How Acceptance and Commitment Therapy (ACT) Helps with Anxiety

Steal Your Life Back From Anxiety

The worst thing about anxiety is that it tricks you into believing this shrinking life you’ve carved out for yourself is all there is. That’s a lie. Nothing could be further from the truth. Anxiety has stolen joy from your life. Acceptance and Commitment Therapy (ACT) can help you steal it back. 

What if anxiety was more than a problem to be solved? What if it was a signal you’re not living the life you’re meant to? What if relating to anxiety differently could point you in the direction of your biggest dreams?

Teaching you to be in the present moment, putting what you value most in the foreground while allowing anxiety to recede to the background, ACT re-introduces you to a life you can love, not just endure. 

Acceptance and Commitment Therapy is a relatively new off shoot of Cognitive Behavioral Therapy (CBT). It combines aspects of CBT with new, evidence based interventions that can help develop the psychological flexibility skills required to address anxiety and re-engage with life.

ACT has two premises. First, accepting uncomfortable thoughts and feelings works better than trying to fight and control them. Second, by identifying and connecting to what gives life meaning and purpose, our emotional struggles become smaller while our capacity for living gets bigger. 

ACT offers a direction away from anxiety’s limitations toward the possibilities of a value rich life — a path where you can acknowledge pain while still committing to what matters most.

The roadmap is in the name — Accept, Choose, Take Action.

Accept  

Accepting uncomfortable thoughts and feelings is the cornerstone of the ACT philosophy.

Counter to advice that’s often given, ACT teaches you to turn toward emotional discomfort rather than away from it.

The ACT assumption is that thoughts and feelings are mostly beyond our ability to control. Our suffering related to anxiety comes more from the desire to change or get rid of what we experience than it does from the actual experience itself. Instead of managing our feelings, all we manage to do is feel worse.

For example, the more you focus on not having worried thoughts, the more you become obsessed with worry. The more desperately attached you are to the need to feel confident, the more disappointed you become when confidence fails you.

When we fight against what we experience rather than accept it, we become engaged in a battle of tug o’ war that can’t be won. We become exhausted, discouraged, and more anxious. The only victory lies in dropping the rope. 

When we let go of the fight, then soften, and embrace what we feel; our anxiety diminishes. Acceptance of our experience enables us to take a step closer, see it for what it is, understand its nuances, offer it compassion. 

Choose 

Choosing a committed life direction gives ACT its heart.

What do I want my life to be about? What do I value? What gives life purpose? These profound questions have the power to clarify our vision, shape our actions, and connect us to our dreams.

Too often, we get caught up in chasing feelings. “I’ll be happy when I feel less anxious, more secure, more control.” Turns out feelings are hard to catch. They’re faster than we are. 

Instead of chasing feelings, ACT encourages chasing meaning instead. Feelings come and go but what you value is an anchor that endures over time.

Anxiety makes us lose sight of what’s important. Attempting to manage discomfort, we pull away from the life we used to love. Painful loops begin. The more anxious we are, the more we contract and avoid in an effort to feel better. The more we avoid, the less meaningfully engaged we are. Less engagement leads to more isolation and anxiety, leading to more avoidance, and more misery.

Disrupting this loop begins with a commitment to choose to live boldly again. Having a clear and valued life direction can give us the courage we need to risk moving forward — alongside anxiety and fear.

Take Action 

Taking action gives ACT its power.

We can’t think and feel our way to a richer life. If you want to overcome anxiety and move in the direction of what you long for, you’ll have to use your hands and feet — you’ll need to get off the couch, you’ll need to act. 

Acceptance of the thoughts and feelings we can’t change is only part of the ACT story. There’s so much that we can change and do have control of — our actions. 

ACT offers a perspective where life is defined more by what we value and how we act than it is by what we think and feel.

The actions we take are determined by what we’ve decided is important to us. We become the central actors in our own life. This sense of agency lessens the impact of anxiety. It’s hard to be swept away by worry when you’re engaged with your life’s work.

When we get in the driver’s seat, acting and living in line with who we want to be, anxiety moves to the backseat. Even if it’s still there, it has less power. It’s not driving anymore. By taking committed action, related to what we value, we are.

CPR for Your Worried Heart: Hope for Viral Fear Lesson #3

CPR: Compassion, Purpose, Risk

To find your way through your fear of this coronavirus you’ll need a strong and healthy heart. The heart is where we find compassion, direction, and courage. All three are required to sustain us in the darkest times.

When flooded with anxiety, though, we lose heart. We can become lost and frozen. A kind of heart attack ensues. We become gripped by worry, feeling more dead than alive.

To resuscitate this dying heart you’ll need to use CPR — Compassion, Purpose, and Risk

When you are feeling overwhelmed, lost, and afraid or when you are feeling like some essential part of you is in trouble, use this CPR acronym as a way to repair your broken heart.

C — Compassion

Love is the strongest medicine there is for fear and anxiety.

Compassion is nature’s Xanax. Nothing soothes quite like it. It works as well for the loudest cries of the newborn as it does for the quieter tears of any child, teen, or grown up. If you’ve witnessed a loving mother in action, you’ve seen this magic take place. There is real, and often immediate, comfort in being held, being touched, being loved, being seen.

It’s not surprising then that CPR begins here. Like access to an anchoring breath, always there to ground you, your ability to pause and find self compassion can be an essential tool to help you live alongside worry, anxiety, and fear.

Overwhelmed in a crisis, like we are now, powerfully negative and self critical feelings can take over. We can start to feel inadequate, cowardly, defective, insecure, and ashamed. Since these feelings are so uncomfortable, we tend to avoid and wall them off. That’s not good because then they attack us subtly from inside. They feed our cycles of anxiety and depression.

When you find yourself feeling broken, pause and bring an intention of kindness and compassion to your deepest pain. It might be hard to locate the pain at first. We often hide behind irritability, anger, or blame. If you are feeling these things, take a breath and reflect for a moment. Gently peal back your anger. Just a few layers down you’re likely to find a more vulnerable part of you, tired of fighting, that just wants to be accepted.

Self compassion is a challenge because while it’s easy to affirm the parts of ourselves we feel good about, it’s much harder to love the parts of ourself that we see as unlovable — but those are the parts that need your help the most right now!

So how do we do this?

If you’re struggling with this notion of self compassion, you might need a little help.

I encourage people to practice visualizing ‘images’ of love and compassion so that they can call on them when needed.

• Create in your mind’s eye a memory of compassion or love.

• Think of a time when you felt loved, held, supported. Think of a time when you gave love to another. How did it feel, what sensations did you experience in your body?

• If it’s hard right now to come up with an actual memory, you might imagine instead how you’d be there for a family member, a partner, a close friend in desperate need. How would that feel, what body sensations would you experience?

• For those who really struggle with self compassion, you might try visualizing a smaller (4 or 5 year old) version of yourself. It’s much easier to love something we see as more vulnerable and innocent. Imagine a time when that ‘younger you’ felt deeply wounded, alone, scared. What would you give to someone like that? How would you instinctively respond to the pain of that little you? My guess is you’d respond with love and compassion! Reflect on how this might feel and the sensations in your body.

• As you sit for a moment with these memories or images, focus on their felt sense and on how your body takes in these experiences of compassion. Your felt sense might one of acceptance, calm, kindness, allowance, affirmation, understanding. Your body might experience a kind of loosening, a relaxation, a warmth as you let go and as you feel held by love and compassion.

• Be creative and visualize this love as a kind of benevolent presence. Maybe it takes the shape of a cascading warmth; relaxing, holding, and enveloping you. See it perhaps as a bright and loving light, a serene picture from nature, the kind face of someone who loves you (past or present) who has a loving arm around you, maybe use the image of a spiritual/faith icon that’s important to you.

• Practice pausing, noticing your pain, then visualizing and calling on these soothing images in times of need.

Once you’ve gotten good at self compassion, it’s time to give some of that away!

I’m sure you’ve noticed there’s no shortage of need out there. It could be as close as your living room or as far away as the other side of the globe.

Love is so many things. It’s a feeling and an experience. It’s also an action. We love through acts of kindness. See a need, meet a need. Look around you and give wherever you can because the more you give, the more you receive in return.

Compassion can also be demonstrated less ‘actively’ with a few words of encouragement, a smile, a kind and quiet presence. Sometimes people just need a compassionate space where they can share their fear and pain. Your task here is to listen, validate and reflect what you hear, offering love and compassion though listening.

The last essential element of compassion is allowing love from others.

We often push away what we need the most. Afraid of being too needy or feeling too vulnerable we tend to hide away and not let those who are there for us give us the help we need.

In the same way that it is important for you to be there for yourself, and be there for others, it is also essential that you let in love and compassion from the real people in your life.

As noted above, love is calming and healing. Being loved by a close other can go a long way toward regulating your pandemic activated and out of whack nervous system. Love and compassion are the bedrock of attachment. Trusting and loving each other helps us emotionally regulate and helps us move forward, together.

P — Purpose

To get through anxious times, we also need to be able to take courageous action.

But what actions should we take exactly? In the absence of direction, we can act for the sake of acting (like mindlessly buying massive amounts of TP), more to distract us from our fears than anything else.

You can do better than that. In a crisis it’s more important than ever to take actions that are tied to the heart of who you are. Because feelings come and go, we can’t rely on emotion to motivate us. We are up one day, down the next. We need something more enduring.

To persevere over the long road ahead, you’ll need to live from the heart, from what gives your life value, meaning, and purpose.

It’s time to remind yourself, or maybe explore for the very first time, what your life is for in the first place. Getting in touch with what you value, what your purpose is leads you in the direction you need to go.

If you value family, then that will inform what you might do to make sure that they are taken care of materially, emotionally, even spiritually.

If you value patience then that will inform the way in which you go about the tasks of your day.

If you value equality and generosity then that might move you to see what you can do for those less fortunate in your own community.

If you value physical health then you might get out for a walk or a run.

Meaning and purpose can be the big existential “what’s this all about anyway” kind and the small “how should I live each day” kind. It’s important to be in touch with the deepest parts of your purpose and the more mundane.

Take a moment and write down what gives life purpose, value, and meaning in each of the categories below. Then rank order each of the categories. See if you can come up with some basic actions or goals that might be connected to what you find purposeful and valuable in each category. Compare those actions with the actions you are currently taking on a daily basis. Do they align? Are they drastically different?

1. Family

2. Romantic relationship

3. Friends/Community

4. Physical Health

5. Spiritual Health

6. Education

7. Job/Vocation

8. Recreation/Hobbies

9. Pets

10. National and global identity

11. Environmental

Living a purposeful life connected to your heart can be a powerful backdrop to each day. Reminding yourself when you feel fatigued of what you are living for, can give you the strength you need to get up and do it all again in spite of the challenges.

R — Risk

Even with compassion and purpose by your side, it’s still hard to move forward in the face of fear.  

We want to shelter in place emotionally, avoid what is uncomfortable, and hide out in the safest places. While this is a good anti-viral strategy for ‘flattening the curve’ of potential coronavirus damage, it’s not such a good strategy for learning how to live alongside your fear of the nasty virus in the first place.

Sometimes there is no way but through. That’s why risk is also a fundamental tool to help you through the darkest times. These aren’t reckless health risks I’m addressing here. These are the day to day risks you’ll need to take to stay engaged with life, family, and community.

Risk means that you’ve acknowledged that this new life can be scary but you are committing to moving forward anyway.

Risk means turning toward the things that scare you and not away from them. Avoidance stategies do not work well in normal times. They work even less well in times of crisis. If your head is in the sand you can’t see what needs to be done, you can’t see those who need your help, you can’t see those that are there to support you. Avoidance makes fears worse, not better.

Emotional and relational risk is important here too. We can’t get through this alone. In a crisis, it’s easy to get caught up with yourself and feel that if you admit your fear and vulnerability and share that with the people you are closest to, you’ll all collapse together. In my experience, it’s keeping this stuff in and then having it eventually spill out all over the place that is most alarming and unsettling to the people in your life. Sharing our fear and worry together helps us digest it together. We can do together what we can’t do alone.

CPR for your worried heart is about exercising compassion for yourself and others. It’s about finding purpose to strengthen your resolve and inform the actions you take. It’s about risking to stay engaged in life and with others.

CPR can help you move forward, not vanquishing fear, but living a brave, inspired, and heart healthy life in spite of it.

Creating Some Distance From Anxiety: Hope for Viral Fear Lesson #2

Strengthening Your Immunity to Anxiety 

Let’s get the bad news out of the way first…

We can’t get rid of anxiety. Whether it’s of the coronavirus or some other stressor in your life, anxiety is an essential human experience. Like sadness or anger, it’s here to stay. It communicates danger and readies us to respond. We need it to survive, so we need to learn to live with it. 

Learning to live with today’s heightening anxiety is a little like living with this virus itself. We’ll ultimately survive this pandemic by building immunity. We’ll survive our anxiety the same way. 

In the viral world, we inoculate ourselves to harmful invaders by being present and mixing with them (mixing with inert versions of the virus in the case of vaccinations). In mixing with foreign substances, the body learns. It learns to recognize and respond appropriately. It learns not to over react and learns not to under react. 

Similarly, easing your anxiety of the coronavirus will require that you stand toe to toe with your fear, mixing with it, acknowledging it — without minimizing or exaggerating — inoculating yourself against it. The more we practice this, the stronger our immunity, and the better our ability to be resilient in the face of worry, fear, and panic. 

Now the good news…

We can increase our capacity to stand toe to toe with fear by creating a space between the very heart of who we are and the part of us that experiences anxiety. This can then empower us to accept anxiety and fear instead of being taken over by them! From there, we can choose how we respond to this crisis, proactively.

And we do this by learning how to just notice…

Just Pause, Notice, and Accept 

The first and easiest thing you can do to start building your immunity in the face of anxiety is to practice the art of noticing.

You need to learn how to just pause and notice all the noise that’s going on in your head.

You need to learn how to just pause and notice what your body is sensing and experiencing.

You need to learn how to just pause, notice, and be with all the feelings you are having, one moment to the next. 

Noticing includes bringing an attitude of acceptance to what’s there. The key here is that you won’t try to change or control what you are noticing. You’ll do the opposite — you’ll bring an intention of acceptance to whatever you encounter. You’ll allow it to be there, make room for it, embrace it!

I know this must sound absurd, underwhelming, even counterintuitive. You’re feeling big fear so you are looking for big medicine. You think, “these thoughts and feelings are so uncomfortable, shouldn’t I try to combat them or get rid of them somehow?”

The unequivocal answer is NO!

The more we try to change or rid ourselves of anxious thoughts and feelings, the more they end up controlling us and the stickier they get. In fact, anxiety and fear often start to ease the moment we stop this battle, stop trying to manage them, the moment we begin to see them — from a distance.

Like our coronavirus strategy, we need help ‘distancing’. We need to create some distance between ourselves (the observing you, the enduring you, your center and core, the essential you — the heart!) and the thoughts, feelings, and bodily reactions the heart of you is experiencing. Six feet isn’t required here, just a sliver is all you need to start to see that you are so much more than your worry and fear. 

We’ve been told a lie over the years. The lie is that we are our thoughts and feelings. That’s not true. Thoughts and feelings can be an aspect of what we experience, but they are not the truth of who we are. They don’t have to define us, they don’t have to dictate our actions. Reactive thoughts and feelings don’t have to be in charge. 

Increasing our observing and noticing muscle strengthens our ability to access the heart of who we are, the essential and vital part of our being. This can ultimately give us the power we need to make healthy, deliberate, and informed choices — taking our lives back from our reactive autopilot and from our anxiety, fear, and panic.

Here’s an exercise called MIND WATCHING to help you practice this skill. Try this a few minutes a day. Those of you familiar with mindfulness practices will recognize this.

Mind Watching

• Find a comfortable and quiet place to sit down. Place hands, palms down, on your lap.

• Notice and focus on your breath, don’t control it, just notice it.

• Soon you’ll be distracted by a thought, maybe an intrusive or uncomfortable thought about this virus. Notice the thought, even name it, “thought about the virus.” You might imagine this thought as a puffy white cloud in the sky. It’s there to see, but slowly moving along with the breeze.

• After you name your thought, return to the focus on your breath.

• Before long you might be distracted by a feeling, maybe worry or fear. Name the feeling “worry” or “fear.” Again, maybe imagine the feeling as a cloud moving slowly along in the sky.

• Return to your breath focus.

• Before long you might be distracted by a sensation in your body. Name the sensation as you experience it, “tightness in chest,” for example. You might bring an intention of acceptance and warmth to that part of your body.

• Return to breath.

• Repeat.

The goal in this exercise IS NOT to get rid of or change your thoughts, feelings, or body sensations in any way. The goal is to notice them, even accept, allow, and make room for them, just as they are, but from a distance, the distance of your observing self.

Keep practicing moving back and forth between breath and experience. Remember, we are not trying to focus on our breath in order to avoid the mind or body. We are simply learning that we have the ability to move back and forth between breath and experience. We have the ability to focus our attention with intention.

In moving back and forth from what we experience to an anchoring breath we begin to see that we have the capacity to observe, from a distance, what we are experiencing instead of being reactively taken over by it.  

Your breath is always there, a reliable anchor. Like a boat anchors itself in the harbor to steady it in the midst of a storm, your breath can anchor you in the midst of the storm of changing and unpleasant thoughts and feelings.

We don’t have to change anxiety, we have to change the way we relate to it.

Distance Creates Freedom

One of our greatest human gifts is our ability to be aware of awareness. We can think about thinking. The Mind Watching Exercise will strengthen your ability to see that with a little focus, you always have access to this observational, “meta,” part of you. From there you can observe what’s going on, from a distance. From there, reacting less, you’ll have more freedom to choose how you respond. You can even choose to respond to your fear with kindness and compassion! (more on that later)

You might think of this observing part of you as your wiser self, the most essential and compassionate part of you that’s enduring over time — your heart!

In my next post I’ll help you explore this heart I keep referencing. To ease our anxiety we will need to get back to the heart of the matter. We’ll need to get back to who we are, what we value, what’s meaningful and important to us. Turns out the best way to address anxiety is to start living again!

Transforming Worry to Action: Hope for Viral Fear Lesson #1

Worry at the Epicenter 

A patient asked me the simplest question the other week, “How are you dealing with all this coronavirus fear?” No pressure, easy enough right? After all, I’m an anxiety therapist who’s been treating worried and panicked people for decades. I paused. Embarrassed, my mind drew a blank. Seems like a therapist should have a well thought out answer to the question my clients are asking the most right now, “how do we deal with our fear of this seemingly unstoppable virus?” 

The truth of the matter is, up to that point — a week or so before the US woke up to the new social distancing reality following the example of China and Italy — I’d largely been dealing with viral fear like many of those in the Seattle area, ground zero for the COVID-19 virus. I’d been buying disinfectant wipes, paper products, and food; obsessively following the news; washing my hands religiously; and trying desperately not to touch my face — oh yah, and worrying a lot!

I was at a loss for words with my client because I had temporarily lost myself. I imagine many of you have lost yourself too these days. When overwhelmed and flooded, we put off dealing more directly with our primary feelings. We can end up instead addressing them through obsessive disaster prep and over identification with our worried thoughts and feelings.

I’ve done some work on my own anxiety in the last few days. I’ve paused to be more mindful of my own experience; I’ve reached out for support to friends, family, and colleagues; and I’ve reminded myself of what I already know to be effective in dealing with anxiety — self awareness, intentional action, and compassionate connection with self and others.

I’m not a physician, epidemiologist, first responder, or 3M factory worker doing 18 hour shifts manufacturing face masks. I’m a psychotherapist though and am pretty good at putting people more at ease by helping them understand anxiety and how to live alongside it. So I thought I’d do my part and try to offer some relief the best way I know how — teaching you something about anxiety by teaching you something about yourself. 

My hope is to offer you some comfort in this crazy time by giving you a few tools to gently lead you back to who you are, moment to moment. Once there, you’ll have more power to relate to anxiety and fear more deliberately and with more kindness. From there you’ll also be reminded of what you already have that you can offer others — in whatever way your talents allow. In this way, you can transform worry into compassionate and intentional action. Maybe then we can all begin to spread more healing and less virus.

The Miracle of Intentional Action 

One of the best ways to manage your anxiety is to act with intention instead of re-acting unconsciously. Reactivity isn’t always a bad thing. The oldest, most primitive parts of our brain enable us to react without thinking. This works well in a crisis; for example, you need to escape a fast moving vehicle while crossing the street or the jaws of a rapidly advancing dinosaur in prehistoric times. Our legs move without us having to tell them to move, this saves valuable time and gets us to safety. 

This doesn’t work so well in periods of prolonged stress — like we are experiencing now with this viral pandemic. Our nervous system doesn’t easily distinguish acute from chronic stressors, though. We can end up in a place where our brain continues to tell us what to do even if it’s against our own interests. 

This involves the way our body responds to stress (accelerated heart rate, increased blood pressure) but it can also involve the thoughts and feelings we are having too. We can end up with a whole host of “mental scripts” running in the background that we don’t control. These thoughts are often around our worst fears and harshest judgments. In turn, these thoughts can quickly influence feelings we might have like worry, sadness, anger, or helplessness. Things can go south quickly when our body, thoughts, and feelings are all bound together in a mutually and negatively reinforcing cycle of anxiety.  

When bodies, thoughts, and feelings build negative momentum in this way, we start to run on autopilot. We don’t act, we re-act. In the face of the coronavirus scare we can start to stockpile excessive supplies we don’t need, tunnel into obsessive thoughts that aren’t helpful, and be overcome by waves of feelings that we can’t control.

The remedy for all this reactivity is intentional action. 

Acting with intention means bringing conscious aim and purpose to what you do. You might think of intention as getting back into the driver’s seat, being the pilot of your life, flying directly, instead of defaulting to autopilot. This is important because when caught up in anxiety, we can get stuck in an autopilot existence.

Reacting from fear, our autopilot tends to take us in directions that are opposed to what we actually value, what we care about, and that are not in line with who we truly are.

There are some relatively easy and concrete things we can begin to do to learn to stand alongside our fear instead of reacting to it. Things that will help you get back to the driver’s seat so you can effectively live in viral times, taking care of yourself emotionally as well as being more available for your family and friends. In my next post, I’ll go over how to create some distance from fear so you can live more fully even alongside worry and anxiety.