“With kindness, erudition, and humor, the authors of Get Out of Your Mind and Into Your Life educate readers into a new way of thinking about psychological issues in general and life satisfaction in particular. Their combination of cutting-edge research and resonance with ancient, tried-and-true practices makes this one of the most fascinating and illuminating self-help books available. If you’re tired of standard psychological parlance and still frustrated with your quality of life, this book can be a godsend.”
—Martha Beck, columnist for O Magazine and author of Finding Your Own North Star and Expecting Adam
“This manual, firmly based on cutting edge psychological science and theory, details an innovative and rapidly growing approach that can provide you with the power to transform your very experience of life. Highly recommended for all of us.”
—David H. Barlow, professor of psychology, research professor of psychiatry, and director of the Center for Anxiety and Related Disorders at Boston University
“This is the quintessential workbook on acceptance and commitment therapy. Written with wit, clinical wisdom, and compassionate skepticism, it succeeds in showing us that, paradoxically, there is great therapeutic value in going out of our minds. Once released from the struggle with thought, we are free to discover that a life of meaning and value is closer at hand than thought allowed. This book will serve patients, therapists, researchers, and educators looking for an elegant exposition of the nuts and bolts of this exciting approach.”
—Zindel V. Segal, Ph.D., the Morgan Firestone Chair in Psychotherapy and professor of psychiatry and psychology at the University of Toronto and author of Mindfulness-Based Cognitive Therapy for Depression
Get Out of Your Mind and Into Your Life
Steven Hayes & Spencer Smith
New Harbinger Publications
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books.
Copyright © 2005 by Steven C. Hayes and Spencer Smith New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
Cover design by Amy Shoup
Text design by Michele Waters-Kermes
Acquired by Catharine Sutker
New Harbinger Publications’ Web site address: www.newharbinger.com
Library of Congress Cataloging-in-Publication Data
Hayes, Steven C.
Get out of your mind and into your life: the new acceptance and commitment therapy / Steven Hayes & Spencer Smith.
p. cm.
Includes bibliographical references.
ISBN 1-57224-425-9
1. Cognitive-experiential psychotherapy. 2. Behavior therapy. 3. Self-acceptance. 4. Commitment (Psychology) I. Smith, Spencer Xavier. II. Title.
RC489.C62H395 2005
616.89’142—dc22
2005022640
All Rights Reserved
First printing
To my mom
Ruth D. H. Sundgren
My first model of love and commitment
—SCH
To my wife and son
Together may we accept life’s trials and commit to our mutual path
—SS
Contents
Acknowledgments
Introduction
ACT: What It Is and How It Can Help You
Suffering: Psychological Quicksand
The Ubiquity of Human Suffering
Mindfulness, Acceptance, and Values
Commitment and Values-Based Living
Chapter 1
Human Suffering
Human Suffering Is Universal
EXERCISE: Your Suffering Inventory
The Problem with Pain
EXERCISE: The Pain is Gone, Now What?
The Problem with Pain: Revisited
Living a Valued Life: An Alternative
Chapter 2
Why Language Leads to Suffering with John T. Blackledge
The Nature of Human Language
EXERCISE: Relate Anything to Anything Else
EXERCISE: A Screw, a Toothbrush, and a Lighter
Why Language Creates Suffering
EXERCISE: A Yellow Jeep
EXERCISE: Don’t Think About Your Thought
What You’ve Been Doing
EXERCISE: The Coping Strategies Worksheet
The Problem with Getting Rid of Things—Squared
Experiential Avoidance
The Mind-Train
Chapter 3
The Pull of Avoidance with Julieann Pankey and Kathleen M. Palm
Why We Do What Can’t Work
Accepting the Possibility That Experiential Avoidance Can’t Work
So, What Are You Supposed to Do?
EXERCISE: The Blame Game
EXERCISE: Judging Your Own Experience: Examining What Works
Moving On
EXERCISE: What Are You Feeling and Thinking Now?
Chapter 4
Letting Go with John T. Blackledge and Michael Ritter
If You’re Not Willing to Have It, You Will
Acceptance and Willingness
EXERCISE: Why Willingness?
Willingness and Distress
EXERCISE: Being Willingly Out of Breath
The “Willingness to Change” Question
Chapter 5
The Trouble with Thoughts with Jason Lillis
Thought Production
EXERCISE: What Are You Thinking Right Now?
Why Thinking Has Such an Impact
EXERCISE: Your Daily Pain Diary
Looking at Your Thoughts Rather Than from Your Thoughts
The Mind-Train
EXERCISE: Watching the Mind-Train
Chapter 6
Having a Thought Versus Buying a Thought with John T. Blackledge and Jason Lillis
Cognitive Defusion: Separating Your Thoughts from Their Referents
EXERCISE: Say the Word “Milk” as Fast as You Can
EXERCISE: Labeling Your Thoughts
EXERCISE: Floating Leaves on a Moving Stream
EXERCISE: Describing Thoughts and Feelings
EXERCISE: Exploring the Difference Between Descriptions and Evaluations
Creating Your Own Cognitive Defusion Techniques
Chapter 7
If I’m Not My Thoughts, Then Who Am I?
Considering Your Self-Conceptualizations
The Three Senses of Self
EXERCISE: Retelling Your Own Story
Being the Observing Self
EXERCISE: Experientially, I’m Not That
Getting Started
EXERCISE: Tracking Your Thoughts in Time
Taking the Next Step
Chapter 8
Mindfulness
Daily Practice
The Practice
EXERCISE: Be Where You Are
EXERCISE: Silent Walking
EXERCISE: Cubbyholing
EXERCISE: Eating Raisins
EXERCISE: Drinking Tea
EXERCISE: Eating Mindfully
EXERCISE: Listening to Classical Music
EXERCISE: Be Mindful of Your Feet While You Read This
EXERCISE: Just Sitting
Mindfulness in Context
Chapter 9
What Willingness Is and Is Not with Michael Ritter and John T. Blackledge
What Needs to Be Accepted?
EXERCISE: What Needs to Be Accepted
The Goal of Willingness
Chapter 10
Willingness: Learning How to Jump with Michael Ritter
The Willingness Scale
Taking a Jump
EXERCISE: Willingness Scale Worksheet
Using Your Skills and Learning Some New Ones
EXERCISE: Physicalizing
EXERCISE: Giving Your Target a Form
EXERCISE: The Tin-Can Monster
EXERCISE: Acceptance in Real-Time
Chapter 11
What Are Values?
Values as Chosen Life Directions
What Values Are and Are Not
Chapter 12
Choosing Your Values
The Masters You Serve
EXERCISE: Attending Your Own Funeral
Taking It a Step Further: Ten Valued Domains
Ranking and Testing Your Values
Committed Action
Chapter 13
Committing to Doing It with Jason Lillis and Michael Twohig
Taking Bold Steps
EXERCISE: Goals Worksheet
EXERCISE: Making Goals Happen Through Action
EXERCISE: Expected Barriers
Many Maps for Different Journeys
Building Patterns of Effective Action
Whose Life Is It Anyway?
Conclusion
The Choice to Live a Vital Life with David Chantry
Appendix
The Values and Data Underlying ACT
References
Acknowledgments
I would like to thank a number of people who have contributed to this volume. My wife, Jacque Pistorello, was constantly supportive and inspirational during the writing of the book. My children, Camille, Charlie, and Esther, were understanding when I had to focus on the book and not them for a few critical weeks. Like Jacque, Spencer Smith’s wife, Marie, also supported us during our “writing binges.”
Many of the ideas in this book have been influenced by members of the ACT Listserv. One, David Chantry, is listed as a chapter coauthor because he contributed so many different ideas, some of which went beyond that chapter (e.g., a variant of the Coping Strategies Diary; the railroad bridge exercise; the empty head exercise; the valued living recording sheet). I thank him for his permission to use these ideas in the book. My students (several of whom provided materials that found their way into specific chapters and are listed as chapter coauthors) were a source of ideas and support throughout. The idea for a book that could be used directly by the public was first proposed to me by Don Kuhl of The Change Companies. The project did not reach fruition, but I would nevertheless like to acknowledge his role in getting me to think about such a project. Kirk Strosahl has prodded me periodically for years to do a popular book, which also had a role in my willingness to do this work. New Harbinger, particularly Matt McKay and Catharine Sutker, allowed me the freedom to approach the book in my own way.
ACT and RFT are collective, not personal, works that have been influenced by the hands of many: students, colleagues, and clients. I cannot thank them all in this forum, but I surely do in my head and heart. You know who you are. Thank you.
—Steven C. Hayes
Reno, NV
May 2005
First and foremost I would like to thank Steve Hayes for inviting me on board to help him create a trade version of this work. It has been a pleasure working with him. I believe the work on this book has affected my life in some very direct ways, and I am thankful for that opportunity.
I would also like to thank his various family members who showed me much hospitality on trips to Reno when we were writing the book.
My wife, Marie, has been patient and helpful in supporting me throughout this process. Aside from giving me the space to work on this project, she also took on the burden of staying up nights with our newborn son, Tristan, on her own so that I could get the extra sleep needed to keep working.
Thank you to the people at New Harbinger who made my involvement with this project possible. I would especially like to thank Catharine Sutker, who introduced me to the project, and Matthew McKay, our publisher, in this regard. It has been and continues to be a pleasure to work with you.
Finally I would like to thank you the reader. I hope our efforts in presenting this material will impact your life in some positive ways.
—Spencer Smith
Santa Rosa, CA
May 2005
Introduction
People suffer. It’s not just that they have pain—suffering is much more than that. Human beings struggle with the forms of psychological pain they have: their difficult emotions and thoughts, their unpleasant memories, and their unwanted urges and sensations. They think about them, worry about them, resent them, anticipate and dread them.
At the same time, human beings demonstrate enormous courage, deep compassion, and a remarkable ability to move ahead even with the most difficult personal histories. Knowing they can be hurt, humans still love others. Knowing they will die, humans still care about the future. Facing the draw of meaninglessness, humans still embrace ideals. At times, humans are fully alive, present, and committed.
This book is about how to move from suffering to engagement with life. Rather than waiting to win the internal struggle with your own self so that your life can begin, this book is about living now and living fully—with (not in spite of) your past, with your memories, with your fears, and with your sadness.
ACT: WHAT IT IS AND HOW IT CAN HELP YOU
This book is based on Acceptance and Commitment Therapy, or ACT. (“ACT” is spoken as a single word, not as separate initials.) This is a new, scientifically based psychotherapeutic modality that is part of what is being called the “third wave” in behavioral and cognitive therapy (Hayes 2004). ACT is based on Relational Frame Theory (RFT): a basic research program on how the human mind works (Hayes, Barnes-Holmes, and Roche 2001). This research suggests that many of the tools we use to solve problems lead us into the traps that create suffering. To put it bluntly, human beings are playing a rigged game in which the human mind itself, a wonderful tool for mastering the environment, has been turned on its host.
Perhaps you’ve noticed that some of your most difficult problems have paradoxically become more entrenched and unmanageable, even as you’ve implemented ideas about how to solve them. This is not an illusion. This results from your own logical mind being asked to do what it was never designed to do. Suffering is one result.
This may seem like a very odd claim, particularly if you picked up this book to help yourself overcome some of your psychological issues. As a rule, people turn to self-help books for tools to solve specific problems: depression, anxiety, substance abuse, trauma, stress, burnout, chronic pain, smoking, to name just a few. For the average person, overcoming these problems implies not just an ultimate end but also an end reached by specific means.
For example, overcoming stress seemingly must first involve eliminating stressful feelings; overcoming smoking seemingly must first involve getting rid of urges to smoke; overcoming anxiety disorders seemingly must involve learning how to relax instead, or to dispute and change overblown and worrisome thoughts; and so on. In this book, ends and means are carefully distinguished, and you will learn that many of these common sense routes to a better life are now thought to be both risky and unnecessary in current psychological theory.
If you are suffering with a psychological problem, you should know that research suggests that ACT helps with many common psychological difficulties (Hayes, Masuda, et al. 2004), and its underlying model has received considerable support (Hayes et al. forthcoming). We will discuss these data throughout this book.
The fact that you are reading an empirically based account is all the more important because this book will take some seemingly strange twists and turns. At times, it may be confusing. To some degree that is unavoidable because ACT challenges some of the most
culturally ingrained forms of conventional thinking about human problems. Research indicates that ACT’s methods and ideas are generally sound, which provides reassurance that these concepts and procedures are effective. (See the appendix for a partial list of studies on ACT and its components.) That doesn’t mean they are easy to grasp. Then again, if these ideas and methods were already well-known to you, this book would probably not be useful.
Here’s a sample of some of the unconventional concepts you will be asked to consider:
Psychological pain is normal, it is important, and everyone has it.
You cannot deliberately get rid of your psychological pain, although you can take steps to avoid increasing it artificially.
Pain and suffering are two different states of being.
You don’t have to identify with your suffering.
Accepting your pain is a step toward ridding yourself of your suffering.
You can live a life you value, beginning right now, but to do that you will have to learn how to get out of your mind and into your life.
Ultimately, what ACT asks of you is a fundamental change in perspective: a shift in the way you deal with your personal experience. We can’t promise that this will quickly change what your depression, anger, anxiety, stress, or low self-esteem looks like, at least, not anytime soon. We can, however, say that our research has demonstrated that the role of these problems as barriers to living can be changed, and sometimes changed quite rapidly. ACT methods provide new ways to approach difficult psychological issues. These new approaches can change the actual substance of your psychological problems and the impact they have on your life.
Metaphorically, the distinction between the function of a psychological disorder and the form it takes in one’s life can be likened to someone standing in a battlefield fighting a war. The war is not going well. The person fights harder and harder. Losing is a devastating option; but unless the war is won, the person fighting it thinks that living a worthwhile life will be impossible. So the war goes on.
Unknown to that person, however, is the fact that, at any time, he or she can quit the battlefield and begin to live life now. The war may still go on, and the battlefield may still be visible. The terrain may look very much as it did while the fighting was happening. But the outcome of the war is no longer very important and the seemingly logical sequence of having to win the war before beginning to really live has been abandoned.