L KEEP A SUPPLY OF CHINESE FINGER traps in my office to show to patients. When you push your fingers into each end of these straw tubes and then try to remove them, the tube DISCOVERING OUR diameter shrinks and grabs the digits firm VALUES BY CONFRONTING _ }y. The more you struggle, the more your OUR FEARS _ fingers are tapped. The only way to cre- ate enough room to get your fingers back out is to do some- thing counterintuitive: push them deeper into the tube, which only then relaxes its grip. ll These toys demonstrate a basic principle about why so many of the issues people bring into therapy seem insoluble, despite determined and well intentioned efforts to deal with them: fighting a problem can itself create a problem. I remember giving one of these finger traps to an especially anxious client and watching as he practically pulled his fingers out of their sockets in his frantic attempt to get them free. Suddenly, abandoning his struggle with the toy, he let his hands relax. “Okay,” he saidknowingly, “I get it.” He pushed the ends of the bes inward and then removed his fingers easily. I knew he meant more than understanding, how the toy worked, though. He saw in that moment a model of how his battle with yy had constricted his life, and that the strange alternative I was put ting on the table might not be so nge afterall: only by moving into his, pain could he ever find the room to live fully A moment or two after this small epiphany, he surprised me by voicing an even deeper issue. As if asking him- self a question he had no idea how to answer, he added “And then what?" It's fan important question, with a surpris ing answer During the past 10 years, a number of therapy’ approaches have come into the mainstream of clinical practice based on the core idea the struggle with the Chinese fin- gor traps of U the more confused and stuck we become. Mindfulness Based Cognitive Therapy, Dialectical Behavior Therapy, and the approach my cok leagues and T have devel oped, Acceptance and Commitment Therapy (ACT), all agree that a first step toward fundamental change is 10 come into the present moment—even if that moment is painful—and let go of the impulse to leapfrog into 2 desired future from which inner trou bles have evaporated. These methods are based on the view that taking the obvious step of ying t0 escape from difficult thoughts and feelings usually makes them worse—just as with finger traps, in which doing the presumably thing is counterproduc- tive—and, in the process, takes. us the more we e human mind, “sensible” further and further away from a liber ated life Rather than being preoccupied with changing the painful content of the mind, these methods change our rela tionship with what troubles us. For example, instead of disputing ne thoughts, patients learn to wateh them mindfully and at enough distance to realize, ina visceral and not ical way, that they're just thoughts ative ist analyte Instead of getting rid of sadness, patients leam to detect how sadness feels in their body, how it tags at their behavior, how it ebbs and flows, and begin to feel at a deep level that they can carry sorrow with them while still living the life they want. This is an important shift away from, many of the traditional methods of psy chotherapy, perhaps especially so in my ‘own home territory of the behavioral and cognitive therapies, which have Jong focused on reducing negative ‘emotions and thoughts asa method of life change. The first wave of behavior therapy aimed at directly changing the intensity of emotions and the form or frequency of overt behavior through desensitization, economies, (using “token” chips or points 10 token human cognition, sense problemsolving strategies, wh applied to subjective experience, too often become traps. In research suggests that human problem solving itself conuibutes 10 intractability of human suffering. Consider how the focus of psy chotherapy is defined within the first few moments of clients’ initial sessions. Clients typically begin by saying some thing like, “T've had anxiety for years and lately i's gotten a lot worse,” or ‘My husband leit me and I'm just lost, or “Tm constantly worrying,” or "just feel empry.” Patients frame their com plaints as something happening that’s creating difficult thoughts, feelings, memories, or sensations. A thousand explanations will then be devised 10 is that common: The research evidence Confirms reward positive behavior change), and the like, The second wave of behavior therapy put more emphasis on cogni- tion, producing cognitive-behavioral therapy (CBI). But like the first wave, CBE targeted the form and frequency fof these cognitions, such as whether they were rational or contained cogni- live errors, and tried to change them igh testing, disputation, and analysis, By contrast, ACT and other mindful nnesebased methods invite patients to step into the now and fundamentally change their relationship with their ‘own experience, Instead of trying to manipulate and change their inner world into a more “desirable” form, these methods encourage patients to deepen and enrieh their contact with & continuously unfolding present. thro The Trap of the “Problem” A basic principle of ACT, buttressed by 20 years of vesearch into the nature of /Octaber 2007 the paradoxical proposition that trying t typically just make: explain the existence of these prob- lems (‘I's my childhood,” or “I’s my neurouransmitters,” or “It's my wife”) In the end, therapist and patient will ‘ypically agree, implicitly or explicitly con the ultimate goal of whatever inter- vention follows: get rid of unwanted thoughts, feelings In doing that, both are complicit in the assumption that these sources of distress need to be changed belore real living can begin, You can see agreement in the names of our most ‘disorders,” through which anxieties, moods, thoughts, and other private experiences are appoi play the role of “the problem.” And you can see ‘ments, which often suggest we need to restructure, manage, or master our experiences, that ted to. in the names of our treat.Although this appears to be a nor smal, logical, and reasonable approach, in may the most helpful. Consider a person with panic disorder trying to rid him- or herself of anxiewy: Irs natural to focus on what seems to c anxiety more likely (stressful situ not being able to leave a room easily, not having pills available, irra: tional thinking, and so on), and the apparent solutions that might lessen that anxiety (learning to relax, staying near the exit, being sure to have tran quilizers handy, thinking more rational Jy). Buc this commonsense approach is based on what Mark Williams, one of the originators of Mindfulness-Based Cognitive Therapy, alls a “discrepancy based_mode of thinking,” in which clients constantly measure and try to narrow the distance between what's wrong or had that’s going on now and what's right or good that isn’t going on now. Thus their minds continuously dows, call for help on a cell phone crawl through the ductwork, kick down the door: Then they begin to consid and discuss the pros and cons of each, The door may not break easily. If we jump from the broken window, some ‘one might get hurt. We may not have the right number to call or the phone battery may be dead. Eventually, a sound plan is agreed to without ever leaving our seats But when the target of our problem= solving efforts is our own thoughts and feelings, rather than the manipulation of our this rational approach typically becomes part of the problem. Once we buy into the idea that we're in a badl situation that needs 10 be changed—v that’s inside a locked room, in a finger rap, or in our own pain—our cognitive problem-solving skills will inevitably Tead us to ind ways to get out of the dif ficulty by applying our analytical skills external environment, ether hange your unpleasant thoughts and feelings hem more entrenched. cycle between an undesirable prese and a desirable future. This problemsolving approach works wonderfully in addressing many of the challenges of reabiworld survival, such as getting into a locked car oF eseaping from a burning building. To illustrate for wainees the vast cognitive capacities ff the human animal that have allowed species of weak, slow, defenseless crea: tures 10 take over the planet, T often give them the following challenge: “It turns out that all of the doors and win: dows are locked” I say, “and we have only one chance to leave here, We can implement any plan you like, but we have to agree on it without leaving our and we ean only implement the plan once, without pretesting it, If it fails, we'll he stuck here forever” ‘Usually the group quickly generates alternative escape plans: break the win In the getoutoftheroom situation, which involves manipulation of exter- nal events, rational problem solving works effectively. But applying th same process 10 an internal emotional state like panic is different, because the target actually tends to grow and spread in reaction to the problemsolving effort itself A person tying to “solve” the prob- lem of panic by getting rid of it regu larly evaluates the level of anxiety being experienced, fearfully checks to see whether it's going up or down, This process actually tends to elicit anxiety, and risks conditioning the person to experience anxiety in more and more circumstances. Anxiety gradually becomes a focus of life, and patients believe they can only live hap- pily by constantly imagining themselves at some point in the future when and they're “cured” and anxiety has left the scene. Typically, life itself has to be put ‘on hold while they continually and repeatedly attempt the impossible task of thinking themselves out oftheir anx- Tn contrast, ACT takes the position that “experiential avoidance’ ung to stecr say from psychological pain— limits our ability 10 be present in our ‘own lives. Research has shown avoid ance of pain is one of the most consis- tently troublesome processes in all of paychology, accounting for about 20 to 25 percent of the variance in successful ‘outcome across a broad range of com- mon psychological complaints —every- thing from depression, to difficulty in learning, to whether a traumatic event will lead to a posttraumatic stress disor der. the paradoxical proposition that trying to change your unpleasant thoughts and feelings wypically just makes them ‘more entrenched, The research evidence confirms Coming into the Present In contrast with traditional cognitive-behavioral thera: pies, ACT doesn’t try to change clients’ thoughts or feelings. It concentrates instead on helping them rec ognize that thoughts are just mental events to be noticed, not tue oF false pronouncements on the finndamental nature of reality itself Similarly, feelings are something 10 be felt, not powerful and dangerous uk lies to be avoided at all cost, According to ACT, the therapeutic task isn't help ing clients successfully dispute their thoughts or feelings: ‘enabling people to say yes to their own experience, whatever it happens to be. In the early development of ACT, my students and I created a protocol and tested it against uraditional CBT for depression in a small randomized tri We found we got better results by teach- ing patients to see depressive thoughts merely as thoughts than we did by try- ing to get them to change their thoughts. After nearly 15 years develop: ing the model, we finally published icin book form in 1999. Since then, more than 20 randomized wials that we've rather, i's WWW. PSYCHOTHERAPYNETWORKER. ORG 4Qconducted have shown that the approach can be effectively applied 10 stress, anxiety, psychosis, chronic pain, depression, burnout, and many other conditions How does ACT work? To help clients tain a present focus, it identifies thr fundamental skills. “The first is Cognitive defusion: separating the process of thinking from the world struc tured by thought. If you try to describe the present moment, you'll notice something odd. Anything you have 10 say about “now” Tags slightly. behind now. Even if you quickly sy the word now, the instant that you're naming is, the now that was there milliseconds ‘ago, not the now that’s the ‘word emerges. This is because language is based onthe arbitrary relation between symbols and our ‘ongoing experience, rho matter how quickly you relate one to the other, it when the and takes time. Conversely, if you silently look about you for a few. moments, everything millisecond ago, There's 0 time lag at the level of expe ence itsel: This difference creates a comundrum. Life can only goon now— no place else to go on. But our ability 10 generate symbolic meaning always lags behind, dampening the vitality of the immediate experience of the moment, and carrying us more and more into a symbolic world where no is merely a concept, not an experience, There's solution to this conun. drum, however. Without throwing out human language and all of its wonders and benefits, we can learn to see think ing itself'as unfolding in the present. In ACT, we call this process “cognitive defusion.” ACT therapists and researchers have developed scores of defusion techniques. For example, if you have a client distill a painful thought into a single word and say it out loud repeatedly for 45 seconds or so, and by the end of that process, the ‘word will have lost most of its punch based on its meaning. Instead, client will become aware of the experi ence of saying the word—how it sounds fo the feeling of saying it, Or clients ith the may practice another mindfulness exer cise, like viewing thoughts as things floating by like leaves on a stream. If, while doing this, they find themselves taking the thought or feeling literally — becoming emotionally engaged in th feeling of sorrow, anxiety, or anger, for instance—the sense of flow this exer- cise brings will stop. But once they able just to notice thoughts in the pres ent—"T'm having the thought that I'm sadl"—without either belief or disbelief compliance oF resistance, the Flow con: fimues again A thought like “I'm bad” invites us 10 argue about whether its true by provid ing evidence (usually from the past) on tone side oF the other, But whether i's tuue o false is irrelevant to the fact that the thought is here, now. Simply notic The second fundamental AGT skill is Acceptance. When patients try 0 avoid, escape, or control painful feelings, the present becomes the enemy. Now is where and when feeling occurs, but they're cone future in which the now will be differ cent, Coming into the present requires ntrating on the imagined psychological acceptance—a voluntary and undefended leap into the multifac ted, multisensory moment. As with any leap, this means abandoning some degree of control. Ina physical leap, we Teave it to gravity to carry us safely back to earth, In a leap of acceptance, we give over control to the now, allowing ‘our experiences to present themselves in their full breadth and depth. ACT uses a variety of metaphors and experiential exercises, many borrowed Coming into the present ing thoughts as processes, rather than or false, lib- crates clients from having to put their life on hold while cognitions are evalu ated, accepted. rejected, argued with, (oF putin some sort of order The process of defusion dampens down the impact of thoughts and allows more flexibility in responding to them, For example, a panicdlisordered person thinking "ITT gg Tll make a total fool of mysclf™ might short cut the endless problem-solving discrepancy-reducing mental ign: role that makes the problem worse by simply thanking his mind for the thought, or by saying the thought again. very slowly ("a toooooootaaal fooooo0l of mysceeceellIIIT) singing the thought to the tne of popular song, or saying it in a Donald Duck voiee, The ACT defusion tech- niques all cary the same message: thoughts are just thoughts, Notice them and then do what works, not nec essarily what they say as events that must he tr anxious here SO rsvonOornERsry NETWORKER a Sepeember/Ostober 2007 requires psychological acceptance—a voluntar multisensory from other experiential therapeutic tr ditions, wo help clients get past the judg ments and analytical mindsets that keep them entangled in unproductive problem solving. When a client com- plains of being in the grip of a particu larly painful feeling, which she feels she must get rid of, we're likely to ask her to spend getting acquainted with it instead. One exes ise, called the “Tin Can Monster,” sug- gests that overwhelming feelings are time thoroughly Tike huge monsters made up of tin cans, bubble gum, and rubber bands, The total effect \we stop to examine their individual ele- 1 be overwhelming, but if nts, We find nothing really fearsome there. In this eyeselosed exercise, we ask patients to get in touch with the dif- ficult feeling and then notice c what their bodies do, The goal is 10 drop any struggle and just notice each fullyjoment. specific bodily reaction. So, for exam ple, as each reaction is named, the ther apis takes the client into that sensation in great detail—where is it located where does it begin and end? Or we right ask the client to imagine that the hoodily sensation is an object on the floor and to describe its color, speed, texture, and weight, When the client is fully open to experiencing each sense tion without defense, the next bodily reaction is sought. This dismantling process continues through urges to act, ‘emotions, thoughts, and memories, The task for clients is to drop their struggle with unwanted reactions and amplify contact with what i. Rather an uying to win a tugef.war with di nces, clients Tearn nd allow them: ficult private expe to “diop the rope selves to feel the experiences as they happen. That shift of perspective pro: foundly alters the function of feclings, changing them fiom something “bad” that must be manipulated to something to be filly felt without fear or evaluated and desperation The third basic ACT skill is the acquisition of a tran- scendent sense of self Patients commonly confuse their passing thoughts, feel ings, and judgments themselves with their self hood. They must develop a consciousness that they are bout their experiences, feelings, and judgments and, in some sense, inde- pendent of them. The prob- Jem is that we can't really separate consciousness from the experiences that com- prise its we can’t e thoughts, ine the Ind undefended f@ap into the multifaceted, space where consciousness resides, because to do so would be like jumping to the side of oneself to look back at looking. At best, we can catch fleeting glimpses. In ACT we produce these fleeting slimpses by exercises that first draw attention t0 the ongoingnesss of expe- rience and then suddenly call attention to the person who's aware of these experiences. therapist might lead a client through Tm not that.” It usually begins with eyes open. For example, an ACT the mindfulness exercise of ‘The client is asked to briefly examine objects in the area, notice the features 'm not that.” The goal is to directly experience fof each one, and then say the distinction between what's scen and the conscious person seeing it. After a time, the exercise continues with eyes closed, The therapist asks the client to explore sensations, emotions, thoughts, Jd memories following the same process—note the features of the inner experiences and then tell himself he isn’t the same as the consciousness not ing them, This exercise arrives at a scendent sense of self by a kind of sub- In this way changing nature of thoughts and fe ings is contrasted with the sense of con: tinuity—the essence of consciousness in which “you” have been “you" your entire life action, the constantly And Then What? But as mindfulness and acceptance methods help clients more fully inhabit the present moment in their lives, they face an unavoidable question: what will they do with the now-ness of their lives? ‘Once experience, what should they do with it? Thisn’t enough simply to help clients “live in the present moment.” The real issue, once they've “made friends, the hhey've quit fighting their own so 10 speak, with problems and learned to avoid avoidance, is how they should live. What should they live for? Or, as ‘my patient put itso succinct Iy, “And then what Jack Kornfield’s delightful book about spiritizal explo- After the Eestasy, the Laundry, captures. perfectly the eternal truth that no matter how ing and inspiting our adven- tures into consciousness and expanded areness are, there's still everyday lie to be lived. For some people, there ean be almost a narcotic quality to contact ing the present moment, particularly if they've spent years trying to escape i People can often experience dramatic reductions in anxiety or depression just by abandoning their attempis to reduce them in favor of accepting and being mindful of them, The experience of living in the pres cent, paradoxically, can tempt us into experiential avoidance all over again just in a new form. Irs quite possible to lade escape from the now for escape into the now. The recent enthusiasm for mindfulness and acceptance in the West needs to be cha neled properly or we risk creating just another form of Wwirw rsvenormERAyNeTWoRRER.ORG 5.Western selFndulgence. By themselves, mindfulness methods as they're often used in Western psychotherapy don't _give sullicient attention to the onganiz= ing influence of purpose in human life In the spiritual traditions from which such drawn, “right action” is specified through ethical principles. But Western therapists are encouraged to take a pro fessional stance, and not direct our clients to any particular belief or "right action” enjoined by a religious or spirk ‘wal tradition, Nevertheless, we still ean help our clients gain access to. the deepest aspirations and turn a life lived, in the present moment into a lite sorth living, Avoidance help us om this journey, if we know how to use them, The things that hurt us do se hecause we ere. A person who fears practices. were and mindlessness can relationships because of past betrayals is a person who values trust and intim: al wouldn't have hurtin the first place. An ACT say ing expresses this idea: in your pain you'll find your values, and in your va ues you'll find your pain, That's part of why experiential avoidance is so harm= ful: as we avoid our huts, we can't help, Dut undermine our values, So, by help= ing clients accept their pain and stop avoiding it, we can help them open up. to what they most deeply want in their lives. Their pain can serve as t powerful guide to therapy. In the wake of a painful hetraya normal human reaction is avoidance of intimacy. I's common to hear people © otherwise, the bet who've been hurt say, “THE never let myself be so vulnerable again.” And yet stich a refusal also cuts one off from the possibiliy of deep human connection, and thus from one of life's basic needs Intimacy implies valnerabiliy—some fone close 10 you wuly ean wound you, by definition, People vowing not to he vulnerable think they're avoiding only the pain, but in fact, they've resolved to avoid intinnaey itsell precisely because they so derply tant it in ther lnes, This act of selideception ercates y than the original hurt: we're dealing now not just with betrayal, but with the pain of life unlived. Acceptance and mindfulness arcn’t just about some trendy notion of "being 1 wound f 3 PSYCHOTHERAPY NETWORKER # Seftemler/Ortober 2 here now,” bur coniprise a set of skills that enable clients to learn to live with emotions they might otherwise find Intolerable—and use them as guide posts 0 a life of deeper purpose. An ACT therapist might commonly ask the intimacy-avoiding client, powerfully im the dircetion of the inti- macy you long for implied learning how 1 carry the pain of your past etrayals, would you do soi “IP moving We take clients into pain because it incvitaly come up when they move toward what they really want, Defusion aud acceptance help clients realize that plain hurt isn’t devastating. By contrast, the kind of de ied burt that comes from avoidance is deeply harmful because achieving full consciousness and full Irumanity By reducing the need 1 avoid nfl feelings, acceptance and mind: o actually become braver and live with the ans es, pain, and discomfort required to autain something they deeply value From an ACT perspective nly undertaken stctions aimed at achieving purposes that are deeply it blocks us from i fulness ¢ help people values are important to one’s sense of selfhood. Res . that can transform lives ate those that are purposely chosen, reflect what you really want, and are fully expressed in your actions. Only doing what you truly value for its own sake, because i's wh: cht suggests that the only values you want, will ukimately conttibute to your development, cven your happé ness, as a human being, Ir’ alko important 10 remember that valuing something isn't the same as achicving life goals, Values are like directions on a compass. They're never ‘but in each a “achieve ud every step they influence the quality of the jour ney, Values dignity and clarify our life course by putting pain in a proper con: text i's now about something that ma ters to us, which we want with our cemtire selves, In the realization that val ues can’t ever be achieved, only lived comes joy because from the first moment clients acknowledge what their values are they're living them. Values aren't some- thing you ean both have and be fin= ished with, ike objects you ean putin a moment (© moment, Dox and store away—they're ongoing, active, and perpetually gen Ifa client really owns up to wanting to be a good father, for example very act of acknowledgement, values are coming alive. The path this implies will never be complete, but a consciousness of that value will enable a coherent journey through a continu ‘ously unfolding now. Said another way the value directs the journey, but i's the journey that ultimately matters. There are no shortcuts to living joy fully: we can’t just take refuge in the moment and avoid the messy process of in tha alue life itself. When we learn to carry our fears, we still have to face all life's day- today decisions and difficulties, But aware of our values and develop a decper commitment 10 our ‘own purposes life becomes muuch more vital than itis when we're merely trying to keep our demons at bay If we stay connected with what we most care about, life itself will present us with exactly what needs to be accep ced. We can begin to do that by staying right here, right nov, in this present moment. But acceptance is then about something. I provides an answer to my client's question: “And then what? Acceptance and mindfulness aren't ends. in ther Rather, they empower us to live a valueilled, mean: ingful, committed life by helping us 10 open up to the full range of thoughts and feelings we experience from moment by moment, selves, jaes, PhD, is profesor of psycholo- atthe University of Nevada at Reno. He's tuvtten 300 peer-reviewed articles and 27 books, inetuding his latest, Get Ou of Your Mind & Into Your Life. Contact: ayes@unredu, Letters to the Editor about the article may be emailed 10 letters@® psyehnetworkerorg. Moving Dost forge wo send your new aes wo DPeychotherapy Networker Subscription Services, 2O. Box 5190, Brenrwood, TN 37024-5190. Ema caserv@unbelcom,All changes of addres shouldbe sen a east 6 weeks rior tothe month of publication ‘Seven