Get Out of Your Mind and Into Your Life
Page 8
“Accept” comes from the Latin root “capere” meaning “take.” Acceptance is the act of receiving or “taking what is offered.” Sometimes, in English, “accept” means “to tolerate or resign yourself” (as in, “Aw, gee, I guess I have to accept that”), and that is precisely not what is meant here. By “accept,” we mean something more like “taking completely, in the moment, without defense.”
We use the word “willing” as a synonym for “accepting” to stay true to that meaning of accept. “Willing” is one of the older words in the English language. It comes from an ancient root meaning “to choose.” Thus “acceptance” and “willingness” can be understood as an answer to this question: “Will you take me in as I am?” Acceptance and willingness are the opposite of effortful control. Remember the dial at the back of the radio in chapter 3? Now you know its name: the Willingness dial.
What follows is a description of what “to take me in as I am” really means.
In our context, the words willingness and acceptance mean to respond actively to your feelings by feeling them, literally, much as you might reach out and literally feel the texture of a cashmere sweater. They mean to respond actively to your thoughts by thinking them, much as you might read poetry just to get the flow of the words, or an actor might rehearse lines to get a feel for the playwright’s intent.
To be willing and accepting means to respond actively to memories by remembering them, much as you might take a friend to see a movie you’ve already seen. They mean to respond actively to bodily sensations by sensing them, much as you might take an all-over stretch in the morning just to feel your body all over. Willingness and acceptance mean adopting a gentle, loving posture toward yourself, your history, and your programming so that it becomes more likely for you simply to be aware of your own experience, much as you would hold a fragile object in your hand and contemplate it closely and dispassionately.
The goal of willingness is not to feel better. The goal is to open up yourself to the vitality of the moment, and to move more effectively toward what you value. Said another way, the goal of willingness is to feel all of the feelings that come up for you more completely, even—or especially—the bad feelings, so that you can live your life more completely. In essence, instead of trying to feel better, willingness involves learning how to feel better.
To be willing and accepting is to gently push your fingers into the Chinese finger trap in order to make more room for yourself to live in, rather than vainly struggling against your experience by trying to pull your fingers out of the trap (see figure 3.1). To be willing and accepting means to give yourself enough room to breathe.
By assuming the stance of willingness and acceptance you can open all the blinds and the windows in your house and allow life to flow through; you let fresh air and light enter into what was previously closed and dark. To be willing and accepting means to be able to walk through the swamps of your difficult history when the swamps are directly on the path that goes in a direction you care about.
To be willing and accepting means noticing that you are the sky, not the clouds; the ocean, not the waves. It means noticing that you are large enough to contain all of your experiences, just as the sky can contain any cloud and the ocean any wave.
We don’t expect this foray into poetic metaphors to make any difference yet. But the sense conveyed by them may give you an idea of what we are aiming for in pursuing acceptance in this book.
If you find your mind agreeing or resisting, just thank your mind for the thought. Your mind is welcome to come along for the ride. But willingness and acceptance are states of being that minds can never learn how to achieve. Fortunately, there is more to you than just your repertoire of relating and symbolizing (see chapter 2). Even if your mind can’t learn how to be willing and accepting, you can learn.
Why Willingness?
One reason willingness is worth trying is that it is remarkable how consistently the scientific literature reveals its value and the danger of its flip side—experiential avoidance. One reason this book is not about anger, depression, anxiety, substance abuse, chronic pain (or any of the other disturbances and disorders that thrive in modern life) is that we are trying to teach a set of skills that has extremely broad applicability, and that should empower your therapy work or self-directed efforts to change your life.
We first reviewed the literature on experiential avoidance about a decade ago (Hayes et al. 1996) and since then it has exploded. We’ll discuss just a few areas to show how broadly applicable this process can be for psychological suffering.
Physical pain. In virtually every area of chronic pain, physical pathology (the objectively assessed physical damage) bears almost no relation to the amount of pain, reduced functioning, and disability (Dahl et al. 2005). The relationship between the amount of pain and degree of functioning is also weak. What predicts functioning is (a) your willingness to experience pain, and (b) your ability to act in a valued direction while experiencing it (McCracken, Vowles, and Eccleston 2004). These are precisely the processes targeted in this book. Training people how to accept their pain and how to watch it or “defuse from” their thoughts about it (see chapter 6) greatly increases their tolerance of pain (Hayes et al. 1999) and decreases the amount of disability and sick leave downtime caused by their pain (Dahl, Wilson, and Nilsson 2004).
Physical trauma, disease, and disability. In head injury, spinal injury, heart attack, and other areas of physical illness or injury, the degree of physical pathology is a very poor predictor of rehabilitation success and long-term disability. What is predictive is the patient’s acceptance of the condition and the willingness to take responsibility for her or his predicament (Krause 1992; Melamed, Grosswasser, and Stern 1992; Riegal 1993).
In chronic diseases like diabetes, your acceptance of the difficult thoughts and feelings the disease gives rise to, and your willingness to act in the presence of these thoughts and feelings predict good self-management of the disease (Gregg 2004). Other health-care problems, such as smoking, show the same results (Gifford et al. 2004). ACT promotes better health management as a result of changes in your willingness to accept discomfort, unhook from your thoughts, and move toward what is most personally meaningful to you (Gifford et al. 2004; Gregg 2004).
Anxiety. Unwillingness to have anxiety predicts having anxiety in many different forms (Hayes, Strosahl, et al. 2004). For example, when exposed to the same levels of physiological arousal, experiential avoiders are more likely to feel panic than those who willingly accept their anxiety (Karekla, Forsyth, and Kelly 2004). This is particularly true if experiential avoiders are actively trying to control their anxiety sensations (Feldner et al. 2003).
Among people who habitually pull out their own hair, experiential avoidance predicts more frequent and intense urges to pull, less ability to control urges, and more hair pulling–related distress than among people who are not experientially avoidant (Begotka, Woods, and Wetterneck 2004).
People with generalized anxiety disorder are more likely to have high levels of emotional avoidance (Mennin et al. 2002), and both the amount of worry and degree of impairment they suffer correlates with experiential avoidance (Roemer et al. 2005). Even a very small amount of training in acceptance can be helpful, however. For example, just ten minutes of acceptance training made panic-disordered persons more able to face anxiety; training in distraction and suppression was not helpful (Levitt et al. 2004). Similarly, for anxious people, teaching them a simple ACT acceptance metaphor, the Chinese finger trap (see chapter 3), reduced avoidance, anxiety symptoms, and anxious thoughts more successfully than did breathing retraining (Eifert and Heffner 2003).
Childhood abuse and trauma. Childhood abuse predicts current distress to some degree, but the practice of willingness mediates that relationship (Marx and Sloan, forthcoming [b]). In other words, if you are unwilling to experience the memories, thoughts, and feelings that childhood abuse produces, you get stuck with chronic distress as an adult. However, if you are wi
lling to experience those thoughts, memories, and feelings again, the same abuse history is significantly less destructive to your life. When people with initially equal levels of post-traumatic stress have been compared over time, research has shown that those who are willing to have these private experiences have less post-traumatic stress over time (Marx and Sloan, forthcoming [a]).
Job performance. People who are more emotionally willing to experience negative emotional experiences enjoy better mental health and do better at work over time. The effect is significantly greater than the effects of job satisfaction or emotional intelligence (Bond and Bunce 2003; Donaldson and Bond 2004).
Substance abuse. Substance abuse is typically motivated by an attempt to avoid negative private experiences (Shoal and Giancola 2001). The more substance abusers believe that drugs or alcohol reduce their negative emotions, the more likely they are to relapse (Litman et al. 1984).
Depression. Up to half of the variations in the symptoms of depression can be accounted for by a lack of acceptance and willingness (Hayes, Strosahl, et al. 2004).
This review could go on for many more pages, and deal with many more areas, but perhaps these examples are enough to make the point. The scientific literature is filled with evidence that the person’s willingness to experience whatever emotion is present is of central importance to many areas of human psychological functioning.
So, why is willingness so important? Perhaps some first person accounts of the importance of willingness will be more convincing than our capsule review of the literature. Read the following statements and see if they hold true for you, too.
Why willingness? Because when I am struggling against my painful experiences, the struggle seems to make them all the more painful.
Why willingness? Because when I move away from the pain that I meet when I’m pursuing what I value most, I also move away from the richness of life that those valued actions bring to me.
Why willingness? Because when I try to close myself off from the painful parts of my past, I also close myself off from the helpful things I’ve learned from my past.
Why willingness? Because I experience a loss of vitality when I am not willing.
Why willingness? Because my experience tells me that being unwilling just doesn’t work.
Why willingness? Because it is a normal human process to feel pain, and it is inhumane and unloving to try to hold myself to a different standard.
Why willingness? Because “living in my experience,” that is, living in the moment, seems potentially more rewarding than “living in my mind.”
Why willingness? Because I absolutely know how my pain works when I am unwilling, and I’m sick and tired of it. It’s time to change my whole agenda, not just the moves I make inside a control and avoidance agenda.
Why willingness? Because I have suffered enough.
EXERCISE: Why Willingness?
Now it’s your turn. Write down three or four of your own responses that come to mind. If you feel resistance, just notice that, and in a kind, compassionate way allow yourself to feel resistant, and then return to the question, bringing your sense of resistance with you.
• Why willingness? Because _______________________________________________________________
• Why willingness? Because _______________________________________________________________
• Why willingness? Because _______________________________________________________________
• Why willingness? Because _______________________________________________________________
WILLINGNESS AND DISTRESS
Brown University psychologist Rick Brown and his colleagues (forthcoming) have recently demonstrated that people who cannot make room for their distressing feelings have a very hard time with self-control. For example, they worked with a group of chronic smokers trying to end their addiction to nicotine by using a self-help book.
Before the subjects began seriously trying to quit, however, Brown set three preliminary tasks for them. He had them hold their breath for as long as they were able; solve simple but confusing math problems faster and faster until they gave up; and breathe carbon dioxide (CO2) (which creates anxiety symptoms), until they indicated they wanted to stop breathing the CO2. The great majority of those who were good at all three tasks were able to stop smoking. Very few of those who did poorly on the three tasks were able to break their addiction (Brown et al., forthcoming). In other words, if you cannot feel your distressing feelings, you cannot take proper care of your own health. No wonder experiential avoidance predicts a gradual worsening quality of life over time (Hayes, Strosahl, et al. 2004).
EXERCISE: Being Willingly Out of Breath
Now, you are about to find out whether you can use acceptance to increase your ability to sit with your uncomfortable emotions. Get a watch and sit in a place where you won’t be disturbed for a few minutes. You are going to see how long you can hold your breath again, but this time, as you hold it, follow the instructions listed below. Read them over several times until you are confident you will be able to remember to do them, even when feeling painful feelings start up for you. Do not start yet. Don’t start until you see the word “start.” Just read over the following bulleted list:
When you do the exercise and the urge to breathe becomes stronger, we want you to do the following: Notice exactly where the urge to breathe begins and ends in your body. Locate exactly where you feel the urge to breathe.
See if you can allow that feeling to be precisely there and, at the same time, keep on holding your breath. Turn your willingness dial all the way up! Just feel the feeling and do not breathe…think of this as a cool opportunity to feel something you rarely feel.
Notice any thoughts that come up, and gently thank your mind for the thought, without being controlled by that thought. Watch out for sneaky thoughts that can quickly lead to breathing before you decide to breathe. After all, who is in charge of your life? You or your word machine?
Notice other emotions that may emerge other than the urge to breathe. See if you can make room for those emotions, as well.
Survey your entire body and notice that, in addition to the urge to breathe, your body contains other sensations and continues to function.
Stay with the commitment to hold your breath as long as you can. As the urge to breathe becomes stronger, imagine that you are continuously creating that urge deliberately. Close your eyes and see if you can replicate this urge in your imagination, divorced from your body. With every pang in your chest, every worry you have about passing out, every instinct to breath, shift it from something unwelcome that is being visited upon you to something you are creating deliberately, just for the sake of feeling what that feels like. This new urge is formally the same, but it is of your creation. Do you need to be threatened by your own creation?
Before beginning to hold your breath, list one or two other actions you might do during this exercise that might help you to be aware of all of your feelings, thoughts, sensations, and urges while you are holding fast to the goal of holding your breath. Write down only acceptance strategies, not experiential control or suppression strategies. _______________________________________________________________ _______________________________________________________________
Read the bulleted list several times, until you feel you completely understand the instructions. You can leave the book open as you do the exercise, so you can glance at pages 49 and 50 and remind yourself of things to do while really feeling what it feels like to want to breathe while not breathing.
You are ready to see if it is possible to better control your behavior (holding your breath) by learning to accept and make room for your thoughts and feelings.
Now, start:
Take a deep breath and hold it as long as you can. When you are finished, write down how long you held it: ________ seconds.
Describe your experience during this exercise.
______________________________________________________________
_ _______________________________________________________________ _______________________________________________________________ Did the aversiveness of not breathing tend to come and go? When did it go up or down?
_______________________________________________________________ _______________________________________________________________ _______________________________________________________________ How did your mind try to persuade you to breathe before you really had to?
_______________________________________________________________ _______________________________________________________________ _______________________________________________________________ What was the sneakiest thing your mind did?
_______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Do you see any possible implications this simple exercise might have for how your life has been going, especially in the area you’ve been struggling with? If so, what do you see?
_______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Now look back at the amount of time you were able to hold you breath before you started reading this chapter. If you weren’t able to see any possible applications for this exercise in the areas you’ve been struggling with, does this comparison open up any new doors for you?
_______________________________________________________________ _______________________________________________________________ _______________________________________________________________ The types of strategies we asked you to employ to help you hold your breath longer are the very kinds of techniques we will introduce you to in the remainder of this book. If you were able to hold your breath longer the second time around, that provides some evidence that the information in this book may be worthwhile to you. Of course, we will be applying this idea to more complex problems than the simple urge to breath. However, the principle is the same. If you commit to a particular act, use mindfulness and defusion strategies when your mind starts giving you problems with pursuing that path, and move forward accepting what your mind offers you; you will be in a better position to live a full and meaningful life—with or without unpleasant thoughts, emotions, and sensations.