Reality slaps: Acceptance and Commitment Therapy

By Yvonne van Dongen In Psychology

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Dr Russ Harris on Acceptance and Commitment Therapy

Dr Russ Harris: “The feel-good society is only 50 years old.” Photo/David White

Dr Russ Harris finishes his morning workshop with therapists in Auckland by assuring them “of course, you can only do this if you’ve got fabulous hair. Especially fabulous curly hair. I do sell curly wigs afterwards if you’re interested.”

Although the former GP has done stints as a stand-up comedian in the past, he delivers these lines gently, as if he’s not asking for a big break-out laugh. Obedient ripples of soft laughter spread through the room because the joke is, of course, not that he has hair resembling a tangle of pohuehue, which he does, but that what he’s been talking about all morning is ACT, a secular, scientific, evidence-based model of therapy that can be applied or used by anyone, quality of hair notwithstanding. No gurus required.

ACT, or Acceptance and Commitment Therapy, is not even offering anything particularly new. Harris has simply popularised a therapeutic model devised by Professor Steven Hayes at the Department of Psychology, University of Nevada, Reno, in the early 1980s that in turn derives from a branch of behavioural psychology called applied behaviour analysis (ABA).

ABA has many parallels with strategies and concepts from religious and philosophical traditions around the world. Hayes, also a best-selling self-help author (Get Out of Your Mind and Into Your Life), gave Harris permission to write about ACT for his 2007 bestseller The Happiness Trap: Stop Struggling, Start Living. Harris followed that with The Reality Slap: How to Find Fulfilment When Life Hurts, The Confidence Gap and ACT with Love.

“Humans have struggled with the meaning of life for thousands of years,” says Harris, “but the feel-good society is only 50 years old. For most of human history, doing good was valued as the way to happiness, not just feeling good.”

EFFECTIVE TREATMENT

ACT appealed to the English-born Australian doctor because it had proved effective in treating major depression, anxiety disorders, schizophrenia, addiction and chronic pain syndrome and helped with weight loss and even conditions such as tinnitus and stuttering.

“There are now more than 60 published randomised controlled trials of the highest evidence base you can get in peer-reviewed psychological journals that prove ACT’s effectiveness in these instances,” says Harris, over a quick sushi lunch.

And although Hayes’s acronym for his model reeks of late 20th-century chutzpah and can-do confidence, many of ACT’s precepts are ancient. At its heart are the concepts of mindfulness and values-guided living and the idea that pain is ubiquitous and inevitable. If these terms sound familiar and you’d credit Buddhism for their existence, you’d only be partially right. Harris says although the practice of mindfulness is critical to Buddhism, it is not unique to this Eastern tradition.

“Buddhism is only 2600 years old. Mindfulness can be found in Judaism, Taoism and yoga going back 4000 years. In fact, Buddha learnt mindfulness from a yogi. And, yes, you can learn mindfulness skills through meditation, martial arts or yoga, but lots of people won’t do that. ACT enables you to learn these skills in a few minutes.”

It’s also a nifty acronym to boot. The A stands for acceptance and asks people to accept their internal experience and be present. The C for choice means to choose a valued direction, and the T asks people to take action.

It’s a model designed to help people live richer, more meaningful lives and accept the pain that goes with them. It’s especially useful when they’re given what Harris dubs a reality slap – where what they want is at odds with what they’ve got, be it death, divorce, job loss, illness or simply commonplace misery such as envy, anger or stress. Whenever our mind turns callous, cold and uncaring in fact, whenever we tell ourselves we’re no good, we’ve stuffed up and we’re losers.

This has particular resonance for teens, many of whom are apt to beat themselves up if something goes awry. Indeed, Harris says the studies that confirm ACT is an effective treatment for major depression include one involving depressed teenagers. ACT is also used by several Australian Olympians and two AFL teams.

I tell Harris I found ACT a form of emotional yoga and he’s not averse to that interpretation. As someone who has experienced more of a relentless reality mauling than a solitary slap in the past year and who was given The Reality Slap by a friend, I can vouch for the helpfulness of its strategies. Of all the advice and self-help tracts I received in this annus horribilis, this one rang truest, since it gave me permission to feel yet provided simple strategies to help me cope. ACT didn’t ask me to deny my emotions, ask me to be a different or more saintly person than I was or blame me for having attracted such ill-fortune.

Acceptance and Commitment Therapy

Photo Getty Images/Listener Illustration

RECOGNISE THE FEELING

To begin with, ACT asks anyone suffering a reality slap to start by recognising the unpleasant feeling assailing them, and name it and to be fully present experiencing what’s happening to them.

In no way should people try to suppress their emotions. Harris has no truck with the control-your-emotions-or-thoughts Cognitive Behaviour school, especially the dictum to stomp on our “bad” thoughts and replace them with “good” ones. This will only start a war with our own thoughts, war we will never win.

If Harris could stomp out any one self-help theory, it would be that popularised by bestseller The Secret, by Rhonda Byrne. This wishful-thinking model says you can attract good and repel bad using the power of thought. Simply ask the universe for what you want, and if you have sufficient faith or goodwill, you will get it.

“It sets people up for misery. It says that if bad things happen, then it’s your fault, you weren’t thinking positively enough. Try telling that to the German Jews in the Holocaust. It’s disgraceful, since it sets people up for false expectations.

“Life involves pain and the fact is some people get more pain than others. Some people have privileged childhoods, but others have painful childhoods. Unfortunately, many popular ideas about happiness will make you miserable.”

Instead, he says, learn how to open up and let painful feelings flow through you. “Drop the struggle” is one of his favourite phrases.

“People misunderstand the word ‘accept’,” says Harris. “People think it means tolerating painful feelings, liking them, putting up with them. But that’s not what we mean. What we mean is make peace with your thoughts and feelings, stop running from them or fighting with them.”

Tricky as that may sound, Harris insists this can be learnt through developing mindfulness skills.

“For instance, imagine you are angry about something. Instead of letting anger jerk you around like a puppet on a string, you can ground yourself in the present moment, push your feet into the floor, look around and acknowledge ‘here I am right now, feeling angry’. Breathe into those feelings of anger. Make room for them. Notice what your mind is saying to you.”

Next, he outlines ACT’s defusion and neutralisation strategies that teach people to separate from their thoughts and see them for what they are: just words and pictures.

“Unhook yourself from unhelpful thoughts such as revenge fantasies. There’s no need to challenge or dispute those thoughts or replace them with positive ones; just let them come and go like passing cars. You can acknowledge that you’re feeling angry and simultaneously take control of your arms, legs and mouth and act in accordance with your values. These are all examples of mindfulness skills.”

When we screw up, as we all do, ACT reminds us we can’t alter what’s happened. Although it may be valuable to reflect on the past and learn from it, there’s no point dwelling on it and beating yourself up for being imperfect.

So, that’s step one. Accept you went off track, accept it’s in the past and it is now unchangeable, and accept you’re human and therefore imperfect.

Step two asks people to choose a valued direction. This is where you ask, ‘What do I want now? Can I make amends? Can I repair the damage? What can I do in the present that’s important or meaningful?’ This means clarifying what you stand for and what your values are.

Finally, step three asks people to take action in line with their values. That’s all there is to it. The three-step ACT programme. Making DIY self-help easy as. So how, you might ask, has Harris made a 10-year career and written four self-help books and two textbooks from that simple message?

By providing examples, explanations and techniques to achieve this, because sometimes the simplest ideas can be the hardest to grasp. Western society might be one of the most self-indulgent navel-gazing societies the world has known, but for all our self-absorption, Harris says, actual self-reflection is rare. “A genuine curious compassionate self-reflection is hard to teach and uncommon.”

WASTE OF TIME

Self-criticism, on the other hand, is not. The low self-esteem “I’m-not-good-enough” story lurks on every street corner and is a complete waste of time and energy.

“Self-criticism doesn’t motivate people. It’s an illusion. We think that by beating ourselves up, we’ll become a good person. It doesn’t happen.”

But its opposite – high self-esteem – isn’t any better. High self-esteem often correlates with a lack of empathy, arrogance, insensitivity, narcissism, discrimination and prejudice.

Says Harris controversially, “Our prisons are full of people with high self-esteem.” Really? “Sure. There are numerous models of self-esteem, but the vast majority focus on building up a positive self-image; talking yourself up through positive affirmations. It’s very easy for someone to build up high self-esteem through thoughts like ‘Look how strong/cool/powerful I am for killing that cop, etc. Look how afraid those other guys are of me.’”

Then there’s fragile self-esteem often exhibited in high-performers whose sense of worth is tied up in being a winner. This can be a double-edged sword. As long as their performance is strong, they’re winners, but as soon as it drops, they feel like losers. Harris shakes his head. “It’s all about how tightly we hold onto the stories our minds create about ourselves.”

Harris wants us to hold our self-image more lightly; to not get so caught up in it. What would be better, he says, is to develop self-compassion and self-acceptance. And if that sounds suspiciously like it could be used as a template for self-justification of any old load of cobblers, he swears it’s not.

“If you were truly mindful, it wouldn’t be possible for you to justify cruel behaviour. To do that, you would have to be in denial. But, yes, I suppose it’s theoretically possible that some person out there could take this model and use it to justify their selfish actions, but to be honest, I don’t think that person would be coming to therapy or coaching. ACT is for people who want to make changes in their life.”

Acceptance and Commitment Therapy

Photo Getty Images/Listener Illustration

CLARIFY VALUES

In any event, ACT requires people to clarify their values first, goals later. Instead of asking what you want from life, ACT asks what you want to stand for as a human being and how you want to treat your body, children, friends, family, environment, etc.

“ACT rests on the concept of workability. Is what you are doing now worth it to give you a rich, full, meaningful life?”

In effect, Harris is asking us to answer the big “what’s it all about” question. It’s a question that plagued him throughout his twenties when he should have been basking in sunshine. There he was, a practising GP living in a nice part of Melbourne with a cool sideline as “Dr Russ” on the stand-up comedy circuit, yet he often thought of killing himself. Harris hid his suicidal thoughts from those around him and became the master of indulgent distraction: drinking fine wine, taking exotic holidays and buying “stuff”. Still, misery dogged him and, he observed, many of his patients as well.

Oh, yes, he had issues – a harsh inner critic being the worst, but first and foremost, Harris suffered from a pervasive sense of meaninglessness.

As he grappled with his unhappiness, Harris discovered that to find the big answers in life, you first have to ask the big questions, such as “What truly matters to me? What do I want to stand for in my life on this planet? What sort of human being do I want to be and how do I want to behave towards myself, others and the world around me?”

The answers altered the way he practised medicine. Before, he’d had more of a production-line mentality. Ill people in, well people out as fast as possible. When patients didn’t recover quickly, he’d feel annoyed. But once he made a conscious effort to connect with patients, slow down his consultations and infuse his speech with genuine caring and kindness, he found patients responded positively. And perversely, even though his income plummeted as a result of those longer consultations, his sense of fulfilment also soared.

Suddenly, Harris had purpose and presence. Purpose, he says, gives our life direction, and presence allows us to make the most of the journey. That journey led him to a Hayes workshop in 2004 and eventually a new career as an author, ACT trainer and consultant.

Harris has had no shortage of personal challenges in which to put ACT to good use, the hardest being when his son was diagnosed as autistic. Harris felt devastated, angry and frightened, but ACT helped him defuse these thoughts and act mindfully.

He researched the condition, shifted cities so the boy had access to top treatment and spent tens of thousands on the only evidence-based treatment for autism, ABA. Yes, the same branch of behavioural psychology that underpins the ACT model. As a result, his son is a friendly, sociable child who attends a mainstream school and no longer meets the criteria for a diagnosis of autism.

Hold yourself kindly

Russ Harris offers a number of simple exercises to practise when a reality slap occurs.

    • The Compassionate Hand exercise begins with people sitting comfortably, centred and alert. For example, if seated, lean slightly forwards, back straight, shoulders dropped and feet pressed gently onto the floor.
    • Now think about that reality slap: remember what happened, how it affects you and the impact on your future. Notice what difficult thoughts and feelings arise.
    • Next, slowly and gently place one hand on whichever part of the body hurts the most, possibly your chest or perhaps head, neck or stomach. If you feel numb, place your hand on the numbest part. Imagine it’s the hand of someone kind and caring.
    • Feel your hand against your skin or your clothes. Feel the warmth flowing from your palm into your body. Imagine your body softening around this pain; loosening up and making space. Hold your pain or numbness gently, as if it were a crying baby or a priceless work of art. Let the kindness flow from your fingers into your body.
    • Now place one hand on your chest and the other on your stomach. Rest them there and hold yourself kindly. Take as long as you like to sit in this manner, connecting with yourself, caring for yourself – five seconds or five minutes, it doesn’t matter. It’s the spirit of kindness that counts when you make this gesture, not the duration.

Read more:
www.actmindfully.com.au
www.thehappinesstrap.com

More by Yvonne van Dongen

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