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Pain is Inevitable; Suffering is Optional

The goal of Acceptance and Commitment Therapy (ACT) is to create a rich, full, and meaningful life while accepting the pain that inevitably goes with it. This is done by changing one’s relationship to their symptoms in order to live a more value-driven life. Further, the goal is to accept what is outsideof one’s control, and commit to taking action to enrich one’s life. It can be summed up in one basic premise: pain is inevitable, but suffering is optional.

Oftentimes, trying to get rid of symptoms actually results in being more bothered by the symptoms. For example, try to not picture a pink elephant in your mind’s eye. What happened? You saw a pink elephant. This is just what happens when we try NOT to focus on any particular thing!

Being too focused on symptoms impacts our ability to life a value-driven life. We’re too busy and using all our energy on “symptom-reduction” rather than choosing to focus on what is meaningful in our lives, such as family, friends, relationships, advancing career, rest, self-care, and so forth. When we instead focus on our values, our symptoms can drift to the background, rather than take center stage.

ACT asserts that problems are essentially caused by two things: cognitive fusion and experiential avoidance. Cognitive fusion is when we become inseparable from our thoughts, and then our thoughts dominate our behavior. Experiential avoidance happens when we attempt to avoid, get rid of, suppress, or escape unwanted experiences (thoughts, feelings, memories, sensations, etc.).

Trying too hard to control how we feel simply gets in the way of a rich, full life. We can’t do important, value-driven things if we are always trying to get rid of symptoms. Control is the problem, not the solution.

What can we do about this? Practice defusion to get stuck from our thoughts and gain distance from them. Defusion is taking a step back and seeing our thoughts for what they are: nothing more or less than words and pictures. As I like to say, look AT your thoughts, rather than FROM your thoughts.
Thought Defusion PICTURE for blog post - Copy

Here are some ways you can attempt to defuse from your thoughts:

  • Say “I’m having the thought that…”
  • Use a silly voice to say the thought
  • Sing the thought like a song
  • Repeat the thought nonstop for 30 seconds until it sounds like gibberish

Another way to defuse from unhelpful thoughts is to practice mindfulness. What is mindfulnessMindfulness means paying attention with flexibility, openness, and curiosity. It allows you to be aware of your experience in the moment as opposed to being “caught up” in your thoughts. Mindfulness involves an attitude of openness; being curious about your experience rather than fighting with it. This is helpful because often times the more we try to fight the way we feel, the more we end up feeling it.
hexagon-4
 
The goal of ACT is referred to as psychological flexibility, which entails being present, opening up, and doing what matters. An important facet of psychological flexibility is acceptanceallowing thoughts and feelings to be present, regardless of whether they are pleasant or painful.

The fun part of ACT (in my humble opinion) is valued living: doing what we want to be doing with our lives. What’s important to us? What do we want to stand for? How do we want to behave and act on a daily basis? Our values are our compass; they guide our decisions and behavior. A good way to figure out what your values are is to imagine your retirement party or funeral — Who would you want to speak about your life and what would you want to hear them say?

Once you have figured out what your values are, then final step is to take committed action (effective action motivated by your values). One helpful way to do this are to make a public commitment; tell someone about it. This will create some level of accountability for you. Another thing you can do is create an action plan worksheet. Last, but not least, simply take the first, tiniest step. The first step is often the hardest, but if you can manage to get started, the rest will follow.

For more on Acceptance and Commitment Therapy, click here and here!

How to Dispute Irrational Beliefs

Albert Ellis is known as the grandfather of Cognitive Behavior Therapy. He combined humanistic, philosophical, and behavioral therapy to form Rational Emotive Behavior Therapy (REBT) in 1955. A main assumption of REBT is that people contribute to their psychological problems by the way they interpret events. Further, our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations. REBT assumes that cognitions (thoughts), emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship. Additionally, REBT postulates that people are born with a potential for both rational and irrational thinking.

According to Ellis, we have an inborn tendency toward growth and actualization, yet we often sabotage our movement toward growth due to self-defeating patterns we have learned. We originally learn irrational beliefs from significant others during childhood, and we actively reinforce these self-defeating beliefs by repetition, and by behaving as if they are useful. But it is not useful to blame ourselves and others; instead, it is important that we learn how to accept ourselves despite our imperfections. Therefore, a major goal of REBT is to achieve unconditional self-acceptance and unconditional other acceptance; the more one is able to accept him or herself, the more likely he is to accept others.

The therapeutic process involves identifying irrational beliefs, and replacing such beliefs with more rational and effective ways of thinking. Changing one’s thinking results in changing one’s emotional reactions to situations. Ellis succinctly puts it this way, “You mainly feel the way you think.” Some examples of irrational beliefs that lead to self-defeat include: I must have the approval of all the people in my life, or else I am worthless. I must perform all tasks perfectly, or else I am a failure. It is better to avoid life’s difficulties than to try and end up looking foolish.

The A-B-C framework and method of disputing irrational beliefs is central to REBT theory and practice.

A = an event, behavior, or attitude
B = belief about the event
C = emotional & behavioral consequence or reaction (can be healthy or unhealthy)
D = disputing irrational or self-defeating beliefs
E = effective philosophy of replacing unhealthy thoughts with healthy ones
F = a new set of healthy feelings

A (the activating event) does not cause C (the emotional consequence); rather, B (the person’s belief about the event) largely causes C. D is the application of methods to challenge irrational beliefs by detecting, debating, and discriminating irrational (self-defeating) beliefs from rational (self-helping) beliefs. E is the new and effective belief system that consists of replacing unhealthy thoughts with healthy ones. In doing this, F (a new set of healthy feelings) is created.ABC Framework 11

In summary, Rational Emotive Behavior Therapy entails the following steps: (1) acknowledge that we are largely responsible for our own emotional problems, (2) accept that we have the ability to change these disturbances significantly, (3) recognize that our emotional problems often stem from irrational beliefs, (4) accurately perceive these beliefs, (5) see the value of disputing such self-defeating beliefs, (6) accept that we need to counteract our dysfunctional beliefs/feelings/behaviors, and (7) practice these methods to improve current and future circumstances.

References:
Corey, Gerald. Theory and Practice of Counseling and Psychotherapy. Belmont. Thomas Learning, Inc. 2005.

Ten Rules for Confidence

[from The Confidence Gap: A Guide to Overcoming Fear and Self-Doubt, by Russ Harris]

Rule 1: The actions of confidence come first; the feelings of confidence come later.
The concept of confidence is defined as “an act of trust or reliance” (trusting and relying on one’s abilities and competencies), rather than viewing confidence as “having a feeling of absolute certainty or assurance.” This is a better approach, because if you wait for the feelings of confidence to come before taking any sort of action, then there’s a chance you might end up waiting forever. That’s not very effective. Harris offers four steps to follow in order to become more confident in any action: (1) Practice the skills, (2) Apply them effectively, (3) Assess the results, and (4) Modify as needed.

Rule 2: Genuine confidence is not the absence of fear; it is a transformed relationship with fear.
People believe many myths about fear, such as: fear is a sign of weakness; fear is the enemy; fear holds you back; confidence is the absence of fear. But the truth is that when anyone steps out of their comfort zone, takes a risk, or faces a challenge, they will experience fear. That’s not a sign of weakness; it’s the natural human response. Fear doesn’t have to be viewed as an enemy, or something to hold you back, rather, it can be used as a motivating source of energy to be used for your benefit. It is not true that confident people don’t feel anxious or afraid, but perhaps they have figured out how to handle it and channel it effectively.

Rule 3: Negative thoughts are normal. Don’t fight them; defuse them.
Dealing with negative thoughts can be annoying, but the fact that we have them is actually a good thing! It’s a sign that our brains are working: trying to anticipate what could hurt us or harm us, trying to predict what might go wrong, etc. If your mind has negative or anxious thoughts, congratulations – you have a normal brain. Negative thoughts are not inherently problematic, they only become so if we get all caught up in them, give them all our attention, treat them as the gospel truth, allow them to control us, or get into a fight with them. The goal is defusion: separate from your thoughts and realize that they are simply words.

Rule 4: Self-acceptance trumps self-esteem.
Having high self-esteem means evaluating oneself positively. The trouble is that it gets hard to do this when one is not successful, or when one makes mistakes. On the other hand, self-acceptance means accepting oneself in spite of deficiencies. It involves letting go of all self-judgments. It doesn’t mean that we stop paying attention to the way we behave, and the impact of our actions; it simply means that we let go of blanket self-judgments. When we make a mistake, we reflect on it and assess our actions. Harris puts it well when he poses: “If beating ourselves for every mistake we make was productive, wouldn’t we all be perfect by now?”

Rule 5: Hold your values lightly, but pursue them vigorously.
Values are one’s guiding principles of behavior, according to what is important to them in life. Harris likens values to a compass: they give us direction, guide our journey, and help us stay on track. (Goals are what we want to achieve along the way). Examples of values include: adventure, authenticity, connection, contribution, courage, creativity, flexibility, honesty, humor, intimacy, open-mindedness, respect, self-awareness, spirituality, and trust. One reason to hold your values lightly is the tendency for them to turn into inflexible requirements, such as, “I must be adventurous at all times.” Remember, the goal is to live by guiding values, not rigid rules.

Rule 6: True success is living by your values.
This means using one’s values to set goals, and to sustain movement toward set goals. You don’t have to wait until you achieve a goal in order be successful; you can be successful right now through living by your values. Maybe a goal of yours is to become a doctor because you hold the value of helping others. It will take you several years to actually become a doctor, but you can do many things to help people along the way.

Rule 7: Don’t obsess about the outcome; get passionate about the process.
Process is the way you go about doing something, whereas outcome is the result of what you’ve done. The idea here is not to give up on your goal(s), but to shift the emphasis to engaging fully in the process, and embracing it as an opportunity for learning, rather than obsessing about the outcome.

Rule 8: Don’t fight your fear: allow it, befriend it, and channel it.
Russ Harris Speaks of using “The ABC of Fear-Whispering” for dealing with fear (A=allow, B=befriend, C=channel). Trying to fight against or avoid an emotion oftentimes just makes the unpleasant emotion stronger. So, instead of fighting your experience of fear, try simply allowing it to be. Harris encourages befriending one’s fear: building a positive relationship with it. You don’t necessarily have to like it, but haven’t you ever been friendly to a person whom you don’t necessarily like? It’s kind of like that. Also, fear is worth befriending if it helps you live by your values, achieve your goals, perform at your peak, and live a richer, more meaningful life. Fear is kind of like nervous energy, but it can be less scary if you frame it as feeling “excited” or “pumped” instead. Think to yourself, “How can I make good use of this energy? What can I channel it into?” Use your fear to your benefit. And remember, you can have fear and confidence at the same time. If you recall Rule 2: Genuine confidence is not the absence of fear, it is a transformed relationship with fear.

Rule 9: Failure hurts – but if you’re willing to learn, it’s a wonderful teacher.
In the words of John Dewey (American philosopher): “Failure is instructive. The person who really thinks learns quite as much from his failures as from his successes.” Just like fear, failure is a fact of life. It’s also a natural part of learning; we reflect on what didn’t work, and think about what might work better next time. It is productive to acknowledge what went “wrong,” while also appreciating what went well. It provides good feedback from which to learn!

Rule 10: The key to peak performance is total engagement in the task.
Peak performance requires practice, defusing from reasons not to do it, making room for discomfort or fear, and fully engaging in the process. The key to peak performance is having focused attention on the task at hand. This requires mindfulness: defusing from unhelpful thoughts, such as, what you look like, what others are thinking, judging your performance, thinking about past or future events, etc. While you can’t eliminate unhelpful thoughts or feelings, you can make space for them while remaining focused and engaged in what you are doing in the present moment. It is in this state of mindful, focused action that we perform at our best.

My Declaration of Self-Esteem

I am me.

In all the world, there is no one else exactly like me.

There are persons who have some parts like me, but no one adds up exactly like me. Therefore, everything that comes out of me is authentically mine because I alone chose it.

I own everything about me – my body, including everything it does; my mind, including all its thoughts and ideas; my eyes, including the images of all they behold; my feelings, whatever they may be – anger, joy, frustration, love, disappointment, excitement; my mouth, and all the words that come out of it, polite, sweet or rough, correct or incorrect; my voice, loud of soft; and all my actions, whether they be to others or to myself.

I own my fantasies, my dreams, my hopes, my fears.

I own all my triumphs and successes, all my failures and mistakes.

Because I own all of me, I can become intimately acquainted with me. By doing so I can love me and be friendly with me in all my parts. I can then make it possible for all of me to work in my best interests.

I know there are aspects about myself that puzzle me, and other aspects that I do not know. But as long as I am friendly and loving to myself, I can courageously and hopefully look for the solutions to the puzzles and for ways to find out more about me.

However I look and sound, whatever I say and do, and whatever I think and feel at a given moment in time is me. This is authentic and represents where I am at that moment in time.

When I review later how I looked and sounded, what I said and did, and how I thought and felt, some parts may turn out to be unfitting. I can discard that which is unfitting, and keep that which proved fitting, and invent something new for that which I discarded.

I can see, hear, feel, think, and do. I have the tools to survive, to be close to others, to be productive, and to make sense and order out of the world of people and things outside of me.

I own me, and therefore I can engineer me.

I am me and I am okay.

V. Satir, “A Goal of Living”

People-Pleasing: Is it really such a good thing?

Excerpts from The Disease to Please (Harriet B. Braiker)
Additional annotations by Molly Pierce, MA, LPC, NCC

Has anyone ever told you that you’re a people-pleaser?  Don’t be so flattered…it’s not really a compliment.  It feels better to view people-pleasing as an admirable attribute, rather than look at it for what it truly is: a serious psychological problem. 

In actuality, the “disease to please” is a compulsive — even addictive — behavior pattern in which you feel controlled by your need to please others, and addicted to their approval.  At the same time, you feel out of control over the pressures and demands on your life that these needs have created. 

The Disease to Please is comprised of three components: (1) People-Pleasing Mindsets, or distorted ways of thinking; (2) People-Pleasing Habits, or compulsive behaviors; and (3) People-Pleasing Feelings, or fearful emotions

People-Pleasing Mindset
If you fall into this category, your behavior is driven by a fixed thought that you need and must strive for everyone to like you.  You measure your self-esteem and define your identity by how much you do for others whose needs, you insist, must come before your own.  You believe that being nice will protect you from rejection and other hurtful treatment from others.  You impose demanding rules, harsh criticism, and perfectionist expectations on yourself in an attempt to gain universal acceptance from others.

People-Pleasing Habits
If you fall into this group, you are driven to take care of others’ needs at the expense of your own.  You do too much, too often for others, almost never say “no,” rarely delegate, and inevitably become overcommitted and spread too thin.  And, while these self-defeating, stress-producing patterns take their toll on your health and closest relationships, they maintain a firm grip on your behavior because they are driven by your excessive, even addictive, need for everyone’s approval.

People-Pleasing Feelings
Under this category, your behavior is primarily caused by the avoidance of frightening and uncomfortable feelings. You will recognize the high anxiety that merely the anticipation or possibility of any angry confrontation with others evokes.  (All you conflict avoiders out there — this is you!)  Your people-pleasing behaviors are primarily an avoidance tactic intended to protect you from your fears of anger, conflict, and confrontation.  These fears don’t actually diminish; they intensify as long as the avoidance pattern persists!  (Long story short: you have to face your fears in order to overcome them).  Because you avoid difficult emotions, you never allow yourself to learn how to effectively manage conflict or how to appropriately deal with anger.  As a consequence, you relinquish control too easily to those who would dominate you through intimidation and manipulation.

Living a life of people-pleasing is not the way to go.  Your self-esteem takes a massive toll.  Your identity and sense of self-worth is all tied up in how much you do for others and how successful you are at pleasing them.   It causes your relationships to lose their authenticity; If your niceness prevents you from telling others what is making you unhappy, angry, upset, or disappointed — or from hearing their complaints — there is little chance of fixing what has gone wrong.

Under the surface of your selfless niceness, resentment and frustration will begin to boil and churn, threatening to eventually erupt in open hostility and uncontrolled anger.  It takes a physical toll, as well.  It may come out in the form of migraine or tension headaches, back pain, stomach pain, high blood pressure, or any of a host of other stress-related symptoms.  You will eventually hit the proverbial wall with your energy exhausted and you’ll want to give up, not knowing what else to do.  In the end, your trusty habits of people-pleasing will fail you. So save yourself the trouble, and don’t spend your whole life living hostage to its ways.