became national news.
Containing an epidemic always requires behavior change, and in that, psychology ought to
have much to offer. In Sierra Leone, the people themselves used ACT and evolutionary
principles to forgo their sacred practices of kissing and washing the dying and the dead, which
are culturally required to honor family ties and foster passage of the spirits of the deceased to the
next world.
The practice had to change because when Ebola claims a life, the virus rises to the surface of
the skin as the person sweats. Kissing and washing the bodies of the dead are sure ways to
become one of Ebola’s next victims. The only safe way to treat patients is to quarantine them,
and then the bodies of those who pass away must be immediately zipped into plastic bags and
burned.
It is easy for governments to impose such policies, and perhaps, with enough guns, to enforce
them. Forcing compliance, however, invites leaving behind a culturally traumatized society. A
more humane and effective psychological approach was needed. Fortunately for the district
around Bo, the country’s second-largest city, locals trained in ACT helped innovate a way for
community members to accept the requirements.
A German psychologist named Beate Ebert had established an ACT mental health clinic in
Bo to help people cope with the horrors of the war and the crushing poverty of their lives. The
country almost completely lacked mental health services. Beate began her work to become an
ACT trainer after attending a two-day workshop on ACT I gave in London several years earlier,
and from the beginning her main interest was to use ACT to foster social transformation.
She founded a nonprofit organization called Commit and Act whose mission is “to bring
psychotherapist support to traumatized people in areas of conflict.” In 2010, Beate started
traveling to Sierra Leone to offer ACT trainings, and one of those she trained was Hannah
Bockarie, an amazing young social worker. Hannah, then twenty-nine, was interested in
psychotherapy for both communitarian and personal reasons.
She’d grown up during the war and had seen many children hurt. She had also been a victim.
When she was turning thirteen, she was captured by rebels. She escaped and hid in a swamp, but
soldiers found her. As they approached, she heard one say, “If we find her, we kill her on the
spot.” But they did not kill her. Instead, they took her to the camp commandant, who
immediately raped her. She again escaped and spent her teenage years in hiding, becoming
addicted to drugs “to push down the pain,” as she says.
Eventually Hannah was able to get off drugs and channel her pain into helping others. She
began volunteering with Doctors Without Borders. With assistance from the United Nations, she
then earned her degree in social work. After ACT helped her address her own wounds, Hannah
became an invaluable partner to Beate in expanding ACT training in the country. ACBS, the
professional society that directs the development of ACT, learned of their work and helped raise
the funds to fly Hannah and several other Sierra Leone counselors to the United States for more
training, as well as flying ACT trainers to Sierra Leone to train more counselors.
When Beate opened the Commit and Act clinic in Bo, Hannah was appointed its director.
Having a resource like this was so special that the people of Bo held a parade in celebration of
the opening.
Special programs were established for victims of tribal violence and for women who as
children had been sold as indentured servants, frequently ending up as sexual slaves. Several
hundred clients were treated individually, in groups, and in workshops. An evaluation by the
University of Glasgow showed that attendees became more mindful, less trapped by their
thoughts, and happier, even among those who screened positive for PTSD (a common problem in
a country that has been war-torn for more than a decade).
Then the Ebola outbreak struck. Within a few weeks, Hannah was appointed the regional
director of the Ebola response because the Commit and Act clinic was one of the few well-
functioning entities that might be able to help change behavior. Recognizing the need to
convince the whole community to accept the need for quarantine and the burning of bodies,
Hannah and Beate reached out to me and others in the ACBS community for help.
I had been working with David Sloan Wilson, the evolutionary biologist mentioned earlier, to
combine ACT with the work of the late Nobel Prize winner Elinor Ostrom. She had identified
eight principles by which the members of communities can come together to solve problems,
such as managing limited joint resources like pasture land and fishing grounds. Our goal was to
develop a more effective approach for fostering prosocial cooperation and caring in
communities. We called the blending of Ostrom’s principles and ACT that we developed
Prosocial. Hannah and Beate bought in and tried to follow this approach to getting the
community to respond to the challenge of Ebola. They began doing Prosocial training with
groups of villagers in the Bo district, combining educational information about Ebola with
instruction and intervention tools taken from ACT and training in the Ostrom principles.
The ACT training used the tool called the Matrix, introduced in the section on work in
Chapter Eighteen, which taught people to look for the inner values they wanted to move toward,
see the emotional and cognitive barriers that moved them away, and consider what it would take
to make their behavior more values-based. The villages were then asked to reflect on how to
apply this values connection, along with Ostrom’s insights about group cooperation, to stepping
up to the challenge of Ebola. Hannah challenged community members to come up with
alternatives for how to honor their loved ones instead of praying over them, washing them, and
kissing them. In one of the early trainings, one of the villagers suggested a powerful solution.
Sierra Leone is lush with large banana trees, and this person suggested using them to craft a
new ritual: cutting a section of the trunk of a tree, washing it in traditional fashion, wrapping it in
a clean white sheet, and placing it on a mat to serve as a sort of totem for the dead. Mourners
could carry it, kiss it, pray over it, hug it, and even bury it as a symbol of the person with Ebola.
If this notion strikes you as odd, please consider some traditional Western religious rituals. I
was raised a Catholic and taught that communion wafers are transubstantiated through ritual into
the actual body of Christ. If 1.2 billion people can participate in that practice, why can’t the
people of Sierra Leone use a banana trunk as a stand-in for their loved ones? As the outbreak
spread in Bo, this ritual helped people protect both their community and the essential core of
their cultural traditions. As a result, in the critical months during the late spring and summer of
2014, Bo had the lowest rate of increase in Ebola of any of the eight heavily infected districts.
ACT training also helped people with Ebola face their terrible fate. One of these was a man
who was refusing to submit to a blood test that would prove whether he had Ebola. He was
terrified. “If anybody comes close to me, I will spit on them!” he had shouted to the hospital
workers. Armed guards were brought in to keep him in the hospital. For days, no one knew what
to do. The man told a guard he would rather be shot than give his blood. The hospital workers
were both angry with him and scared of him.
When Hannah heard about the situation, she asked to be allowed to see him. She recalled to
me, “In ACT, we say people are ‘entangled’ with thoughts, and he had this concept firmly in his
head: ‘I’m not going to let anyone near me. I can’t face this. This can’t be.’” She donned full
protective gear, sat on his bed, introduced herself, and asked “What do you care about? To die
here alone?”
He replied that he was suffering because no one was allowed to touch him—that everyone
would rather kill him than touch him. “Everybody’s against me now,” he said. “I’m troublesome.
I’m problematic. I’m threatened.”
Hannah replied: “So what have you done about it?”
The man looked at her as though she didn’t understand and said, “If I have it, I will spread it.”
She responded, “But what do you want to stand for in your life in the midst of all this?” He
paused and broke down, sobbing uncontrollably. In halting words, he said he cared most about
his family—he wanted to be with them. He wanted them to know he loved them. He wanted
them to respect him.
“Then take some actions,” Hannah suggested, very quietly. “Let them take the blood sample.
Show your love for your family. Show it.”
He gave the sample, and as he had feared, he had the disease and would soon die a horrible
death. But Hannah helped him see that he could take the energy of his pain and pivot it toward
love of family rather than toward anger and fearsomeness. His family could now visit him,
wearing their protective gear, and tell him how much they loved him. They would see that he
was accepting his fate with courage and dignity, instead of hearing later about his threats and
ravings.
Hannah had been to his village a few weeks earlier to do an ACT/Prosocial training and as a
result, when he passed away, his family knew what to do. They allowed his body to be carried
away and incinerated and they lovingly sent his spirit on to the afterlife with a proper burial,
praying over, washing, kissing, and then burying a banana trunk.
In the aftermath of Ebola, the culture in Sierra Leone has been torn asunder. Across the
country, families have fallen apart; sexual and domestic violence is on the rise. But the gentler
and more socially transformative path blazed by the Commit and Act clinic in Bo continues to
yield dividends. A women’s movement to confront the violence, and specifically to rein in
domestic violence, has emerged out of Prosocial in Bo. For the first time, men who abuse women
are going to jail, and behavioral services are being provided to survivors and perpetrators. The
Commit and Act clinic was recently cited by the Sierra Leone government as a major reason that
sexual violence toward girls is falling in the city (see http://commitandact.com). Healing
continues, using the flexibility processes to promote social transformation.
EPILOGUE
A ll across the world, psychological flexibility is becoming recognized as a vital life skill,
in clinics, workplaces, churches, government agencies, and schools. With each person
who learns the skills, the culture evolves just a little bit. Human communication softens;
human connection grows.
It’s not just ACT, of course. Meditation programs have proliferated; values-based groups are
growing; you can hardly open a magazine or turn on your computer without encountering blogs,
popular books, television shows, or movies that are focused in some way on psychological
flexibility writ large. Readers of this book will recognize what is happening, even if the specific
outlet uses other terms. For example, tens of millions of children have seen films or cartoons
about the importance of psychological flexibility (go to http://bit.ly/StevenUniverseSong if you
want to see an amazing example). It’s gratifying to me that over the last thirty-five years, ACT
has played a role in fostering this change in cultural focus.
We can do much more to foster healthy evolutionary processes in our lives, homes, and
communities. In this area, the readers of this book have an important role. I hope by now you are
convinced that I’ve fulfilled the promise made at the beginning of this book to put forward a
small set of scientifically established processes that empower doing what matters in virtually
every area. I also hope that you have been inspired to help others learn about flexibility processes
and that you’ve already seen benefits in your life and the lives of those you love from doing so.
If so, think about the fact that social change begins with someone making the simple choice to
step forward. If this book has been useful to you, stepping forward is what I am asking of you as
this last page is being written. I am asking you to share what you have learned and put it to good
use. It does not matter much whether you use the terms in this book. What matters more are the
actual things you do or encourage in others. When you open up, you empower others to do
likewise. When you take the perspective of others, or make your chosen values clear and step in
their direction, you help create human connection and healthy motivation. When you let others
know that there is an alternative to mental entanglement and emotional avoidance, you give the
gift of hope. And all of that leads to a kinder more nurturing world, reducing the negative
experiences that foster inflexibility in the first place.
Life is a misery when we allow ourselves to be dominated by the Dictator Within. When we
are freed from its grip, there is another mode of mind just a hair’s width away—as the title of this
book says, a liberated mind that can help us pivot toward what matters.
We have the seeds within already. If you see a spectacular sunset tonight, you will have the
intuitive wisdom just to say “wow” as you open your eyes wide to take in the whole of it. You
will not say, “It needs a little more pink.” That “wow” mode of mind is not restricted to beauty.
If tomorrow you meet a crying child telling a tale of personal horror, you might again say “wow”
as you listen intently to take in the whole of that child’s pain. You will not say, “Could you talk
about something a little less disturbing?”
This book did not teach you anything that you did not, at some deep level, already know in
your very soul. All it did was lay out the principles you can use to evolve your life in a chosen
direction by tapping into the power of psychological flexibility—the power of a liberated mind.
Humanity is in a race, a race to create a kinder, more flexible and values-based world—to say
it another way, a more loving world that is better able to face the challenges that our own
scientific and technological developments present to us. Either we will learn how to create
modern minds for this modern world of ours, or we will loom ever closer to disaster.
None of us knows how it will turn out, but based on human history, I put my bet on the
human community evolving to meet the challenge. I put my bet on our capacity to choose love
over fear. That can only happen one person, couple, family, business, and community at a time.
When each of us learns how to put our own mind on a leash, and become more able to open up,
show up, and move forward toward what we deeply care about, we shine a light into the darkness
that helps others do the same. There is a good word for it: the word is love.
We know how important that is. The crying eight-year-olds within us know. Deep down, we
all know that love isn’t everything, it’s the only thing.
Peace, love, and life, my friends.
—S
Do you see
the sun shines, day after day
whether you have faith
or not
the sparrows continue
to sing their song
even when you forget to sing
yours
—Julia Fehrenbacher
NOTES
Epilogue
Hold Out Your Hand: This beautiful poem is published by permission of the author. Julia has a book of her poems available
called (fittingly for me and for the last page of this book) On the Other Side of Fear (Balboa Press, 2012), and you can find her e-
books at http://www.etsy.com/shop/juliafeh.
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
INDEX
The page numbers in this index refer to the printed version of this book. The link provided will take you to the beginning of that
print page. You may need to scroll forward from that location to find the corresponding reference on your e-reader.
abuse
ACT training for victims, 324–27
childhood, 193–97
domestic violence, 101–03, 111, 198, 324–27
Duluth Model approach, 325, 326
recovering from, 324–25
recurrence to those who don’t face their feelings, 9
revictimization, 195–96
acceptance (the third pivot)
and chronic pain, 368–69
CrossFit athletes study example of discomfort acceptance, 348–49
“dropping the rope” metaphor, 104–05, 135
funnel metaphor diagram, 192
getting professional help with, 202
as a gift, 197–98
“I’m RFT With It!” acronym for increasing acceptance in others, 315–16, 323, 325
instant gratification of avoidance instead of, 97–98
methods, 201–7
nurturing acceptance, 314–16
pivot from experiential avoidance to, 20–21, 98
and stress, 285–86
three underlying principles of, 199–201
true message of, 96–97
ACT (Acceptance and Commitment Therapy)
actively looking for more challenges, 271–73
and addiction, 25–26
addressing large-scale social problems, 274, 378–85
best practices, 143–44
CO2 challenge, 105–06
compatibility with religious teachings, 351, 361–62
core hypothesis, 29
development of, 40–43, 56–60, 63–64
“dropping the rope” metaphor for acceptance, 104–05, 135
and eating disorders (ED), 305–07
effectiveness, 45, 266
exposure approach, 105–07, 198–202, 207, 298–99
in the family relationships domain, 272–73
as a form of evolutionary science, 129–32
and generalized anxiety disorder (GAD), 154–56
“leaves on a stream” exercise, 156
making progress with, 145
the Matrix diagram, 346–48, 383
and mental health conditions, 294–95
“normalize, validate, reframe, activate” sequence, 320
online support communities, 148
Prosocial training, 382–83
regular practice of skill application, 136–37, 263–64
research results, 24–27, 123, 124–25, 275–77
response to, 96
six skills (pivots), 18–24, 109, 124–25
Swedish studies of using ACT methods to cope with chronic pain, 132–36, 368
toolkit
applications in all aspects of life, 266–67
grid, 264–66
workplace example of discovering the barriers to the six yearnings, 268–71
transdiagnostic results, 26
as a way of facing fears, 16
as a way to break the spell of unhelpful rules, 92–94
action (the sixth pivot)
building habits in small steps, 22, 123–24
building new habits incrementally, 256
commitment, 122–24, 254
funnel metaphor diagram, 251
the hero’s journey, 252–53
making the behavior changes necessary to pivot, 254–55
methods, 257–60
and stress, 287
yearning to be competent, 247–51
addiction
link between depression, anxiety, and substance abuse, 293, 302–03
poly-drug users in twelve-step programs research, 25, 123
shame and self-stigma, 302–03
twelve-step programs, 303–04
using ACT to treat, 25–26
aging, 366
alexithymia, 8–9, 195–96
Alternative Uses Task, 160–61
Andersson, Gerhard, 374–75
Angiola, Julie, 372
anxiety
applying ACT to generalized anxiety disorder (GAD), 155–56
author’s attempts to control, 17, 29–40, 78, 100–03, 111, 145–46, 198, 259, 299–300
cognitive behavioral therapy (CBT) as a treatment for, 298
and eating disorders (ED), 305–06
generalized anxiety disorder (GAD), 154–56
link between depression, anxiety, and substance abuse, 293, 302–03
monkey trap example of fighting for control, 17
positive aspects of, 100–01
relaxation-induced panic, 78
research on ACT methods and, 298–99
statistics, 298
using traditional CBT to overcome, 56
athletic performance and ACT training, 348–50
Atkins, Paul, 273
attentional flexibility, 21, 114–16, 219
autism, 174–75
Automatic Thoughts Questionnaire (ATQ), 33
avoidant persistence
awareness of avoidant thoughts and behaviors, 145–46
dangers of avoidance, 199–200
and eating disorders (ED), 304–05
pivoting to committed action, 22
substance abuse motivated by avoidance, 300–01
awareness
after the Self pivot, 176–77
flashlight example of focusing, 112, 215–16
large-group awareness training, 59
gender
gender bias, 332
incidence of eating disorders (ED) by gender, 304
generalized anxiety disorder (GAD), 154–56
genetics
effect of abuse on, 193
epigenetic processes, 61
and experiences, 61–62
human genome mapping, 60–61
influence on psychological conditions, 60–61
meditation’s effect on genes, 113
and mental health conditions, 292–93
methylation, 62
global transformation
changing a cultural practice, 380–81, 383–84
Commit and Act organization, 381–82, 385
creating a more loving world, 387–88
Ebola outbreak example of using ACT to save lives, 379–85
needs of the modern world, 378–79
Prosocial training, 382–83
goals
SMART (specific, measurable, attainable, results-focused, time-bound), 251–52, 280–81
socially compliant goals, 21–22, 337
student writing study about values and goals, 120–22
vs. values, 117–19, 231–32
Gregg, Jennifer, 370–71
growth, post-traumatic, 24–25, 365
habits
building, 22, 256
cues for new behaviors, 257–58
making small changes, 257
reverse compass, 258–59, 299–300
Hardy, Raymond Reed, 217
Hayes, Camille, 329–30
Hayes, Charles, 34
Hayes, Esther, 341
healthy behaviors
body knowledge, 281–82
chocolate cravings and ACT skills studies, 275–77
cravings, 282–83
exercise and ACT skills study, 276, 283–84
importance of, 275
sleep, 289–91
stress, 284–89
weight control, 276–84
heart attack, author’s experiences with a panic attack mimicking a, 34–36
Hefferline, Ralph, 89
“Hold Out Your Hand” (poem), 388–89
Hollon, Steve, 33
humanistic and existential therapy, 48–49
humans vs. other species
button-pushing experiments, 86–88
cooperative behavior, 74–75
human understanding of the concept of “more,” 69–70
language development
explaining the stages of, 51
learning through deriving relations, 68
learning through direct association, 67
perspective-taking relations, 72–74
relational frame theory (RFT), 71–72
symbolic meaning of words and mental images, 66
two-way relations between words and their meanings, 67–69, 72
learning experiences
desire to learn new skills, 247–48
recognizing the value of, 99
at work, 345
Leeming, Emily, 348–49
Levitt, Jill, 106
life in the modern world
illnesses due to lifestyle, 3–4
scientific progress, 3
technology’s effect on, 4
Lillis, Jason, 307
lying, 75–77
Mad Men (TV show), 12
Marlatt, Alan, 302
Maslow, Abraham, 48–49
materialism, 225–26
McGraw, Phillip (“Dr. Phil”), 13
Meadows, Guy, 291
meaning
choosing a life course, 224–25
social pressures to find, 225–26
meditation. See also mindfulness practices
benefits of, 216
effects of contemplative practice, 113, 212–13
potential problems of, 213–14
the Stroop Task, 213
memories
distortion of history, 115–16
painful, 194–95
mental health. See also specific mental health conditions
causes of mental health conditions, 14
the coherence effect and psychological health, 91
and genetics, 292–93
getting professional help, 293–94, 320
having compassion for those who suffer, 308–09
link between depression, anxiety, and substance abuse, 293, 302–03
psychological treatment methods, 14
responding to children’s suicidal thoughts, 319–20
statistics, 3–4
using ACT to treat mental health conditions, 294–95
using medication to treat, 14
the mind
bringing ourselves back to the present, 110–11
Dictator Within, 9, 18, 32–34, 36, 41–42, 63, 65–66, 73–74, 81–82, 93–94, 95, 123, 161, 250, 336, 387
mindfulness practices. See also meditation
without acceptance, 214–15
as another method of avoidance, 213–14
author’s experiences with, 58–60
contemplative practice, 113, 212–13
directing one’s attention, 112–13
with an emphasis on purpose, 212
Erhard Seminars Training (est), 58
flashlight example, 112, 215–16
following the breath exercise, 113, 219
foot focusing exercises, 218–19
large-group awareness training, 59
meditation, 213
parade and placard thought exercise, 113–15
motivation
extrinsic rewards, 248, 335–36
intrinsic, 247–48, 335–36
self-esteem, 172–73
selfishness, 273
self-judgment defusion exercise, 167–70
self (the second pivot)
conceptualized self (ego), 20, 36, 175
connecting with the hidden sense of your transcendent self, 175–77
funnel metaphor diagram, 173–74
methods, 177–89
perspective-taking self, 20, 36–37, 91, 174–76, 340
self-esteem, 172–73
self-story, 76, 172, 179, 182–83
social consciousness, 174–75
transcendent self, 171
yearning for belonging to the group, 171–72
sensations of fear, exposure to, 57–58, 99–100
shame and self-stigma, 277–79, 284, 302–03
Sierra Leone
Ebola outbreak of 2014, 379–85
improvements made in Bo, 381–83, 385
mental healthcare system, 379, 381–83, 385
Singh, Nirbhay, 219
skills practice, 136–37, 263–64
Skinner, B. F., 49–50, 51–52
sleep
and ACT training, 289–91
cognitive behavioral therapy for insomnia (CBTi), 289–91
consequences of poor sleep, 289
good sleep hygiene, 290
open focus presence exercise for insomnia, 291
The Sleep Book (Meadows), 291
SMART (specific, measurable, attainable, results-focused, time-bound) goals, 251–52, 280–81
social consciousness, 174–75
socially compliant goals, 21–22, 337
social transformation
Commit and Act organization, 381–82, 385
creating a more loving world, 387–88
needs of the modern world, 378–79
Prosocial training, 382–83
spiritual well-being
cancer patient example of using ACT with prayer, 361–62
cosmic consciousness, 352–53
essential characteristics of, 351–52
and flexibility skills, 352
forgiveness, 358–60
perspective-taking exercise to develop both/and thinking, 356–58
perspective-taking exercise to foster compassion, 354–56
and religious faith, 351, 361–62
sense of we, 358
transcendence, 352–54
sports
and ACT training, 348–50
CrossFit athletes study example of acceptance, 348–49
storytelling
the hero’s journey, 252–53
lying, 75–77
about ourselves, 73–74
stress
benefits of flexibility skills to lessen, 284–88
effect on health, 284
identifying stress buttons and solutions, 287–88
parenting role example of using flexibility skills to relieve stress, 287–88
passengers on the bus exercise, 288–89
practicing a flexibility habit linked to a stressor, 288
the Stroop Task, 213
Strosahl, Kirk, 364
substance abuse
link between depression, anxiety, and substance abuse, 293, 302–03
poly-drug users in twelve-step programs research, 25, 123
research on ACT methods and, 300–01
shame and self-stigma, 302–03
triggers, 301–02
twelve-step programs, 303–04
using ACT to treat addiction, 25–26, 300–03
suffering, turning toward, 5–6
suicidal thoughts, 319–20
Swedish studies of using ACT methods to cope with chronic pain, 132–36, 368
systematic desensitization, 50–51
technology
constant exposure to tragedy, 4
online support communities, 148
terminal illness
ACT training for coping with, 375–77
thought(s)
automatic thoughts exercise example, 152–53
Automatic Thoughts Questionnaire (ATQ), 33
cognitive reappraisal, 363–64
complexity of relational thought, 70–72, 78–79
contradictory, 150
defusion exercises, 94–95, 153–54
inability to delete, 77–78
mind wandering, 153
noticing, 115
relational frames, 69–72
subconscious, 79
suicidal, 319–20
symbolic meaning, 66, 74–75
and their impact on behavior, 95
thought processes, 37, 41, 94–95, 152–54
tinnitus
author’s experiences with, 271, 374
research on psychological flexibility and, 374–75
Tinnitus Acceptance Questionnaire, 374
tinnitus retraining therapy (TRT), 373–75
Titchener, Edward, 80
Tolle, Eckhart, 352
turning toward the dinosaur, 38–39, 100
twelve-step programs
poly-drug user research, 25, 123
using ACT in combination with, 303–04
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
About the Author
Steven C. Hayes, Ph.D., is a professor of psychology at the University of Nevada, Reno. The
author of forty-three books and more than six hundred scientific articles, he has served as
president of the Association for Behavioral and Cognitive Therapy and the Association for
Contextual Behavioral Science, and is one of the most cited psychologists in the world. Dr.
Hayes initiated the development of Acceptance and Commitment Therapy (ACT) and of
Relational Frame Theory (RFT), the approach to cognition on which ACT is based. His research
has been cited widely by major media, including: Time magazine, The New Yorker, The New
York Times, Men's Health, Self, The Wall Street Journal, Psychology Today, O, The Oprah
Magazine, and Salon.com.
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