Posts

Foundations of ACT and the Limits of CBT

Steven C. Hayes, PhD

Steven C. Hayes, PhD (@stevenchayes) is Foundation Professor at the Department of Psychology at the University of Nevada, Reno. He is the developer of Relational Frame Theory (RFT), an analysis of human language and cognition, and the creator of Acceptance and Commitment Therapy (ACT).

He’s the recipient of numerous awards including the Nevada Psychological Association Psychologist of the Year Award, a B. F. Skinner Award from Palo Alto University, and a Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies.

He’s the author of more than 530 scientific articles and 38 books, including the  #1 selling “Get Out of Your Mind and Into Your Life“, and his TEDx talks “Psychological flexibility: How love turns pain into purpose” and “Mental Brakes to Avoid Mental Breaks” have racked up 150,000 views and counting.

In today’s episode we talk about the foundations ACT and the limits of CBT. What exactly is Acceptance and Commitment Therapy and how does it differ from, and improve upon traditional CBT?

We discuss the concept of psychological flexibility and its role in either preventing or provoking the development of mental health issues. We ask whether or not there is value in addressing issues from your past, the importance of self-compassion during periods of psychological distress, how to discover your own personal values, and putting it all together, in Steve’s own words:

“How to back out of the war within, come into the present moment, focus on what we care about, and get on with the business of living.”

Steve’s website: stevenchayes.com

 

Steve’s Recommended Links

Psychological flexibility: How love turns pain into purpose – Steve’s first TEDx talk

Mental Brakes to Avoid Mental Breaks – Steve’s 2nd TEDx talk

ACT for the Public – Yahoo Group

Association for Contextual Behavioral Science

Book’s Mentioned in This Episode

               

 

Enjoy this episode?

Please share it with your friends or leave us a positive review on iTunes or Stitcher 🙂

Image courtesy: martinak15

Feeling Good With CBT

David D. Burns, M.D.

Amongst many other achievements in a very long and distinguished career, David D. Burns M.D. is probably most famous as the author of “Feeling Good: The New Mood Therapy”, a book which more than any other is responsible for thrusting CBT into the public consciousness in the early the 1980s, and has since gone on to sell in excess of 4 million copies in US alone.

This episode was a pretty special event for me. Not only because David is a huge figure in the cognitive therapy movement, while this is still a piddly little podcast with barely any listeners. But on a personal level because this very book had a massive impact on me during the peak of my struggles with mental illness, and gave me the impetus needed to take control of my situation. So it’s crazy that here I am almost two years later, well on the way to recovery, and interviewing him for a podcast.

Dr. Burns is currently Adjunct Clinical Professor Emeritus of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. He has received numerous awards, including the A. E. Bennett Award for his research on brain chemistry, the Distinguished Contribution to Psychology through the Media Award, and the Outstanding Contributions Award from the National Association of Cognitive-Behavioral Therapists.

In addition to Feeling Good, which also boasts the distinction of being the book most frequently “prescribed” for depressed patients by psychiatrists and psychologists in the United States and Canada, Dr. Burns has written a number of other popular books on mood and relationship problems, such as “10 Days to Great Self Esteem“, “When Panic Attacks“, and “The Feeling Good Handbook“.

He’s the creator of the Burns Depression Checklist, a 25 point questionnaire used by mental health professionals to detect and measure the severity of patient depression, which some of you may have filled out during the consultation phase with your therapist.

He’s also hosted a TEDx talk about “Feeling Good” which has so far amassed more than 95,000 views and counting on YouTube.

During the course of today’s episode we discuss the origins and trajectory of David’s career, the chemical imbalance “myth”, his phenomenally successful self-help book “Feeling Good: The New Mood Therapy”, the 10 cognitive distortions, his development of a new approach to cognitive therapy known as T.E.A.M therapy, and much more.

 

David’s Recommended Links

FeelingGood.com – David’s website

Books Mentioned in This Episode

51xcjb2p9ll-_sx295_bo1204203200_     51m2iplcvl-_sx327_bo1204203200_     41hbx0x7e3l-_sx311_bo1204203200_     5116886kqtl-_sx299_bo1204203200_

 

Enjoy this episode?

Please share it with your friends or leave us a positive review on iTunes or Stitcher 🙂

The Importance of Being Honest When You’re Not Being Earnest

Reading time: 13 mins

If there’s one thing depression and anxiety makes you good at, it’s telling porkie pies. Whether it’s a little white lie, such as blaming your trembling hands on a double espresso, or something more elaborate like staging happy-go-lucky selfies for Instagram when in reality you feel like you’re dying inside, we’re all guilty of it.

In a society where mental illness is seen as a contagious disease, lies are the vaccines that inoculate those of us who are suffering from being ostracized like emotional lepers.

My go-to lie is to blame every low or anxious mood on nausea. It’s the perfect affliction to fake because they explain away any kind of agitation without inviting further inquiry, and its impossible to disprove.

Been invited to a social event? Can’t. Feeling a bit ropey today. Maybe next time. Woken up feeling shit and depressed? Need to stay in bed, must’ve eaten something dodgy. About to have a panic attack in public? Sorry, I’m gonna have to leave, I feel a bit sick.

So long as you’ve confided in at least one or two close family or friends, I don’t think there’s anything wrong with playing your cards close to your chest. Not everyone needs to know your business.

But there’s another kind of lie that I was guilty of telling in the early days of my battles with depression and anxiety, and one that isn’t quite so innocuous. It’s a lie I see told week in week out by many of the people at the mental health support group I run, and I suspect you might have told it once or twice yourself.

It’s nothing too elaborate. In fact it generally consists of just six words. But what’s interesting about this particular lie is that it’s not even necessarily intended to deceive. Because when the person uttering it does so, they themselves believe it to be true. What they’re doing, in fact, is lying to themselves first and foremost, and to everyone else as mere side effect. And it goes a little something like this:

“I tried that. It didn’t work.”

In the early days of my battles with anxiety and depression, having never experienced anything like it before, my knowledge and understanding of what was happening to me was elementary at best. I had no idea about the possible underlying causes of why I felt the way I did. All I knew was that I wanted to fix it. And quick.

But in my rush to find answers, my haphazard approach to research was both broad and shallow. Whether it was meditation, exercise, CBT, you name it. I wasn’t interested in the finer details, the science, or the research behind any of them. Just gimme the fucking instructions, for Christ’s sake. Just tell me what to do and let me get on with it.

Cardio three times a week? Fine. Twenty minutes of meditation every day? Cool. Cut all processed foods from my diet. Let’s do this. But no matter what I tried, and I tried pretty much everything, nothing ever seemed to work for me.

And it appears I’m not the only one. In the two years I’ve been running my support group, according to all the feedback I’ve received from people about their own experiences with various self-help techniques, I’d estimate the success rate of the big three depression and anxiety antidotes – exercise, meditation, CBT – to be around 5%. If that.

What’s interesting about this observation for me is that it stands in stark contrast to the results of clinical trials, which in the case of depression for instance, demonstrate a success rate of about 60% for exercise [1], 58% for CBT [2], and 52% for meditation [3].

So, what exactly is causing this discrepancy? The answer, I believe, is self-deception.

More often than not, in reviewing our failed attempts to remedy our own mental health issues, when we say “I tried that”, what we really mean is, “I tried that a couple of times”. And when we say “It didn’t work”, what we really mean is “It didn’t work quickly enough”, or we just didn’t enjoy it, or we just weren’t disciplined enough.

While we may indeed be guilty of expecting too much too soon, or just too much of an easy ride, this isn’t immediately obvious, because in many other pursuits, fast results and having fun aren’t entirely unreasonable expectations to have. Think about it.

At the commencement of most new learning experiences, progress is experienced rather quickly. For instance you can quite literally attend your first guitar lesson having never once picked up a guitar in your entire life and leave an hour later having memorised three chords, and as a result are now able to strum along to dozens of different pop songs.

Same with learning a new language, or even driving a car. You can feel the results almost immediately. This makes it fun and only serves to fan the flames of your enthusiasm to continue learning. It is in fact easier and more fruitful in the early stages, and only becomes harder and more nuanced the further along you progress.

When engaging in techniques to alter our brain chemistry or the content of our cognitive processes, this supercharged learning curve is turned on its head. Results are often much slower to present, sometimes even nonexistent in the early stages, and then still very subtle when they finally do begin to emerge.

It’s only in the later stages of engaging in such activities that the results begin to accumulate to any significant degree. Therefore its very easy, and thus very common, for people to become disheartened and subsequently disengage in the early stages of remedial mental health pursuits.

This impatience, though understandable, is in truth, unjustified, and more often than not, I believe, fueled by an unconscious dismissal of the terms and conditions laid out by the program or technique we’re attempting to engage in.

This was certainly the case with me back when I was claiming that things like diet, exercise and meditation weren’t having any effect. The reason they weren’t having any effect is because I was attempting, through a paradoxical combination of haste and laziness, to employ the techniques in isolation of the parameters within which they were designed to be effective.

In other words, I was ignoring say, the 90 day aspect of the diet program, or the daily aspect of the meditation course, or just the fact that nowhere in any of the literature did it say that doing cardio was going to be easy, let alone enjoyable.

Truth be told, I don’t know of a single quick fix approach to any mental health issue that is taken seriously by the scientific community. Most of the studies demonstrating the benefit of things like CBT, exercise, meditation, etc, are between 6-16 weeks in length. Even antidepressant medication can take about 6-8 weeks on average to start working.

But when you’re in the depths of depression or racked with anxiety, that’s a fucking long time to have to wait to see results. So quitting early is common. Even clinical trials, where a team of therapists and counselors are often there to provide support and leverage to participants, tend to see a dropout rate exceeding 30% [4]. So if you’re doing this stuff at home, alone, it’s easy to see how this figure could double or even treble.

The problem with “I tried that, it didn’t work” is that with a little semantic sleight of hand, it’s true. You can easily fool yourself into believing that you have indeed tried X, and that no, in fact, X did not work.

But this is the same kind of slippery get-out clause a cheating husband might conveniently employ when his wife accuses him of sleeping with other women. A charge he is able to deny in good conscience because indeed he hasn’t slept with anyone. Sure, he’s had sex with ten women in the past month. But that isn’t what he’s being accused of. He’s being accused of sleeping with other women. But he’s never so much as taken a nap with a single one of them. So, technically, he isn’t lying.

And this, I suspect, is exactly what many people are guilty of doing in relation to their own lack of success in trying to remedy their depression or anxiety using self-help techniques. I know I was.

So what to do?

Well, in the absence of being earnest – that is, in the absence of being serious in ones intention, purpose, or effort – you just have to be completely, brutally honest with yourself about it.

If you didn’t enjoy doing mindfulness meditation, or you found running too strenuous, fine. No big deal. If anything, this is good! This is an honest analysis of the situation that can help you reevaluate your approach. Maybe you’d be better off trying vipassana or guided meditation. And instead of running, maybe try low-intensity yoga instead.

In convincing yourself that it was the technique that was lacking rather than your commitment to it or the way you approached it, and then dismissing the entire project as inadequate or fraudulent, all you’re doing is limiting your options for your recovery based on a false evaluation, leading you to potentially dismiss something which had you stuck to it for the prescribed measure of time, could have been of immense benefit.

Furthermore, being too quick to dismiss this or that technique can quickly begin to contribute to the illusion that you’re somehow incurable. A special case. CBT works for millions of other people but it didn’t work for me! Wow, I must be really fucked up.

Apply this dismissive approach to every half-hearted attempt at the options available to you and pretty soon you’ll find yourself locked inside a prison of your own making, the walls a mere mirage constructed entirely of false testimonials that have you convinced you have nowhere else to turn.

Depending in whose company you make these claims as well, the consequences could be much further reaching than the end of your nose.

Let’s say for instance you choose to claim that you’ve tried CBT and that it didn’t work, and then post this claim on a mental health forum, or announce it during a discussion with a mental health support group. In reality you didn’t try CBT at all, you merely dabbled for a few days and got bored with it. But they don’t know that.

A fellow sufferer, hear your denouncement of CBT as “a waste of time” because “it doesn’t work”, and on your condemnation alone decide not to engage with it, despite the fact that it may have been of considerable benefit to them.

The importance of this point can’t be overstated. Truth be told, there are a relatively limited number of legitimate – that is, adequately studied and clinically verified – options available to people struggling with their mental health. And we do a great disservice to these methods, which are often based on solid research and designed by hard working, well meaning people, by denouncing them based on false testimonials, and which only serve to unfairly destroy their wider reputation.

Don’t get me wrong, I’m not saying that we should never criticize any of these methods simply to avoid discouraging those who might possibly benefit from them. On the contrary, they should be scrutinized to the highest degree, so that their methodology can be further refined and perfected.

But in order to scrutinize the efficacy of any therapeutic technique fairly, one must be reasonable about the bases on which they are to be scrutinized. Particularly when the technique in question requires a certain level of input and commitment from the person participating in it.

Is it really fair to scrutinize an 8 week daily meditation program based on a few sporadic days worth of participation? Hardly. To come to a negative conclusion about this particular meditation program based on this level of engagement would be analogous to a chef judging the outcome of a meal based on the recipe in a cookbook, but ignoring how he went about following the instructions.

It said four eggs, but I haven’t got eggs so I’ll just use a couple of turds. It said cook in a frying pan, but I haven’t got one of those so I’ll just use this rusty old hubcap. It said serve on a plate, but mine are all in the dishwasher so I’ll just spread it on the back of a raccoon carcass. Oh look, my scrambled eggs taste like shit. I’m not using that recipe book again. One star Amazon review: “Rubbish cookbook. Doesn’t work”.

On the other hand, let’s say you did complete the entire program down to the letter, and it really didn’t work for you. Now your evaluation of the technique is of genuine value to both the people who developed it and the people who are maybe thinking about trying it, as you can now offer up a detailed analysis of your own experience which the creators can use to refine their technique and the public can use to make a truly informed decision about whether or not it might be suitable for them.

More valuable than this though, is what the experience has taught you. You now know that meditation or yoga really isn’t the answer for you. But in seeing the entire process through from start to finish, you cultivated your ability to follow through and can now seek out other methods without looking back over your shoulder, confident in the knowledge that the road before you has narrowed based on conscious refinement and not pure self deception.

With all this in mind, maybe it’s time to look back over your past efforts to improve your mental health and ask yourself: That CBT course, that exercise regime, that diet program. Did you really try it, or did you just dabble with it? It didn’t work, or you didn’t do the work?

Now don’t get me wrong here, if you have been guilty of this, I’m not calling into question your commitment to the cause. I know you want to be able to see these things through. Nor am I underestimating the unfathomable level of resolve it takes to complete such mammoth tasks with any level of consistency while in the depths of depression or riddled with anxiety.

Believe me, I’ve been there. Jesus Christ, it took me four years and numerous half-arsed attempts before I finally mustered up the resolve to stick to anything for longer than a week.

All I’m asking is that should you call it quits at any point, that in hindsight you be honest about your level of adherence to the terms and conditions, so as not to misremember the experience and thus undervalue the potential inherent within the technique.

If you only managed three days of that 8 week meditation program. If you only quit McDonald’s for two days. If that exercise bike you bought was turned into a fucking coat hanger one week after buying it. Fine. No big deal. Just be honest about it. For your own sake.

And if somebody else asks you whether you’ve tried this or that therapeutic endeavor, this doesn’t mean you have to embarrass yourself by admitting that you didn’t really understand it, or that you just weren’t disciplined enough. Just say “no”. Because that’s the truth.

With this kind of honesty, you leave your options open to revisit certain approaches when you’re good and ready. For a fresh start, with a refined approach, and clear conscience. Instead of backing yourself into a corner that doesn’t exist because of failures that didn’t technically happen.

So, whatever it is. Whether it’s CBT, diet, meditation, exercise, you name it. Like my grandma used to say when we talked about fisting: Don’t knock it til you’ve really, really, tried it!

 

Sources

  1. The Benefits of Exercise for the Clinically Depressed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/
  2. The Efficacy and Effectiveness of Psychological Treatments: http://www.cpa.ca/docs/File/Practice/TheEfficacyAndEffectivenessOfPsychologicalTreatments_web.pdf
  3. Meditation Programs for Psychological Stress and Well-being, A Systematic Review and Meta-analysis: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1809754
  4. The Uphill Path to Successful Clinical Trials, Keeping Patients Enrolled: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684189/

 

Image courtesy: Carlos Luna

How to Write the Perfect First Blog Post?

Reading time: 8 mins

How many of you can relate to this experience?

You’ve decided, for whatever reason, to start a blog. You agonize for days over a name for your project where the .com, .net, or .org hasn’t already been snapped up by some arsehole domain squatter. Fifty attempts later, you finally settle on something you’re happy with and fork out a couple of quid on GoDaddy.

You buy a little web space, install WordPress, and upload a swanky, stylish, modern template that makes you look all premium and professional and stuff. And just like that, you’re ready to go. The world is your oyster.

You click “New Post”. A big blank page opens up before you. Oh, the potential. The little cursor seems to flicker with impatience, ready to skitter across your screen spilling syllables by the boatload. You crack your knuckles in preparation for the wordy symphony you’re about to hammer out on your keyboard. Just call you Williwig van Shakeshoven.

But hang on a minute. Hold your horses, sunshine. Let’s not be too hasty now.

Online, as in real life, first impressions matter. There’s fifty gazillion other blogs floating around out there in the ether. A bajillion of which already cover your chosen topic. Umpty-seven of which are authored by writing geniuses with God-tier marketing skills and eleventy-squillian subscribers.

You can’t just wing it and toss out any old codswallop. Not if you hope to compete with these behemoths of the blogosphere. No siree, Bob. You need to hit these mofos with a haymaker of an opening gambit. Come in like a wrecking ball, like that little Miley Cyrus fella says.

Your first ever blog post needs to be fun. It needs to be witty. It needs to be informative. It needs to be profound, amusing, intelligent, relatable. It needs immaculate spelling and punctuation. It needs flawless grammar and syntax. It needs structure and flow and character and style. It needs to be, well… Perfect.

Oh, the pressure. Your heart sinks. You sit and stare at your laptop screen. All that white space glaring back at you that mere moments ago felt like a blank canvas of infinite potential suddenly morphs into a bottomless abyss of nothingness. The words don’t come. The cursor flickers, slow and laboured. On. Off. On. Off. On. Off.

Five days later, you still haven’t written a thing.

Ladies and gentlemen. Welcome to writer’s block.

Shit.

Oh, don’t worry. I know I’m being a drama queen. But that’s anxiety for you. And this, along with depression and other mental health issues is what this blog is all about.

Anxiety, however, is my specialty. I’m the Michael Jordan, Tiger Woods, Lionel Messi, Roger Federer of worry. Place me in any innocuous situation and I can catastrophize the bejesus out of it.

My heart skips a beat, I’m going to have a heart attack. Every minor stomach ache is stage four bowel cancer. If a loved one doesn’t answer their phone after three attempts, they’ve died in a car crash. And the content of my first blog post is as important to humanity as Charles Darwin’s “On the Origin of Species”.

What this latter delusional anxiety boils down to, is self-consciousness. I. Care. What. You. Think. I wish I didn’t. I’d like to pretend I don’t. But I can’t. Because I do. And that’s that.

Like all world-class professionals though, I have my off days. And today is one of those days where I’m off my anxiety game enough to be able to step back and take a sober look at this self constructed predicament.

Those of you with experience in CBT might be familiar with cognitive restructuring exercises. These are (usually) written exercises where you identify your negative thought patterns or limiting beliefs and then subject them to a little rational scrutiny. The goal being to contradict them and thus undermine the emotional power they exert over you.

Let’s say you berate yourself for being a “loser”. You might look for evidence why this isn’t true, such as listing off some past victories. Or maybe you could reframe past mistakes by finding the important lessons they contained, and thus turn them into a win.

The limiting beliefs fueling my writer’s block in this particular instance are twofold:

1) It matters what you, the reader, think of me. Therefore…
2) My first blog post needs to be perfect.

There are plenty of surface level criticisms to be leveled at these limiting beliefs, and plenty of vacuous platitudes I could employ to counter them. Why do you care what people think? You can’t please everyone. Who says it needs to be perfect? There’s no such thing as perfect. Ruh, ruh, ruh.

However, for your entertainment, I reckon I’ve discovered a couple of deeper misconceptions in these limiting beliefs which are slightly more profound, and infinitely more amusing.

First of all, I said a moment ago, that I care what you think. You! But who is this “you” exactly?

As this is the first draft of my first ever blog post, by definition, there’s no blog to be read yet and hence no readership. So this “you” that I’m speaking to isn’t a separate other you at all, because an actual other you doesn’t technically exist yet.

Even if I claimed to be writing for a future you, having imagined what you might be like, you’re still no more real than the nudist Kerry Washington I share an apartment with whenever I start daydreaming at a stop light.

This you that I’m so desperate to impress is really just a Frankenstein’s monster of my own paranoid projections. In other words, you aren’t you at all. You are actually just me in disguise and relabeled with the pronoun “you”.

This whole situation is like  sitting in front of the mirror and being worried about having something of interest to say in case the reflection staring back at you disapproves in some way.

In short, I’m worried what to say myself because if I don’t say the right thing and impress myself, I’ll disapprove of what I have to say, and then feel bad about myself as a result.

Jesus!

But this is just a transient issue. The fact is, there will at some point in the future be other people who aren’t me who read this blog post. Which brings me to the matter of whether or not this first blog post even matters.

It doesn’t. And neither does yours. Not that it doesn’t matter, period. It just doesn’t matter yet. And by the time it does matter, what it actually says won’t matter much anyway. In fact, the worse it is now, the better it will eventually be.

Confused? Let me explain.

I’m sure there are some examples of bloggers out there who went from total anonymity on a Monday, to a viral sensation by Wednesday off the back of their first blog post. And good for them. But for the rest of us, no matter how revolutionary it is, our first blog posts will go completely unnoticed.

Launching a blog is like setting up a market stall in the middle of the desert. The only people who know you’re there are you parents and three of your friends. Sure they’ll pay you a token visit. Maybe they’ll tell their friends, and if you’re lucky, some of them will pop by for a minute or two.

But after this, the bulk of your early readership will consist of little more than the occasional straggler who stumbles across your blog by sheer fluke of a misspelled Google search.

If you want to get past this and build an audience, you have to expand your inventory. Write and write and write some more. Rack up those blog posts until people begin to arrive on purpose. By which point your first blog post is buried so deep in the archives, even you might struggle to unearth it.

Regardless of what your anxiety might try to tell you, your first blog post will not shape the first, nor the lasting impression that 99.99% of your readers will form of you. That’s the responsibility of future blog posts you haven’t even thunk about thinking about yet. So, save your writer’s block for those.

The sole purpose of your first blog post is to get yourself off the starting blocks and into the race. Nothing more. For everyone else, the only use your first blog post will serve is to satisfy the curiosity of those readers who want to see how much of an amateur you were when you first started out.

So, do these future readers a favour and let your first blog post be shit. The shitter the better. With any luck, by the time anyone actually reads it, you yourself will have turned into the kind of blogging royalty that will intimidate the next generation of newbie bloggers into a bout of writer’s block about their own first blog post.

Genuine spontaneous side note. As I sit writing this, finally coming to the end of my own first blog post, I’ve begun to suspect that writing your first blog post about the anxiety of writing your first blog post is probably one of the biggest clichés in blogging. But bollocks to it. I’m not going to check. I don’t even want to know.

Anyway, I’m sorry if you stumbled across this blog post while searching for some practical advice on how to construct an amazing, original, SEO-friendly masterpiece that will make you an overnight viral sensation. I’m not saying it can’t be done. I’m sure it can. I’ll bet it has. But I don’t know how to do it.

I don’t know what makes a great first blog post. I don’t even know what makes a good first blog post. But, in my humble opinion, the perfect first blog post is the one that gets published.

Here’s to perfectoin!

 

Image courtesy: Drew Coffman