Mindfulness
Bob Rich’s Self-Therapy Guide: Act the Way You Want to Be
In this series, Dr. Bob Rich teaches you how to leave behind depression, anxiety, and other forms of suffering all too common in our crazy world. Recovering the Self published two sections of Bob Rich’s book From Depression to Contentment: A self-therapy guide in a series of posts – the first section ending with the quest for meaning and the second section concluding with The Development of Resilience. The third section of Bob’s work continues here with special attention to various techniques and practices that are helpful in controlling depression.
In the previous post, Bob discussed Narrative Therapy and its use in treating behavioral issues. Here he talks about how to act – and there is more to the word than apparent at first glance.
Act the Way You Want to Be
As I said, thinking, action, emotions and bodily sensations are all part of the one thing. CBT and Narrative Therapy focus on thoughts. Acceptance and Commitment Therapy is all about doing. The acronym ACT should be said as the word “act.”
This is a mindfulness-based therapy, so by now you should be well prepared for it, because you regularly enjoy mindfulness meditation, right? Mindfulness comes in because, instead of avoiding unpleasant thoughts, emotions or sensations, we accept them and observe them without judgment. It is allowing your inner experience to be as it happens to be, without an attempt at control or struggle.
Years ago, I learned about ACT through a course run by Russ Harris. Here is his definition: “Imagine a therapy that makes no attempt to reduce symptoms, but gets symptom reduction as a byproduct. A therapy firmly based in the tradition of empirical science, yet has a major emphasis on values, forgiveness, acceptance, compassion, living in the present moment, and accessing a transcendent sense of self. A therapy so hard to classify that it has been described as an ‘existential humanistic cognitive behavioural therapy’.”
If you like the little I say here, you must read his book, The Happiness Trap, which is a complete self-help guide to ACT.
The acceptance part of the name is there because our normal reaction to having a problem is to struggle with it, to try to make it go away. Problem solving is a process of identifying a problem, and finding a way of getting rid of it. This works so well in practical matters that we automatically apply it for thoughts and emotions we identify as problems, but there, the effect is the opposite. With psychological issues, the more we try, the worse the situation gets, and this is all tied up with thoughts. So, unlike cognitive therapy, the aim of which is to change the thoughts, ACT simply accepts them.
By trying to get rid of “symptoms,” we worsen our situation. Worrying about being anxious is anxiety-provoking, resenting depression is depressing, and so on. ACT starts with the paradoxical viewpoint of simply accepting what is, and that makes half the problem immediately go away. I may be sad, but no longer depressed about being sad.
A typical start to therapy is to look at your past attempts to solve the problem (e.g., of ongoing sadness), and seeing that none of them have worked. They will all have something in common: a struggle to get rid of it. When you turn off the “struggle switch,” the original problem may still be there, but you’ll feel liberated, having shed a huge load. Remember, “If something works, do more of it. If it doesn’t work, do something else.”
You are not what you think, but what you do
The second part, commitment, is commitment to a certain kind of action. This then sneaks up on you, and becomes your new “second nature.”
When a famous philanthropist died, he was lauded for his many acts of charity and compassion. He was so involved in his charitable activities that, for decades, he’d passed control of his business to his sons.
How did this start? According to his authorized biography, as a young man he was ruthless in his business dealings, and in his treatment of his workers. Profit was all. This affected his reputation, to the point that he was losing business. He engaged what we’d now call a PR consultant, who advised him to make highly visible charitable bequests, support foundations for good causes, etc. He started all this good work for entirely selfish reasons: to appear to be a good guy. But the result was — he BECAME a good guy. His actions came first. The motives followed.
Socrates said, “Seem the man you wish to be.” That’s it.
The next technique is explained through one of Russ Harris’s metaphors. You’re steering a boat way out at sea, and want to approach the shore. However, every time you steer shoreward, a bunch of frightening monsters swarm out from below decks, surround you, shout at you and threaten you. As soon as you change direction, they go away.
As long as you’re scared of them, and give in, and avoid steering toward the shore, you feel safe — and stay all at sea.
Suppose that when they started to carry on, you continued steering for shore regardless. You’d find that they cannot stop you, and have no power to do any harm. All they can do is to threaten. They are actually cardboard cutout monsters! And if you continued ignoring them, time and again, after a while they’d give up.
How does this work in practice?
Agnes suffered from severe Obsessive-Compulsive Disorder (OCD). She HAD TO wash her hands exactly 17 times after doing anything she considered dirty, such as grasping a door handle in a public place. She felt forced to internally recite certain words in given situations. There were a whole lot of other must-do things, but this’ll do as a sample.
She knew that terrible anxiety would strike if she defied her compulsions in the slightest.
She was referred to me soon after I did my ACT course with Russ Harris, so decided to test it with her.
I asked her to make a list of all the things she’d attempted until then to free herself from this prison of compulsions. She compiled one, of fifteen different tries. We examined them. I said, “Seems to me, what’s common to them is that every one of these therapies and drugs and whatnot was intended to get rid of your compulsions. They haven’t worked, so we need to give something entirely different a go.”
“Like what?”
“What has been the cost of all this work to avoid the anxiety?”
“I don’t have a life. Might as well be dead than live like this!”
“OK, Agnes, let’s do an experiment.” I waved toward the handbasin, which had elbow-activated taps, since I was renting a room in a medical center. “Wipe your palms on the floor, then immediately do whatever you need to in order to stay hygienic and safe.”
As soon as she finished washing her hands the first time, I said, “Can you please come back to your chair instead of more handwashings?”
“I CAN’T DO THAT!”
“When you have that thought, ‘I can’t do that,’ is it in words you can read in your mind, or sounds, or what?”
“Uh, it’s like I said them to myself inside.”
“Right. Sing them. Do you know the old Beatles song, You can’t do tha-a-a-t?”
Despite her obvious anxiety, she laughed at me. “A singer you’re not.”
“No. I can’t hold a tune if my life depends on it. What about you?”
She sang it fine. “My mother is a Beatles fan, and I know all their songs.”
“OK, within your mind, sing the song in your mother’s voice.”
When she nodded, I got her to do it in the Beatles’ voices, from a deep baritone, and a squeaky cartoon character’s.
I looked at the clock. “Hey, Agnes, it’s been eight minutes since your first handwash, and guess what, you’re still alive.”
Her signs of anxiety had disappeared, but now her hands started shaking, sweat appeared on her forehead, her posture became stiff. She turned toward the handbasin.
“Wait.” I then told her about Russ Harris’s monsters on the boat. “I distracted you, so you weren’t listening to the cardboard cutout monsters. As a result, you were fine until you paid attention to them again.”
This was the start of her healing.
– Dr. Bob Rich
