May 22, 2018

ACT on Your Values and Build a Life Worth Living – Dr. Angela Derrick

act therapy for anxiety and depressionDo you wish you could stop the “tug of war” you have with your thoughts and feelings — and just drop the rope!?
 
While other therapies teach you how to challenge your thoughts, Acceptance and Commitment Therapy (ACT) teaches you how to accept your thoughts (whether they are positive, negative, or even painful), face them directly, and then let go of the struggle to make them “go away.” 
 
Accept them, face them and let go of the struggle.
 
We can accept and live with all of our thoughts and feelings
 
If you or a loved one is in treatment, you may have heard about Acceptance and Commitment Therapy (ACT). ACT is an empirically based treatment commonly used in the treatment of eating disorders and anxiety and mood disorders, as well as chronic physical health concerns. 
 
ACT uses a variety of strategies to help you build greater psychological flexibility. 
 
Why is psychological flexibility important?
 
Psychological flexibility is the ability to adjust your thinking in the moment to be more intentional, values-driven, and effective. 
 
When you are in the midst of great pain or difficulty, it can be challenging to see beyond your current situation. Greater psychological flexibility allows you to see outside of your present struggles so that you can live a full and meaningful life. 
 
Here are 6 important ACT tools that can help us in recovery:
 
ACT uses six core processes to help you as you work towards recovery; I describe each of them below:

1. Mindfulness

Mindfulness is being aware in the present moment without judgment. Practicing mindfulness means stopping and noticing both our internal and external present moment experiences without attaching judgement to them or assigning a label to our feelings (i.e. “I feel pain and this is bad.”)
 
It’s easy for our brains to slip into busy, active states in which we are either stuck in the past or worried about the future. In these states of mind we are more likely to become or stay depressed and anxious. Although mindfulness can be difficult to practice at first, it can become more familiar and habitual over time.
 
Here is an example of how you might practice walking with mindfulnessI feel my feet as they make contact with the ground. I feel my arms swinging by my side. I feel the cool breeze and the warm sun on my skin. I hear the birds chirping and see the new flowers poking up alongside the path. I smell the freshness of the morning after the rain. 
 
In contrast, a walk without mindfulness might look something like this: It’s so cold today; I wish it would hurry up and warm up. This is so uncomfortable and my jacket is too thin for this weather. I’ve got to hurry up and get where I am going so I can get started on that project I have procrastinated on. That’s just like me to procrastinate again. What will happen if I can’t get it done? I might not pass that class.

2. Cognitive defusion

Cognitive defusion is reducing your attachment to your thoughts — a process that can help you gain distance from your thoughts. For instance, you can begin to see your thoughts as just thoughts rather than as truth
 
Here’s an example of how this might look: instead of thinking, “I’m inadequate,” you might think, “I’m having the thought that I’m inadequate.” For many individuals with eating disorders, an important shift away from “I’m fat” could be “I’m having the thought that I am fat, but I am not my thoughts.”

3. Acceptance 

ACT teaches us that pain in life is unavoidable. When we try to push away or avoid pain, it often amplifies and gets louder and stronger. A common phrase used in ACT is:
 
“What you resist persists.” 
 
It isn’t effective to try to make feelings like sadness, fear, anger or disappointment go away. What we can do instead is try to live more comfortably with our emotions by changing our relationship to the emotions. We can learn to co-exist with discomfort rather than pushing it away.
 
One of my favorite metaphors to illustrate this concept (ACT uses a lot of metaphors) is to imagine holding a small prickly cactus in your hand. If you squeeze it tightly, the prickles will pierce your skin and you will experience suffering. However, if you just allow the cactus to sit in your hand and you observe it there, it is still prickly but it is no longer causing you harm. You can learn to hold your cactuses lightly.

[Note: We are not actually recommending that you try to hold a cactus in your bare hand.]

4. Self as context

The process of self as context means that you develop a greater perspective on your own point of view, seeing yourself clearly by developing awareness of who you are and the thoughts/beliefs/identities you may be fused with. You can observe your thoughts and feelings without being defined by them. 
 
Here’s an example: you can notice your body image dissatisfaction thoughts and still see your identity as separate from the eating disorder. This ability to observe yourself helps support the development of your identity, which is an important component of eating disorder treatment.

5. Values-directed living

You can strive to live life according to your values, rather than being ruled by pain; pain is inevitable. It is possible to life a meaningful and fulfilled life NOW, even if you are depressed, anxious, or struggling with an eating disorder, a sick parent, a broken down car, infertility, or financial strain. You don’t need to “be fixed” or “make anything go away” in order to have a life worth living. 
 
Here’s what this might look like:
  • If one of your values is education, you might be willing to accept greater financial strain in order to prioritize the long-term benefits of finishing college.
  • If one of your values is family, you might be willing to challenge your desire to isolate yourself in order to attend your cousin’s birthday party.
  • For individuals with eating disorders, you might decide to go out to an Easter brunch, for example, because you value the connection, socialization, or spirituality of the day as more important than the temporary distress of eating the omelet. 
6. Commitment

Commit to action. Once you’ve identified your values, you can identify small, short-term, measurable goals to help you take steps towards your values. Commit to take concrete action on those goals. 
 
We often ask individuals in treatment to identify specific behaviors that will move them closer to their values and then commit to following through with these behaviors that day. This helps turn a desire for change into action in concrete ways. 

Here are two examples of what this might look like: 
  • I am going to eat my breakfast today because health is a value.
  • Today, I am going to speak up about my discomfort with my friend because assertiveness is a value of mine.
Many individuals, including those who have been struggling with mental or physical pain for many years, can develop greater psychological flexibility and find relief from suffering with the help of the above six core processes of ACT. 

Learn more about how to apply ACT concepts in your own life:
  • ACT Resources
  • The Happiness Trap: How to Stop Struggling and Start Living: A Guide to ACT by Russ Harris


Angela Picot Derrick is a clinical psychologist and Senior Clinical Advisor at Eating Recovery Center of Chicago and Insight Behavioral Health Centers. Insight Behavioral Health Centers provides specialized treatment for mood and anxiety disorders at five Chicago, Illinois treatment centers and one center located north of Austin, Texas in Round Rock. Dr. Derrick has studied and treated eating and mood disorders for over 15 years and is honored to help her clients build hope, self-compassion and resilience as they work towards recovery. 
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