Acceptance And Commitment Therapy
'Accepting A Change In Your Health Can Be Essential To Recovering From It'
By Definition –
Acceptance and commitment therapy (ACT) is the art of learning to accept a change in circumstances, but still make the best of the situation, without trying to change your perception of the likely outcome. It is used particularly when dealing with terminal diseases or medical conditions that do not have a cure, but can also be used for a whole range of other applications.
The Short Answer –
Learning acceptance and commitment therapy is frequently essential to coping with chronic pain from a range of long-term conditions. It has two key elements – the acceptance of a change in circumstances and then the commitment to carry on and make the best of the situation.
In this article we look at both elements – asking how in practical terms can you reach the stage of acceptance and then what sort of techniques may prove invaluable to help you manifest the commitment to get the best result.
The first part to acceptance and commitment therapy is ‘achieving acceptance’. What precisely works for you is a very personal thing. We can advise you on how you might get there, but what works really well for one person, may not have the same effect for someone else.
Achieving true acceptance relies on you being able to be fully open to the reality of your situation and accepting both the positives and the negatives of your new circumstances.
How this can be achieved really depends on you – some people find going away on a short break really helps (either with a partner, good friend or just on your own). Whether you are someone who prefers to rationalise things by talking them through with someone you trust or if you just prefer to think things through on your own is an entirely personal choice.
Facing the ‘black hole’
However, in order to achieve a genuine acceptance of your current situation, it is vital that you focus on the ‘black hole’ as well as the good parts. This is likely to go against your natural instinct which would be to turn away from your bodies’ own fragility.
Facing up to this reality and the ‘worse outcome possibility’ however is only going to help you achieve genuine acceptance if it is done while putting it into a proper context.
Simply seeing the downside, will only lead to negativity, self-defeatism and ultimately depression as you take your focus away from the balancing positive side again.
To achieve a genuinely balanced ‘acceptance’ we would recommend the following key processes –
1) Take a break from normal activities to assess your long-term goals and scientifically rationalise your current situation.
2) Book another consultation with a medical specialist. Prepare a whole list of questions to ask them, so you can understand as much about your new condition as possible including possible outcomes.
3) Consider counselling one to one with a professional to explore both sides of your new circumstances
4) Visit support groups and talk to other sufferers to understand both what is possible, but also how hard it might be achieve and what level of commitment would be required
5) Set long-term objectives to focus on, with your disease/ injury/ situation being at the centre of those objectives (thus not ignoring them).
If you can go through all of these and set new goals that acknowledge your limitations as well as your advantages, then you will have achieved true acceptance and are ready to move forward.
Consolidating With Commitment
Acceptance and commitment therapy rely on you understanding your new circumstances and forging a real plan for moving forward.
The Cambridge Dictionary defines commitment simply as
“a promise or firm decision to do something”.
In the context of recovery, this means finding goals/ objectives that accept the presence of the problem, but move you forward to where you want to be in a year, two years, three years time.
Coping with Cancer
For example, if you’ve recently been diagnosed with cancer, your acceptance is likely to include the possibility that it will end your life.
The commitment may be the resolution that you will have every treatment available and fight it until the bitter end, with the goal that you will still be here in two years’ time to be part of your son/ daughter’s wedding (or to dance at their 18th birthday party – whatever is realistic and relevant to you)
Wrestling (mentally) with rheumatoid arthritis
If your diagnosis was rheumatoid arthritis, you may resolve to quit smoking and drinking to slow the progression of the disease and set a series of ‘achievements’ that you might want to record in the next five years.
This however, is where it becomes more confusing. As mentioned earlier, the term ‘acceptance and commitment therapy’ was termed by Steven Hayes in 1982 in moulding together an approach that included both cognitive and behavioural therapy.
Today, we can sum up CBT or cognitive behavioural therapy (see CBT) in the context of problem solving, as being a method of removing the overwhelming emotion from a seemingly huge problem by breaking it down in to smaller, easier to handle, problems.
These smaller problems, can all be overcome with specific tasks, eventually leading to the overwhelming problem (that seemed far to be big in the beginning) being resolved.
Finding a role for CBT
As such, CBT is then often included as part of the ‘how to’ in achieving the commitment. By breaking down your huge task (battling a disease or recovering from a serious accident) into a series of much smaller challenges, then your resolve will always be stronger.
This is because by laying out a path step by step, you make the task seem easier and therefore naturally your belief or commitment that it can be achieved will be far greater.
However, this is often where confusion comes in. Cognitive behavioural therapy is one of a range of mindfulness techniques – most of which deal with finding ways to reduce you pain or symptoms.
They aim to achieve what is known as ‘defusion’, which is effectively reducing your symptoms by changing your mindset, whether it be through distraction (focusing on something else) or genuine defusion which is convincing yourself that a certain pain is not actually painful at all.
The ‘Defusion Confusion’
‘Defusion’ works as a method of symptom control by disconnecting yourself from negative thoughts about your pain. Self-hypnosis is one example, by which you hypnotise yourself into describing your pain in ways that don’t seem any near as menacing.
By altering your brain’s perception of the pain it is proven that you can change the way your brain processes messages about the pain stimuli from your central nervous system – to such an extent that in the end you feel physically in less pain than you would otherwise.
This sort of technique is loosely banded together under the label of ‘Mindfulness’, meaning techniques that work by changing the way your mind thinks about certain things.
The Feldenkrais method is another example of mindfulness, based on separating your body parts and teaching yourself smoother methods of moving to avoid using ‘awkward’ use of the painful areas, as is ‘the McKenzie Method’ and others that work on similar principles.
Mindfulness is NOT defusion
However, it is important if you are going to understand and fully utilise acceptance and commitment therapy that you realise it is very different to defusion.
That is not to say that they can’t work hand in hand – but they are different stages of a healing process and there is no guarantee that you need to practice both, or indeed that both ACT and Defusion are always relevant.
If we take a very late stage cancer diagnosis as an example, whereby a degree of acceptance and therefore the commitment to have honest, loving conversations with family members may be essential – but the much more elongated process of disassociating pain from your mind, may be completely irrelevant.
Choosing is not the same as falling
Similarly, if you’ve just had elective surgery to replace a hip, then you probably don’t need acceptance and commitment therapy, since it was planned with a wholly positive long-term expectation.
Trying several of the defusion techniques to handle the pain during your recovery might prove to be very useful, whereas ACT would not.
I make this point because if you are going to formulate a personalised treatment plan then batching them together as one ‘treatment’ really isn’t very helpful.
Indeed, the association of ACT (acceptance/ commitment therapy) with mindfulness in general while technically accurate, is often not helpful if people have a negative predetermined view.
Even if you don’t believe in mindfulness as a concept, in certain circumstances you will still have to go through the ACT process, you just might not have a name for it and might rush through without really knowing that you are going through it.
If you don’t believe in mindfulness, then many of the defusion techniques may be wasted as negative beliefs will normally lead to zero outcomes.
The Final Word –
Hopefully having read this article you will have a better understanding of the importance of going through the right steps to put your mind in the right place and achieve the best outcome.
In some people’s minds, as soon as they hear the term ‘mindfulness’, they hear click away.
That is fine, because it’s been proven not to work in those that really believe it wont (partly because they can’t commit completely in the first place), but Acceptance and Commitment Therapy is still something that they are likely to have to go through in one form or another in order to move forward.
The alternative is to purposefully not deal with it. This is a slippery road that either ends in depression or a much harder ‘mental bump’ as you hit acceptance, but not on your terms.
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