ACT

Personal musings on acceptance, mindfulness and valued action


I’m a long way from being anything other than a novice when it comes to Acceptance and Commitment Therapy (ACT). It’s a new-but-old approach, and like most therapies, seems to work best if the therapist actually uses it personally.

There’s no doubt that bad things happen to good people.  That’s challenging, and people who are seen to be ‘resilient’ seem to cope better with these events than those who are less resilient.  Resilience means being able to bounce back from impact, being flexible – and that’s the aspect that ACT addresses.  The ability to be psychologically flexible, or to adjust your actions to help achieve the direction you really value in life is the main target of therapy.

Maybe it’s my occupational therapy heritage, but it took me a while for ACT to click in place for me – and it wasn’t until I read about the committed action part of the therapy that it all made sense.  Actions that satisfy important values in a person is an integral part of occupational therapy.

Values, or what a person believes is important in life, are not goals. Goals are able to be ticked off and achieved – or not achieved, depending on many factors.  Values are the underlying reasons for choosing those specific goals – values provide direction, and shape the range of goals a person accepts.  Values don’t finish – we never ‘complete’ things like having a satisfying family life, being open to new experiences, or appreciating beauty.

Actions are behaviours we do. They can be seen, counted and measured.  Added up, a series of actions provide momentum in a direction – sometimes they lead to completing goals, sometimes they don’t because of intervening events.  Actions are about what individuals actually do, not the results of those actions which can vary.

When life happens, actions often change – the person becomes unable to keep lifting heavy boxes, doesn’t get off to sleep well, finds it hard to keep driving.  As a result, often the momentum in their lives is lost.  And if the person isn’t flexible about the goals he or she is aiming for, negative emotions usually arise.  It’s hard not to feel frustrated and angry when the goal of ‘getting to work on time every day’ is stymied by being unable to sit for long enough to drive there!  Then a lot of the work of therapy is about helping the person deal with these emotions while trying to help them regain the ability to continue with their previous actions.  Most of the time in Western health anyway, the focus is on trying not to feel the negative feelings, or trying hard to control them.

Acceptance and mindfulness are processes that help people recognise that they are not equivalent to the thoughts and feelings that come and go (even though we have all probably learned that we are). There is a ‘me’ that these thoughts and feelings are recognised by, but they are not the complete ‘me’. And thoughts and feelings don’t remain at the same intensity – they come in waves, gradually peaking and ebbing away.

The only times when they don’t ebb away are when we try hard to either avoid having them (ignore them or pretend they’re not there), or try to control them. The effect of trying to ignore or somehow control them is that they remain in our attention for longer, and can then influence the actions we take.

Once actions are influenced by thoughts and feelings, it can be quite a rapid process for these actions to move away from the reason they were being done!

An example might help to illustrate this: if the original reason for having a clean and tidy home was so that the family feel comfortable there, but the actions to achieve that are restricted by thoughts that pain is horrible and it’s important not to have pain, then it’s tempting for the person to strive to keep the house to the same standard.  This can make it harder to actually be present emotionally so that the family feel comfortable being there!

So a big part of ACT is to help the person take action to move towards those valued things in their life at the same time as experiencing negative emotions. 

Some of the tools to help people start to do this are ‘acceptance’ and ‘mindfulness’Acceptance involves moving from a battle to a dance with the negative experiences.  Instead of trying to defeat the pain, being ready to be a partner to it instead.

Mindfulness is about being fully present to all that each moment brings – and letting it pass by without judging, remembering or predicting.

Neither of these two processes are easy! Taking action is equally difficult – but the rewards of regaining momentum toward what is important becomes motivating, and life becomes about being rather than doing.

Reflections on ACT case formulation in chronic pain


I’ve been reviewing ACT and contextual cognitive behavioural therapy in chronic pain management over the past year or so, and it’s really interesting reflecting on the different way in which I see people after being exposed to the ACT approach.

Just to recap, some of the main precepts of ACT and CCBT are:

  • people’s attempts to control their negative emotions lead them to avoid encountering these emotions
  • but in doing so they often increase the intensity and frequency with which they experience them
  • and their attempts to avoid the experiences also lead them away from pursuing activities that enable them to achieve things that are important to them (eg values)
  • this becomes evident through ‘cognitive inflexibility’ or the difficulty to do things in different ways in order to maintain value-aligned behaviour (more…)

Three things I learned about in 2008


  1. I learned more about ACT, or Acceptance and Commitment Therapy, and its value in pain management, at least for some people.  There are some things about this approach that really appeal to me, especially the mindfulness part (noticing myself becoming aware without judging or critiquing).  The action part may not always be so helpful for people who possibly need to become aware of how to lighten up a little, but perhaps that’s just because I need to learn more about that part.  Great sites for this are: Live Mindfully, ACT Mindfully, and the grand Association for Contextual Behavioral Science
  2. I reviewed some of my basic scientific methodology (but not the statistics part – yet!).  It’s good to revisit why a certain approach to ‘truth’ or ‘reality’ has been adopted in modern health care, and while I’m not entirely sure of my philosophical base, I have spent some time looking at Scientific Realism.  I’m quoting now from the Stanford Encyclopaedia of Philosophy, so excuse the jargon, ‘ Scientific realists hold that the characteristic product of successful scientific research is knowledge of largely theory-independent phenomena and that such knowledge is possible (indeed actual) even in those cases in which the relevant phenomena are not, in any non-question-begging sense, observable.’ What this means in practical terms is that you can probably trust that most robust (ie replicated) findings in science are going to look pretty much like they really are, or at least are going to be analogous to what is actually in the world.  I’m sorry about this, but I’m a geek and happy with it! I love this stuff!
  3. I visited theory and evidence on goals and goal-setting. And this is going to be a bit of a focus for me for the next few months because I think it’s time for me to find out whether certain styles of setting goals make a difference for people.  Like most health professionals, setting goals has become a standard tool of trade – but as for the science behind it in pain management? Not a lot has been looked at recently at least.  There is a lot written about goals – but it all seems to assume that setting them is a good thing.  A bit like ‘pacing’ which has always been assumed to be ‘good’ – but is it?  Or the occupational therapy belief that ‘activity is good’ – or is it?  Here’s an example of a reference on goal-setting, and here is one current study being carried out on goal-setting, in New Zealand, but in relation to brain injury rehabilitation.

Tomorrow – last post before Christmas!! Looking forward to 2009, what will be on the agenda?  Let me know what you think.

Carrying on with self-management strategies doesn’t make a difference


Continuing in the vein of yesterday’s post where I discussed a study showing no additional benefit from adding graded exposure or graded activity to treatment by classification, today I want to discuss a recent finding showing that all the hard work put into helping people develop and use self management may not make a difference to their recovery in the end.  It’s this study (doi:10.1016/j.ejpain.2008.06.009) by Charlotte Curran, Amanda C. de C. Williams, and Henry W.W. Potts – Cognitive-behavioral therapy for persistent pain: Does adherence after treatment affect outcome? European Journal of Pain

What?! Shock and panic around the world! Pain management skills are not used!

The whole basis of self management lies with the idea that people develop practical skills they can use in the ‘real world’ so that when they experience pain, they have a range of strategies that improves their ability to cope.  So if they’re not actually using these skills after six months, what on earth are we doing all this treatment for? (more…)

A Prospective Analysis of Acceptance of Pain and Values-Based Action in Patients With Chronic Pain


ResearchBlogging.org
Lance M. McCracken and Kevin E. Vowles

These two researchers have been publishing more and more on acceptance and values and Acceptance and Commitment Therapy (ACT) and Contextual Cognitive Behavioural Therapy (CCBT), and this paper is another example of the type of work being undertaken.

The objective was to ‘prospectively investigate the combined processes of acceptance of pain and values-based action a in the emotional, physical, and social functioning of individuals with chronic pain.’

A concept I’m interested in is ‘psychological flexibility’ or the willingness individuals have to allow for ways of behaviour and goals to differ depending on the context or situation in which they occur – in other words, allow for the realities of life while all the while still aiming for things that are important to them to achieve. And by things, I mean activities that express the values of the person. ACT includes concepts such as acceptance, cognitive defusion, contact with the present moment, self-as-context, values,and committed action (Hayes, Luoma, Bond, Masuda, & Lillis, 2006), which are construed as ‘psychological flexibility’.

Quoting from the article “Acceptance has been investigated in more than 15 studies (e.g., McCracken, Vowles, & Eccleston, 2004; Viane et al., 2003; Vowles,McCracken, & Eccleston, in press a; see McCracken & Vowles, 2006). A number of treatment studies of mindfulness-based methods support the role of the process of “contact with the present moment” (e.g., Kabat-Zinn, Lipworth, & Burney, 1985: Sephton et al., 2007), but just one study included direct assessment of mindfulness (McCracken, Gauntlett-Gilbert, & Vowles, 2007). There is just one study of values-related processes in relation to patient functioning with chronic pain (McCracken & Yang, 2006). In each of these studies the general result is that processes of acceptance, contact with the present moment, and values-based action are significantly associated with better emotional, physical, and social functioning.'[my emphasis]


Participants in this study seem familiar to me
– very similar to the chronic pain patients referred to the clinic in which I work, that is they have had pain for 77 months (8.0 – 516), in their 40’s, mostly married or in long-term relationships, mainly experiencing low back pain, lower limb pain, or whole body pain, and 60% or so not working.

They were recruited from the people referred to the Centre, and completed the questionnaires for this study when they first attended for assessment, and again roughly 18 weeks later at the commencement of their pain management programme. The questionnaires included measures of acceptance, importance and success at living according to their values, emotions, and disability.

Results?
Now as usual I’m not going into detail into the multiple regression analyses and other statistical methodology – that’s for you to read, when you read the article in depth. Suffice to say that ‘the present analyses demonstrate that measures of acceptance of pain and values-based action predict functioning later in time for patients seeking treatment for chronic pain.’

Unexpectedly, ‘there were only two of nine possible occasions where both the acceptance and values variables performed as significant predictors, in the equations for depression and psychosocial disability.’ It was thought that this would occur in every equation. The authors suggest that
‘Our inability to find these relations may have been due to the statistical control procedures that included pain intensity, a variable that shares variance with both acceptance and values, and the
overlapping variance between the acceptance and values variables, which, according to the correlation results, is estimated at 25.0%.’

They add that ‘the study interval was quite long, providing opportunity for a wide range of influences on the measures of functioning at Time 2 that could have reduced their relations with the acceptance and values measures from Time 1’.

I like this point made by the authors: Flexible and effective behavior will tend to have both qualities [of acceptance and values] and these qualities are expected to mutually enhance each other, with acceptance loosening up restrictive influences exerted by pain on behavior in the near term, and values giving direction and purpose to behavior over the longer term.

Now you know I’m going ask ‘What does that mean for us as clinicians?’
Well…people who report that they accept their situation and act to achieve things that they value in their life despite their pain present ‘better’ in terms of their results on measures of things like emotional, physical, and social functioning.

Not really rocket science in that anecdotally clinicians know that angry and resentful people rarely function as comfortably in their lives as people who are more accepting and ‘get on with life’. What is rocket science is that these concepts are based on a theoretical model that can be empirically tested, and used to help us develop ways to encourage people to become more accepting, and to live lives based on things that are important to them, rather than spend energy on seeking to return to ‘the way things were’ or ‘what might have been’.

It means that some of the work of occupational therapists whose primary focus is to help people identify important areas of activity and facilitate their achievement in these areas is validated. That perhaps over time, the urgency to ‘reduce pain’ (which in many ways constructs and reinforces disability because it implies that having pain and restrictions is not normal) may reduce. Perhaps by helping people with pain identify what is important to them, we as clinicians might look at what is important to us – making more space in our lives for things we value, like balance, family, creativity, and inquiry.

I can foresee some clinicians finding the concept of accepting pain particularly hard to reconcile with their own value system of relieving pain (almost at all costs). And this will conflict with the aims of patients who dearly want me to help them ‘remove their pain’. So, putting these concepts into therapy in an acceptable way for the people with whom I work continues to be my challenge. After all, these patients are seeking treatment – this shows that they are unhappy with their current situation, living the antithesis of acceptance. I can see this topic being discussed over and again in the next few years.

I hope you’ve enjoyed my stroll through mindfulness and acceptance over this week – have no fear, I can see that I’ll carry on this particular path many times as I continue learning and enquiring! As I discover things, I’ll be sure to post them. Keep in touch too – your comments mean a lot to me, and it’s always great to see what other people think, whether you agree or not! And if you want to subscribe, don’t forget the RSS feed link at the top right of this page – or bookmark – I post most days during the week.

McCracken, L.M., Vowles, K.E. (2008). A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.. Health Psychology, 27(2), 215-220. DOI: 10.1037/0278-6133.27.2.215
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., Lillis, J. (2006).
Acceptance and Commitment Therapy: Model, processes and outcomes.
Behaviour Research and Therapy, 44, 1–25.

Mindfulness effectiveness


ResearchBlogging.org
One of the most delightful aspects of the ‘new wave’ of cognitive behavioural therapies is the continued adherence to test the effectiveness of therapy in a scientific way. There has been quite a flow of ACT (Acceptance and Commitment Therapy), CCBT (Contextual Cognitive Behavioural Therapy) and allied therapies in the psychological literature, and now it is fast appearing in interdisciplinary journals.

The official publication of the IASP (International Association for the Study of Pain) is the journal Pain. It publishes studies relevant to a broad range of disciplines involved in the study and management of pain. It’s fascinating to see the different articles that make their way to the journal – from basic science to primary prevention/public health campaigns!
This article, Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study is a good example of the type of study on ACT practices that is published in this well-read journal.

Morone, Greco and Weiner write about their pragmatic study to ‘assess the feasibility of recruitment and adherence to an eight-session mindfulness meditation program for community-dwelling older adults with chronic low back pain (CLBP) and to develop initial estimates of treatment effects.’

Now the first point to make is that mindfulness meditation alone does not equate to ACT. It does, however, form a foundation for the practice of ACT, as well as having well-documented effects from simple meditation practice on physiological arousal.

Back to the storyParticipants were 37 community-dwelling older adults aged 65 years and older with CLBP of moderate intensity occurring daily or almost every day. Participants were randomized to an 8-week mindfulness-based meditation program or to a wait-list control group. Baseline, 8-week and 3-month follow-up measures of pain, physical function, and quality of life were assessed.

This is an interesting group of participants – I work in a public hospital outpatient centre, and I notice that there are increasing numbers of people in this age group being referred to the service. I’m not sure if this is because medication prescribing has changed, that older adults are reporting chronic pain more readily than 15 – 20 years ago, whether it’s an artifact of having a larger number of people aged 65 in the community, or what it is – but it does have an impact on the type of programmes we provide. In view of the increasing growth in the over 65 year age group in the next 20 years, it is a group that we are going to see more often, and who will require more expenditure in health care especially if disability from chronic pain is not addressed effectively. Whew! that was a long sentence!

So a fairly typical methodology was employed for this study – a wait-list control, and baseline, 8-week and 3-month follow-up measures taken across several domains.

The actual intervention was over eight weeks, and included an introduction to the ‘principles and practices’ of meditation, reading materials, a recording of a ‘body scan’ meditation and a sitting meditation, discussion and problem solving around the habit of meditation, and psychoeducational material on stress, pain and the ‘mind-body’ connection was also provided. A walking meditation was introduced towards the latter part of the eight weeks, and the only major difference from ‘standard’ Mindfulness-Based Stress Reduction Programmes ((Kabat-Zinn, 1982; Kabat-Zinn et al.,1992; Kabat-Zinn, 1990; Kabat-Zinn, 2003.) was the elimination of a full-day silent meditation ‘retreat’ and the yoga component.

Now for the exciting part: what were the results?

Well, the study was a pragmatic and applied one, so the first thing I was interested in was participation rates and adherence. 19 participants were selected for the meditation group, 13 participated, one was lost at followup, leaving 12 completing. In the waiting list group, 18 were initially recruited to this group, 14 eventually participated (after a delay of 8 weeks), and 13 completed.

Allowing that these participants were specially recruited, I’m not sure we can generalise to the group of people who are usually referred to a public hospital service. However, it is interesting that these participants continued to attend what is probably seen as an ‘unusual’ type of therapy for pain.

The authors commented that these participants attended the majority of sessions, engaged in the ‘homework’ activities (meditation practice) during the programme, and reported that they maintained the practice three months later. This is great as it demonstrates that older adults understand the programme, are interested in it, find benefit from it, and as the authors quote a program participant stated it best ‘‘Mindfulness meditation has a quieting effect on me. It gives me a peaceful feeling while doing it and I am able to reduce my back and leg pain by deflecting the pain and by focusing on other parts of my body’’.

It’s also interesting that things like activity planning and exercise were not specifically included in the programme, but activity levels increased.

As expected, acceptance of their situation increased, as did quality of life measures. Pain intensity reduced and ‘global’ health and mental health as measured by the SF36 reduced.

Notable too – people who crossed over from the waiting list group also improved.

The authors are open about several aspects of this study that mean its interpretation needs to be somewhat guarded: it is a small group, a pilot study, between group differences can’t be established due to low power, and the differences between the groups were not entirely controlled for.

However, it’s the beginning of the ‘real world’ type of study that can help us as clinicians think about the people we work with and whether this therapy may be useful.

MORONE, N., GRECO, C., WEINER, D. (2008). Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study☆. Pain, 134(3), 310-319. DOI: 10.1016/j.pain.2007.04.038
Kabat-Zinn J. An outpatient program in behavioral medicine for
chronic pain patients based on the practice of mindfulness
meditation: theoretical considerations and preliminary results.

General Hospital Psychiatry 1982;4:33–47.
Kabat-Zinn J. Full catastrophe living: Using the wisdom of your
body and mind to face stress, pain, and illness.
New York: Delacorte;
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Kabat-Zinn J. Mindfulness-based interventions in context: past,
present, and future.
Clin Psychol: Sci Pract 2003;10:144–56.
Kabat-Zinn J, Lipworth L, et al. The clinical use of mindfulness
meditation for the self-regulation of chronic pain. J Behav Med
1985;8:163–90.

Explaining mindfulness – doing and being


Today I worked with a person who is very analytic, and finds it quite difficult to feel emotions or experience sensations without thinking about them. He has persistent pain that he calls ‘frustrating’ or ‘unbearable’ – emotions that for me are quite poles apart!

His overall anxiety levels are quite high, and at one time it was suggested that he use biofeedback to learn about things like his muscle tension so that he could manage his headaches. Somehow this didn’t seem like the right thing to do today, so I tried two things from the ACT approach to see how they worked. My post yesterday looked at some of my difficulty finding a way to explain in simple and practical terms how mindfulness worked – for this man, explanation would give him ‘head’ knowledge, but not ‘heart’ knowledge, so I decided to step right on in there and just do it!

The first thing I did was see what good things and not so good things he could identify about his usual way of coping with pain. This approach is based on the Motivation Interviewing approach I’ve posted about before. I did this to help develop intrinsic motivation for a change from experiential avoidance to allowing himself to begin to approach his pain without the ‘mind chatter’ he has.

The problem was that although he had stopped his work, wouldn’t drive, walk more than 5 minutes, and spent most of his time sitting with his feet higher than his heart, he couldn’t identify any ‘not so good’ things about these strategies! He found it so hard to identify with any emotions, that he rationalised his coping strategies as being ‘helpful’ despite their interfering with normal activities.

So I changed tack, and talked about what was important to him – his values. He really values being able to work, support his family and his independence. By helping him see the discrepancy between his coping strategies and his values, he was able to acknowledge (to a certain extent anyway) that his coping strategies were not working (creative helplessness!).

BTW Experiential avoidance is ‘a process involving excessive negative evaluations of unwanted private thoughts, feelings, and sensations, an unwillingness to experience these private events, and deliberate efforts to control or escape from them (Hayes, 1994; Hayes, Strosahl, & Wilson, 1999).’ in Kashdan, Barrios, Forsyth & Steger (2005).

I proposed the thought that perhaps he was working quite hard to avoid experiencing pain – and in discussing a specific situation, he was able to identify some automatic thoughts relevant to his pain, although he continued to find it hard to identify the emotions related to those thoughts.

The next step I took was to go through a mindfulness script with him to help him become more aware, and more discriminating of, the sensations he was experiencing. My assessment of him was that he was ‘globalising’ his pain – in other words, he described his pain as ‘everywhere’ rather than being able to discriminate exactly what sensations he was experiencing. I’m not sure whether ‘globalising’ is a word – but it works for me in the sense that it describes what happens when someone attributes an entire experience with one word – it’s all awful, or pain is everywhere, my legs are all burning. It’s different from catastrophising, which is seeing the worst possible outcome, and from black and white thinking in that it’s more of a ‘short-hand’ than a strategy of thinking ‘all good’ or ‘all bad’.

The problem with that approach is simple: it becomes one massive and difficult-to-manage experience, which seems to engender the ‘freeze’ response aspect of the fight, flight, freeze trio.

So… we started with a simple body awareness process, leading to awareness of sounds, and finally to awareness of breath. Actually what sounds like a simple process is incredibly difficult to do! Especially for someone who rapidly and without awareness flicks into ‘analysing’ any sensation/experience (thinking about thinking).

While I can never be entirely certain that someone really ‘has it’, what I noticed was that he identified some profound ‘lightbulb’ moments in that the sensations he experienced were different in different parts of his body. For example, he could feel a tingle in one part of his foot, but a warmth in his heel. He also noticed that when he was aware of one part of his body, he was unaware of parts he wasn’t attending to. This from a man who had told me ‘I try to ignore my pain but it won’t go away’.

Exactly.

Ignoring is actually a process of trying to avoid experiencing – and it simply doesn’t work.

He also found that directing his attention gently to the sensations involved in breathing worked to still his mind. Previously he had found it very difficult to ‘relax’, so active focus works more easily than passive ‘relaxation’.

I notice some interesting things here – experiencing worked more easily than attempting to explain. So rather than trying to ‘convince’ him that his coping strategies weren’t helpful, it was more helpful to elicit his own understanding of the conflict between his values and his current strategies. Then by moving straight on to a different way of experiencing his pain, we were able to circumvent his over-used analytical strategies. At some point in our work together it might be appropriate to discover why he avoids emotions (the function this has for him), but at this stage it’s enough to have worked out that there is an alternative.

This session has provided the following:

  1. he now has a relatively straightforward ‘mission’ for home practice (being aware of breathing while doing any task, and gently attending only to the sensations rather than commentating on the experience)
  2. our working alliance has become stronger
  3. he was able to remain on-task and focused on his sensations rather than being distracted by thinking and analysing
  4. I have discovered that sometimes explanation doesn’t need to happen, doing it can work just fine…

Resources?
A nice explanation of mindfulness for chronic painJust say Ouch
Some great recordings for developing mindfulness A.R.T. – please note that I’m not endorsing this, just letting you know it’s out there – and that there are many others available too
One script for developing mindfuless – and again, there are many out there! For example, this is one from Center for Mind-Body Medicine (2003). MindBodySpirit Medicine: The Professional Training Program. Minneapolis, MN, October, 2003.
And there are several different ones, all in pdf (like this one) from All About Depression’s Relaxation section.

More tomorrow – let me know if you’re finding this interesting, or have questions! And remember you can subscribe using the RSS feed above (left hand corner, just click and follow the directions), or you can bookmark, and it would be wonderful if you could find time to comment!

Control or acceptance?


I’ve been reading a wee bit of ACT, acceptance and commitment therapy recently. I’m trying to find a relatively simple way to explain ACT to my patients, many of whom just don’t do reading, and prefer living life in a practical way, rather than an intellectual or even spiritual way. I’m not sure I’ve found an explanation that works terribly well yet.

So this is my attempt at a ‘simple’ explanation of ACT – and I’m keen to hear what others think of it!

The first step in ACT seems to be about recognising that the previous attempts we have made to control our thoughts and feelings about a situation seem to fail. Or they need an awful lot of energy. Or they compromise other important things in our lives. I can’t remember who described it as ‘creative helplessness’, but it is a great term!

The second step is to acknowledge that we have emotions, and that they don’t respond well to either being ignored or to be focused on. But emotions are part of us, and are present when we make judgements about a situation.

It’s natural to make judgements about things – this is how we simplify our lives, by making up ‘rules of thumb’ about how we think the world works based on what we’ve experienced, been taught, or seen happen to others. And the rules we live with we just don’t seem to revisit unless we have to.

Some of us are very rigid about our rules – the world just is this way, and there is no other way… others of us are more flexible and recognise that much of life is chaotic and random, and although we would prefer to have life happen in a much more orderly way, often it doesn’t. It seems that people who live according to the second way are more able to accept situations than people who live according to the first.

So if we’ve lived rather orderly lives, where everything happens the way it ‘should’, we may be secure but our world gets rocked when something unexpected happens. And perhaps some of us are more fundamentally able to be flexible about this, while others of us are not, but it seems that people who can work out a way to flow with an unexpected situation deal with it rather better than people who strongly want it to follow the rules. People who can deal with the unexpected deviation from a script also seem less emotional about it – happy when good things happen, but not awfully distressed when bad things happen.

So what I think mindfulness does is provide a way for us to flow with a situation by enjoying things that move in a direction that we ‘want’ but also allowing us to flow with a situation that doesn’t move the way we want by releasing our emotions, giving them some space to be – then recognising that they soon dissipate.

The tools that mindfulness uses, instead of being incredibly ‘talky’ involve lots of imagery and metaphor – which works really well for a visual creature like me – but I’m not so sure that it works as well for practical types. Mindfulness uses words like ‘gentleness’, ‘flow’, ‘moving with’, ‘openness’ and so on… Not that easy to describe to my practical blokes who are more familiar with a spanner than a book!

Some of the tools of mindfulness are awareness of breathing (not control), awareness of sounds (not naming them), awareness of sensations (not judging them), visualisation (such as putting judgements into ‘bubbles’ and allowing them to float away).

I wonder how I can translate this into ‘blokespeak’!

So my focus for this week’s series of posts is attempting to find some ways to help practical people understand how to become ‘mindful’ rather than ‘judgemental’, work with emotional flow rather than cognitive labelling, and finding out what is important and whether what happens is allowing what is valued in life to occur.

Truths from the past


Mindfulness, Contextual Cognitive Behavioural Therapy and Acceptance and Commitment Therapy suggest that the problem with traditional cognitive behavioural therapy is that it attempts to control the uncontrollable. These therapies work on helping us to let go of the attempt to control against difficulties, and instead, focus on being aware of, but not judging, our negative experiences.

The practice is based on some aspects of zen buddhism and meditation, but is nicely balanced by attention to the scientific validation of the outcomes of this approach.

I was flicking through YouTube in search of something to post today, and came across this brief clip from Arthur Miller. Dating from 1963, I think he raises some thoughts that perhaps in therapy we are only just starting to address. Watch (it’s brief!), listen and wonder…