Acceptance and Commitment Therapy – Separating Thoughts from Feelings

Our thoughts and feelings can become fused, and when they are, they become distressing to us, but we don’t have to let them rule our actions and the meaning we get from life. 

Fusion happens when we create the following within our minds:

  • Rules
  • Reasons and justifications
  • Judgements
  • Thoughts about the Past
  • Thoughts about the Future
  • Thoughts about the Self

It is often created by the chattering mind, but this is not all there is. There is also the part of the mind, the observing self, which notices it. And it is this which allows us t defuse our thoughts from our feelings. By defusing our thoughts and feelings we can reduce the distress we experience.  The key process to understand here is Defusion.

To defuse, we can start simply by using phrases such as “what is my mind telling me? what is my mind doing, what am I noticing my mind saying?” Which allow us to distinguish between the mind and our own self. We can talk about the mind as an entity distinct from our self, and simply by writing things down it allows us to distance our self from thoughts.

Then ask ourselves, “how helpful is that thought?”, “is it helping me get to where I want, or will it keep me stuck?”.

Ask yourself how fused you are to these thoughts, i.e. “How caught up am I with the thought?”, “do I notice how hooked in I am after that thought?”

Defusion Techniques

1. Say aloud your NAT. Then say “I’m having the thought that (NAT)”. Then say “I’m noticing that I’m having the thought that (NAT)”

2. Say aloud your NAT. Sing happy birthday in your head but use the NAT as the words. Use the voice of a cartoon character to say the NAT

3. Repeat the harsh word from the NAT again and again until it becomes a meaningless word

4. Imagine the NAT on a computer screen, then play with the font and spacing etc

5. Imagine a stream and leaves floating on the steam, every thought is out on the leaf and watch it float away in its own speed, if you notice a feeling, then put the “here’s a feeling of impatience” on a leaf. Bring yourself back. Don’t try to control their speed.

6. Focus on breathing. Then notice thoughts. Where are they in space? What form do they take (sounds, pictures), moving or still, what is above and below? Continue to notice and make observations about your thoughts

Letting Go Metaphors

Sometimes leaves on a stream don’t do it for you, so maybe use the other letting go metaphors as below:

  • Bubbles
  • Clouds
  • Suitcase on conveyor belt
  • Birds
  • Trains, cars
  • Waves
  • People walking by

Remember it’s not about getting rid of thoughts or not feeling anxious, it’s letting them be and not fighting but gaining distance. It can help to thank your mind for having a thought, because Negative Automatic Thoughts (NATs) are natural and there to protect us evolutionarily. 

Go through examples of when we didn’t act on thoughts, I.e. Didn’t punch the bad driver, didn’t quit our job, so thoughts don’t have to control action, we can have the thought and do something different anyway.

Chessboard Metaphor

It can help if we imagine that our thoughts are like black and white chess pieces, battling back and forth. We can simply be the chessboard; in touch with the thoughts but not battling.

The chessboard metaphor allows us to picture the observing self but there is an exercise which illustrates it in situ:

Continuous You Exercise

  • Notice X (thoughts, feelings, sensations, one after the other )
  • Be curious, what do you notice about it?
  • Notice how yes, there is X but there is also you noticing X
  • If you notice X you cannot be X
  • X changes (from happy to sad, from positive to negative, from pain to numbness) but the you who notices X does not change, since you were a child there has been you, and you continue to be you.

Homework

A great piece of homework can be to:

  • Write thoughts on card
  • On back summarise them all into a title of the film, i.e. “The Useless Jane story”
  • Read them through, then read the title on the back, what does it do?
  • Now whenever you have a NAT tell yourself “oh look at that “Useless Jane” story again”
  • And also take the card and carry it with you.
  • 5 times a day read the thoughts then the title

For low self esteem, put the bad thoughts on a card and hold it close to your face then on the other side put the good thoughts and hold it close to your face, making the point that neither really allow us to connect with the world around us.

www.happii.uk is a website providing information about mental health and wellbeing. Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region.You can contact her here.

Acceptance and Commitment Therapy – Committed Action

When we are faced with challenging situations, distressing feelings, emotions and even pain and fatigue it is important to continue living a life which is as close to our values as possible. This can allow us to gain meaning, achievement and enjoyment from life despite these obstacles. 

Values 
Values can be imagined as a direction, not a goal; for example, a marriage is a value or a direction but a wedding is simply a goal. Values are ongoing guides for life which do not disappear once we have achieved a goal.

To discover your value, first pick an action, that you can do (such as raise a family). When doing it, ask yourself, how do you want to do it?, what qualities or strengths do you want to display during it?; these are qualities that would apply even if you were paralysed, or changed your action. Examples of values can be generosity, hard work, fun etc.

Remember that values don’t need justification because they are universal and your choice.

Disneyland Metaphor

To help us understand the idea of values, imagine two children in the back of the car on their way to Disneyland. 

Kid One: are we there yet?

The Other Kid: takes his time to begin noticing, exploring, learning about the world outside the car

The other kid is living alongside his values, because despite the wait for the exciting goal of Disneyland, he is able to be in the moment and apply his values to the journey on the way to the goal. 

Challenges

When you’re trying to identify your values but a difficult situation (X) keeps distracting you or getting in the way:

  • Notice your thoughts, then feelings and sensations
  • Try to open up around each of them, breathe, think about the things around that thought, feeling or sensation
  • Tune in to what X (for example, cancer) means to you (for example it means I can’t look after my kids)
  • What sort of role (for example, mother) do you want to be playing in life?
  • What does a good role (mother) look like? (For example, caring, fun)
  • So if you were being a good role (mother) what would you be doing with regards to X? (For example, using my waking hours to talk with my kids)
  • So if you were not being pushed around by your negative thoughts and attached to those emotions, what would you be doing with regards to X? (For example, spending less time thinking about cancer and more time with my kids)
  • Can you make room for the bad thoughts and feelings to do the kind of things that it takes to be the good (role)?

With values, take it slow and really dig beyond them. Also check that it’s your values not society’s values, so ask, “if I waved a magic wand and everyone approved of everything I did no matter what, what would I choose to do?”

However it is worth mentioning that values are best held lightly, because at times we need to sacrifice one value in order to service another. Values need to be prioritised because if one value is, for example, ‘caring for others’, but our parents are abusive to us, then we have to prioritise a different value of ‘self protection’. It’s like holding a dice; the values are different sides of the dice and we can’t always see them all, but as life changes, so we realise different values and bring different values to the forefront.

Committed Action / Do What It Takes

After we have uncovered our values we need to translate values into activities which are flexible enough to allow for our own difficulties. 

  1. Choose a domain to change
  2. Choose values
  3. Develop goals guided by values
  4. Take action mindfully

Step 1: Domain (choose 1):

  • Work
  • Health
  • Education
  • Social
  • Parenting
  • Partner
  • Family
  • Spiritual
  • Community
  • Environment
  • Leisure
  • Personal growth

Step 2: Complete this sentence: Values underlying my goals in this domain are:

Step 3: Create SMART (specific, measurable, achievable, relevant, and timebased) goals:

  • Immediate (24 hours)
  • Short term (next few days and weeks)
  • Medium term (next few weeks and months)
  • Long term (next few months and years)

Tips:

  • Public commitment – tell someone you’ll do it
  • Ask yourself: What’s the tiniest step you can make towards that goal in the next 24 hours?

What if though, after trying these actions that we discover that they are unrealistic goals? If we are upset that we are not able to reach a goal, then remind ourselves that when we notice a gap between reality and our desire, it is of course pain that follows. But we have an option of following the pain and inaction or making room around the pain for action. Ask ourselves:

  • In the next 24 hours is this possible?
  • So what can we do in the next 24 hours that means we can live by these values on our way to our longer term goal?

Reason for inaction

Our mind always gives us reasons not to do things and waiting for it to decide that we can do something is fruitless. We decide not to do things because:

  • F: Fusion to Negative thoughts
  • E: excessive goals where resources are not sufficient
  • A: avoidance of discomfort
  • R: remoteness from values

Solution to inaction:

  • D: Defusion
  • A: Acceptance
  • R: Realistic
  • E: Embracing values

Remember that we can take action even though our mind tells us not to. 

Imagine that the person you most love in the world has been kidnapped. If you do what you’ve said you’ll do they’ll be set free. Would you do it even though your mind is telling you not to? Of course you would.
So your rich and meaningful life has been kidnapped, it has happened over time, you haven’t realised it, you missed the ransom note, you’ll never get to see this life again unless you take action. Are you going to do it?

When stuck for motivation:

Ask yourself, where are you on a scale of 1-10 in terms of leading a rich and fulfilling life? If it’s low, then ask yourself what’s getting in the way of that? Then problem solve how to overcome that barrier. If high, then maybe it’s time to stop using this therapy. 

Edinburgh Bike Metaphor

If you discover that you actually like your unhelpful behaviours which might be getting in the way of living your values or reaching your goals then think about how you might get to Edinburgh if you were riding a rickety bike. Yes, you’d get there but what state would you be in when you get there?

 www.happii.uk is a website providing information about mental health and wellbeing. Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region.You can contact her here.

Acceptance and Commitment Therapy – Part II

We can find great examples of those who found meaning, purpose and vitality in the midst of suffering in Mandela’s biography or those about holocaust prisoners. They, like people with long term pain or fatigue, are stuck but not broken.

So when we look at people’s behaviours and thoughts, we don’t ask whether they are good or bad, true or false; we ask whether they are helpful, whether they are making our life rich, full and meaningful.

Shakespeare: “There is nothing either good or bad, but thinking makes it so”

One aspect of ACT is to use mindfulness which is, essentially, “paying attention with flexibility, openness and curiosity”.

You can’t be mindful all the time, and we don’t need to be because sometimes the way we think is not too bad in the long run. Sometimes we can control our thoughts and if that assists in leading a valued life then carry on. 

But when people are struggling they tend to display:

  • Dwelling in past or future or lack of insight into own thoughts and feelings
  • Limiting Negative Automatic Thoughts 
  • Experiential avoidance
  • Attachment to their own idea of themselves (i.e. their diagnosis, body image etc)
  • Lack of living a valued life
  • Unworkable action

Try this exercise which illustrates all of ACT in one go:

  • Sit and reflect on what you can sense (go through each sense and thoughts and feelings and pause) = Present moment / mindfulness
  • Notice that there’s a part of you which can observe all of the above, like on a stage, it’s the observing self = self as context / our attention
  • Reflect on why you came here today, what do you want to improve? = values
  • How did you get here (i.e. With action despite some crap going on) = do what it takes
  • Focus on your breath, empty lungs then notice how it automatically refills = mindfulness again
  • Let thoughts come and go (like cars, like a storyteller, like it’s a radio playing, like a screaming child, dictator) but focus on breath again = defusion
  • Notice feelings and physical sensations but refocus on breath after saying “here’s a feeling of frustration” = acceptance
  • Life is like a stage show and just now you dimmed the lights to focus on breathing, now turn up the lights onto the rest of your body then the room, and senses and thoughts and feelings

Reducing inclination to control

It is important to understand that attempts to control our feelings (through distraction or avoidance or Cognitive Restructuring or Thought Challenging) can negatively affect our quality of life. Actions are better when they are led by our values i.e, exercise for health if it’s one of our values but not for distraction.

Ask:
1. What have you tried? 

  • D:istraction
  • O:pting out
  • T:hinking
  • S:ubstances, self harm, strategies
  • 2. How has it worked? 
    3. What has it cost?

    Metaphors to understand why battling your experience isn’t the way forward:

    • Quicksand
    • Tug of war with monster pulling you towards pit; you’re losing, what do you do? Our instinct is to pull harder but it’s not working, so let go.

    Exercise examples of how we can’t control these things anyway:

    • Try to forget a memory
    • Try to make your leg numb
    • Try to fall in love
    • Don’t think about ice cream

    Homework:

    Notice what you’re trying and what effect it has and at what cost. Write it down. 

    www.happii.uk is a website providing information about mental health and wellbeing. Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region.

    You can contact her here.

    Acceptance and Commitment Therapy (ACT) – Part I

    Acceptance and Commitment Therapy (ACT) is a form of behavioural therapy which helps us deal with some of the harsh realities of life so that we can live it in a rich and fulfilling way.

    It’s particularly useful for those who are struggling with situations which may not change such as long term health conditions or a family situation which is challenging and enduring.
    There are six core therapeutic processes:

    • Contacting the present moment (paying attention to the present moment)
    • Defusion (watching yourself thinking)
    • Acceptance (making room for pain and letting it be)
    • Pure Awareness (recognising that our identity doesn’t change even though our thoughts and emotions do; there is still a side to us that observes ourself)
    • Values (understanding what matters to us)
    • Committed action ( do what it takes)

    These can be merged into 3 functional units:

    • Separating thoughts from feelings
    • Be present
    • Do what matters

    The three processes are:

    A: accept thoughts and feelings and be present

    C: choose a valued direction

    T: take action

    ACT can be explained in a nutshell using the Clipboard Metaphor:

    A therapist might use this metaphor to help explain how we may struggle with our own emotions, physical sensations and thoughts and how this gets in the way of life. The metaphor also shows how using ACT processes instead may be beneficial. The thapist would sit with the client and presents them with a clipboard.

    The clipboard represents the distressing thoughts, feelings and physical sensations you have.

    1.  Hold it close to your face. While you’re absorbed in these thoughts and feelings:

    • Do you feel engaged with me? Connected? If I did some hilarious dance, could you see?
    • What can see you in the room around you?
    • If I asked you to hug someone, drive to work, write a letter could you?

    So you’re disconnected with people, the world and what you want to do.

    2.  Now I’ll hold the clipboard and you try to push it away.

    • How does a day of doing this feel?
    • While you’re doing this, if I asked you to hug someone, drive to work, write a letter could you?
    • How easy is it to converse with me?

    So you’re disconnected with people, the world and what you want to do.

    3.  Now, put it on your lap.

    • Can you talk with me?
    • Can you hold a baby, drive a car, write a letter?
    • What can you see around you?

    So you are more connected with people, what you want to do and what’s important to you and it’s less exhausting. Even though it’s still there.  Of course you don’t want it there but pushing it away didn’t work so how about we try something different and let it be?

    Letting it be allows you to connect with everything important to you and the energy you would use fighting thoughts and feelings you can use for those meaningful activities.

    Assessment

    When we are starting to use ACT, it is important to firstly understand:

    1. What stands in your way?
    • Thoughts
    • Avoidance
    • Behaviours

    2. What valued direction do you want to move in?

    • What to stand for
    • What domains of life are most important?
    • What relationships do you want?
    • How do you want to grow and develop?
    • What strengths to cultivate

    www.happii.uk is a website providing information about mental health and wellbeing. Happii.uk is provided by Anna Batho, a therapist working in High Wycombe and providing therapy in Amersham and the wider Buckinghamshire (Bucks) region.You can contact her here.