Emily, a senior in college, is her own toughest critic. One low grade or a mistake and all she can think, “I’m a failure. I’ll never graduate or amount to anything.”
Emily has herself convinced that one mistake means she fails in all aspects of her life.
When we get so wrapped up in our thoughts, beliefs and assumptions and how they relate to a situation, we make decisions and take action based on our internal experiences rather than what is really going on in the world. The technical term is cognitive fusion and in Acceptance and Commitment Therapy (ACT), a form of cognitive-behavior therapy and popular mindfulness technique used by some therapists at Family & Children’s Services (FCS). The idea is to accept what is out of your personal control and commit to the action that improves and enriches your life. This is done through mindfulness.
Mindfulness suggests staying aware, focused and open to ideas that can be cultivated through proven techniques such as walking, meditation and short pauses. The idea is gaining popularity for decreasing stress or helping fight depression.
Rather than getting caught up challenging your thought or evaluating it for truth, ACT helps recognize the thought as a thought, rather than trying to figure out if it is true or not.
Most therapists use Cognitive Behavioral Therapy (CBT) to help with a range of problems. CBT is great for some problems. ACT compliments the outcomes for others. “The clients that do not respond to CBT, respond more quickly to ACT in my opinion because it gives them permission to feel what they feel and think what they think without having to get caught up in it,” Jenkins states. “One client that comes to mind is Cindy*, she has a gambling addiction as well as bipolar disorder. When we switched gears it was like a lightbulb for her. She realized ‘okay, I am going to have some level of these thoughts, urges, cravings, forever.’ So it’s not really about getting rid of them or overcoming them, it’s more about accepting them and realizing these thoughts will become a part of your experience,” Jenkins explained. Cindy may struggle with some feelings of depression and mania that will most likely be a lifelong struggle. Yet, she can still have meaningful relationships and she can make choices regarding her feelings whenever they start to interfere.
“It takes some time to develop the rapport with our clients. We have to spend time with them so we can figure out the best treatment,” Jenkins said. The first phase is evaluating the addiction and seeing what road blocks can be put in place such as social support, family, meetings, recovery programming, etc. The next step is to find out what was driving the addiction, trauma, mental illness, etc. Then ACT is implemented to see how the client responds.
With ACT the focus is on mindfulness and sitting with it, rather than evaluating your thought process. It is about accepting the craving, developing body awareness of why this is happening and what is going to defuse it.
Part of ACT is meant to undermined what they call the ‘agenda of control’. “We have to present these skills to clients not as control strategies, but as mindfulness/awareness strategies. If a client starts getting into the mindset of, ‘in three minutes I’m going to crush this craving’ they may get frustrated if it doesn’t work,” Jenkins said. ACT is about acknowledging that we don’t have control over a craving or how long that craving will last. All we can do is control our behavior and our response to that. The more you can be aware of your feelings there is a greater chance of making a positive decision.
There are a few exercises that are recommended when working with ACT. Jenkins described an exercise that he likes to do with his clients, “I like to tell clients to close their eyes and visualize leaves on a stream. I have them picture leaves floating down a stream and I tell them to watch their thinking and whatever thought pops up, put that thought on leaf and just let it float by.” He also utilizes an app called ‘calm’ it includes meditation exercises and calming background noises. The app can also help remind you to take a minute and just breath.
No matter what therapy is chosen, the most important variable is the client. “Whatever therapy is chosen, it won’t work without work. “You’ll get out what you put in,” Jenkins states.
*Name is changed for the privacy of the client.