Dr. David Van Nuys:Welcome to Wise Counsel, a podcast interview series sponsored bymentalhelp.net, covering topics in mental health, wellness and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.
On today's show, we'll be talking about acceptance and commitment therapy, or ACT therapy for short, with my guest, Dr. Steven C. Hayes. Steven C. Hayes, PhD, is Nevada Foundation Professor at the Department of Psychology at the University of Nevada and author of 30 books and nearly 400 scientific articles. His career has focused on an analysis of the nature of human language and cognition and the application of this to the understanding and alleviation of human suffering.
In 1992, he was listed by the Institute for Scientific Information as the 30th highest impact psychologist in the world during 1986 through 1990. Dr. Hayes has been president of Division 25 of the American Psychological Association - that's the division of experimental behavior analysis. He also served a 5-year term on the National Advisory Council on Drug Abuse in the National Institutes of Health.
His popular book, 'Get Out of Your Mind and Into Your Life' was the number one self-help book, reaching number 20 overall on Amazon and briefly outselling Harry Potter for several days.
Now, here is the interview.
Dr. Steven Hayes, welcome to Wise Counsel.
Dr. Steven Hayes:Glad to be with you.
David:Yes, it's great to have you here. Now actually I heard about your work from someone else who suggested that you would make a great interview subject and so I must confess to being quite ignorant. I've been to your website and I see that you have a very full, rich, productive professional life, a very elaborate website that would take quite a while to thoroughly plumb and understand everything there, so I'm probably going to ask you some fairly naive questions. Hopefully you'll be tolerant of that.
Steven:Sure.
David:I know that you've developed a new approach to therapy that you call 'ACT', and do you call it 'A-C-T' or do you call it 'ACT'?
Steven:I call it 'ACT', 'A-C-T' to my ears always sounds like 'E-C-T' and I'm waiting to be shocked, but no, we call it 'ACT' just by tradition.
David:Yeah, well, that's good, because there's a theater company in San Francisco called 'A-C-T', so...
Steven:It's unbelievable.
David:Yeah, that's another good reason not to. And I also saw a lot of information about RFT, which somehow A-C-T comes out of RFT. Do you think it makes sense for us? And RFT stands for relational frame theory. A-C-T stands for acceptance commitment therapy.
Steven:Well, see, now you're going to have to call it 'ACT' if you're going to... When you say 'A-C-T'... Or are you going to say ACT?
David:Oh, right.
Steven:It's OK.
David:ACT is an acronym for acceptance commitment therapy. So should we start talking about RFT in order to get into ACT or...
Steven:Well, I think it's difficult work, especially for the lay public, but two things in there that are maybe useful. If I could just do an orientation for ACT, would that be helpful?
David:Yes.
Steven:I can link it a little bit to RFT.
David:Yeah, that'd be great.
Steven:You know, a lot of the therapy traditions that are out there are dealing with the issue of cognition in one way or another because it's just so central to human functioning, but there's been very little careful linking to more scientific approaches to cognition. Those dominant themes that are out there are more information processing kind of models, thinking people are computers and so forth.
And I really early on, although I come out of that tradition, ACT is part of the cognitive behavior therapy tradition, really and behavior therapy more generally, I was dissatisfied with the linkage between our understanding of what you and I are doing right now, or what anybody listening is doing when they're struggling with themselves in their own mind, worried about their own problems, evaluating their own experiences.
I became dissatisfied with understanding that process as how it relates to the process both of creating human suffering and of solving human suffering. So ACT is part of a larger effort to try to create a modern and new approach to thinking itself, and then out of that, trying to create technologies that are linked to those principles that you can test in carefully controlled studies and that we can teach other people through self-help and, of course, through therapy and other means - how to use these techniques.
So I can explain what the essence of RFT is and how it links to ACT, but that's at the level of process. What we're trying to do is go beyond simply a commonsense understanding or some of the scientific ways of understanding cognition that are, I think, harder to turn into real vital treatment programs. I don't think people really are computers and thinking of them as machines can only take you so far.
David:Oh, I totally agree with that. I'm not sure if we need to go into RFT. It sounds like that might be fairly technical. So perhaps we should stick with ACT.
Steven:I can probably do... You'd hurt my heart to completely skip it.
David:OK.
Steven:I can do a one-minute version.
David:OK, do it.
Steven:Here's the thing that we've learned that is very simple and most people would say it's common sense. What we have found, even with research with human babies, is humans do something that, so far as we can tell after 25 years of trying, there's no other living creature on the planet that does this. If you don't do it, you don't develop language, you don't learn how to think, reason and problem solve. The one core ability that humans, even human babies do, that so far as we can tell no other living creature on the planet does, is that if you learn something in one direction, you derive it in the opposite direction.
And so if you don't know that, for example, I have an infant in the house, and when I teach my little guy that this is called a ball, and later I say, "Where's the ball?" he'll look around the room and find the ball. There is no other living creature on the planet, other than human beings, that do that. And if you don't do that, you don't develop language.
Now, how RFT came to that and said, "This is way inside baseball, " there's about 80 studies on it, it's very arcane.
David:Wait a second, I have to stop you there, because I'm not sure I'm getting the example, because if you say to a dog, "Where's the ball?" the dog will do search behavior.
Steven:Sure, but you have to teach the dog when they hear "Ball" to go find the ball. If you put the ball in front of the dog and say "Ball" and then you say later, "Where's the ball?" they will not look for the ball. Even the language-trained chimps, so-called, won't do it. There's about 25 years of effort, about 30 studies, very careful studies.
I come out of the animal learning tradition and I've done about and published about nine animal studies. They simply do not do it. The words that even the language-trained chimps learn, and the dolphins and the rest, are not really symbols. They're communication, but they are not... You don't train it in one direction and get the other direction for free.
David:That's the part I'm not understanding, is when you talk about one direction and the other direction.
Steven:OK, so when, and this is very important to understanding ACT, and it's the reason I asked to actually have the opportunity to talk a little bit about RFT, is because the technology that we've developed, it really targets this specific process.
When you are thinking about the past, for example, as a human being, it's as if the events you're thinking about are actually present. You can get so much into it that you almost disappear into it. The pain is revisited as if you are actually there.
If you're thinking about the future, you can do the same thing, which is both good, in terms of solving problems and creating things, and bad, in terms of struggling with things that may never happen, fearing futures that never will be. "This anxiety's going to happen, I'm going to die, the people around me are going to die." The kinds of ways that we have to bring the past and the future into the present depend upon our unique ability to have the symbols that we use stand for and bring into the present...are interacting with the things that it stands for or is related to.
David:OK, now I'm with you. I think I've got it.
Steven:With me on that? Now, with your dog, you can teach them, when you hear 'slippers', go get the slippers. But when you say 'slippers', he's not imagining slippers, etc. You teach him a new word, you have to teach it in both directions. You could teach a parrot, for example, to say the word 'ball', when they see a ball, but then you'd have to teach them, when they hear the word 'ball', to go get the ball. Both directions would have to be taught.
With infants, at first both directions have to be taught, but by the time they're just 14, 15 months old, you teach it in one direction, you get the other for free. And this leads to these gigantic cognitive networks that we live in. We live inside our heads most of the time, you know - thinking about the past and the future, and evaluating what we're doing, which is great when you're solving a problem in the external world, but leads both to an entanglement with your mind and an attack on your own emotions, very often. Why that happens, we'll unpack.
But ACT is a combination of acceptance and mindfulness processes and commitment and behavior change processes that allow people to interact more flexibly with their world, despite the fact that they have this language-generating engine between their ears that's constantly tempting them to leave the present and go into the past or in the future, even when it's not useful to do that. Or to go off into judgment and evaluation, even when it's not useful to do that.
So that's what we're trying to do, is teach people to be present and sort of leave a little bit of gap between themselves as a conscious human being and this problem-solving ability that comes from allowing symbols to stand for events.
David:OK, I think I'm with you. What I'm hearing so far is that as human beings we live in a very symbolic world, this internal world that we've constructed of symbols, and that we sometimes become so, what, overidentified with it that we get kind of lost and tangled up in it.
Steven:Exactly.
David:And we can develop... Sometimes we need to have a little distance from that.
Steven:Little bit of distance. And part of the things that are... The two ones that are in there that are really big are time and evaluation. It's very hard for human beings to stay in the present moment. I think there's every reason to believe all the rest of the creatures on the planet, that's where they live basically all the time.
David:Right.
Steven:There's a past and there's a history, but we have the ability to rearrange the past, reflect on the past, rethink the past and to deal with a future that's never been. That's great for us in problem-solving, but it also creates a temptation to live somewhere else other than where life happens, which is right here, right now.
David:Yes.
Steven:And the other one is the evaluation part. You know, problem-solving works on the idea of getting rid of bad things and creating good things. But here's the problem - a lot of the parts of your own history and things your body does, some of the feelings you have, you can evaluate.
And so it's a very tempting thing for a human being to say, "I don't like feeling this so I'm going to try to get rid of it." Turns out that's probably the single most destructive thing a human being can do.
David:Really?
Steven:Because it - when we collect measures, what we call an experiential avoidance. Experiential avoidance is the combination of trying to get rid of feelings we don't like and they tend to involve us or entanglement with your thoughts and the inability to act flexibly in the presence of difficulty in some thoughts. Even if it soothes your interest. Even if it's what you want.
That combination will pick up about a 25% of the variance in anything bad you can name, and whether it's learning a new piece of software to pulling out your hair to becoming depressed or drinking too much or almost anything you can name.
Because if you can't fit with your history as you want towards what you really want, if you can't walk through discomfort, anxiety, sadness, difficult thoughts, worries, fears, insecurities, and you're going to live inside the box that established quote good feelings and good thoughts, even if your life would be a lot more expansive to get out of that box.
A lot of things that we think we'd want in our life are going to make us uncomfortable. If you get connected to someone and you really love somebody and you really care about, guess what? You're going to feel vulnerable. The root word of vulnerable is woundable. Because when people are close to you they can hurt you.
David:Yes.
Steven:If you take the human mind's tendency to evaluate things and then to get rid of the bad things, it would say, "Don't let people get close to you. Don't be vulnerable. They might hurt you." And of course that's what we do.
We get betrayed in relationships and what do we do? Instead of -- precisely because we want relationships that hurt to be betrayed and what we do is we decide that what we'll do is never be so vulnerable. And which means you can't have what you really want.
So the human tendency to evaluate your own feelings and then treat them like external objects. Begins to treat your life in an objectified way. It becomes narrower, less flexible, less able to move forward, and that's what happens to part of us.
David:OK. What you're saying is so rich. It stimulates all kinds of thoughts and associations in my mind.
Steven:Yes.
David:And it's hard to follow them all. But I want to go back to when you were, when you first spoke about acceptance you used the word "mindfulness." And of course...
Steven:Yes.
David:...I'm familiar with that in the context of mindfulness meditation and Buddhism.
Steven:Yes.
David:And I saw on your website you went to, I saw a warning that one should not equate this - what you're describing - with Buddhism, and yet I certainly hear some resonance with that. Maybe you can talk about that a little bit.
Steven:Well there is resonance, but I think there's resonance in the act message with many of the deeper clinical traditions.
David:Yes. Yes, I remember that.
Steven:Also with the, also with the mystical aspects particularly of all of the major religion. All of which, every single major religion has in its mystical aspects ways of reigning in the excesses of human language, especially as it relates to time and evaluation.
So whether it's Zen Koans, which you can't answer literally and evaluatively, or chanting or silence or dancing or -- every single tradition has a way of putting this judgmental problem-solving repertoire on a leash.
David:Yes, and even in the Ewam tradition...
Steven:Yes.
David:Followers of Carl Ewam, there is this, there is a notion of the need to embrace your suffering rather than run from it. To kind of embrace...
Steven:Yes.
David:...the polarities and all the pieces of yourself.
Steven:Exactly. No, the analytic traditions definitely have this sort of the experiential and existential traditions, and so what act is part of is a wing of the culture I think that's a little wiser than the commercial feel-goodism that we seem to have turned - there's this running rampant and we've turned loose on the world, and increasingly so over the years.
It's linked to these traditions, but part of your job is to open up to your own pain, the difficult areas. Don't buy into them, don't just do what they say, but learn to just observe them, watch them. I think Freud's term was an attitude of dispassionate observation, and then connect with your values and get your feet moving in accord with what you really want to be about in your life, and not just what your history tells you to be about.
So my resistance on the Buddhism part is not that it's not linked. I've actually written articles on ACT and Buddhism. I didn't come from Buddhism, I had no formal training there, other than just being a child of the '60s and reading what anyone would read, Suzuki or Watts or some of the people who were popular in the '70s.
David:OK.
Steven:But...but more recently I've gone back and had to make the relationships, because people ask these questions. But I worry about the message being put into a small box.
The message that's inside ACT is a message of liberation and spirituality, of values-based action, that's in many of our traditions, and across all different cultures that I've ever looked at. And it gets overwhelmed by the judgmental, evaluative, temporal part of the human mind, and by the institutions that feed that, like the commercialism that's, I think, feeding it right now.
David:Yes.
Steven:So if people say, "Buddhism, " and they say, "I don't know, that Eastern stuff, " I would rather not have that be a barrier. Yes, Buddhism, but not just Buddhism. Also the Kabbalah, but not just that, also the Christian mystics, but not just that, also any tradition you can name, it's in there. It's not good for human beings to run away from their own pain and to buy into their own thoughts and to try to live inside a little cognitive box that our minds would tempt us to climb into.
David:Yes, it's very fascinating, because you are articulating some major ideas that, as you say, these major spiritual traditions share, and at the same time, I know how committed you are to the model of science, and the extent to which you have attempted to anchor all of your ideas in research.
Steven:Exactly. And, you know, the traditions that are in the humanities and also in our spiritual and religious traditions, so particularly issues of art and literature and religion and spirituality, have sort of cast a light forward as to what kind of a life do we really want to be living? And also they often have hints of how do we get in our own way of being able to do that.
But what I have become...what I've committed my life to is finding a way to take those sensibilities and bring them out inside Western science and say, "Can we learn some things in this other area that then we can bring back to the culture, back to what we're doing in therapy, but not just that, what we're doing in our homes and our schools and our businesses, what we're doing in life itself, that will help illuminate and make sense of some of what's in these other traditions?"
The very first article I ever wrote that really was an ACT article. It was in 1984. It was called "Making Sense of Spirituality," and it was attempting to try to do a Western-science based monistic analysis of what spirituality really was about, and so I am persuaded that Western science is one of the most progressive things that the human mind has ever invented, but unless you bring it in contact with the deepest issues and ask of it, "How do we live lives that are connected and liberating?" it's not going to give you proper answers. It could easily enough give you answers on how to do an even better job of suppressing your emotions or running away from past pains.
And that's, in fact, what's happened. Inside science and technology is the feel-goodism that I think is harming us. If you think that the only answers are in pills that's a new invention that came from science and technology. So if you don't put it in the service of the right things, it's not going to give you the right answers.
David:Well, you've got me cheering in the stands here. [laughs] As another child of the 60s here, I really like where you're coming from with all of this, and the very ambitious effort that you've made -- a successful effort, it would seem -- in terms of integrating those basic spiritual questions and values, and connecting it to Western science and Western thought.
Steven:Right.
David:That is a major task, and part of the task of our generation, I think. So I applaud you for taking that on. Now I want to make sure I understand acceptance commitment therapy. My understanding of the acceptance part, at this time -- you tell me if I've got it or not -- is the acceptance part about accepting those things in our experience that we would want to avoid?
Steven:Yes, although not everything needs to be accepted. The Serenity Prayer I think has a good example: accept the things you can't change, and change the things you can, and the wisdom to know the difference. What ACT is trying to bring in is perhaps some wisdom. What is the difference?
From an ACT point of view, automatic thoughts and feelings, your own sense of self, your history are all off the table for change. In fact, they do change -- some of these things -- on their own, but it turns out if you directly target them for change, things like automatic thoughts and feelings, they're much less likely to change, ironically. Conversely, when we're talking about situations or behavior, change is 100% applicable.
So sometimes people hear an acceptance message something like this: "If I'm in an abusive relationship, I should just accept that." That's not true, and in fact what we do is teach people to open up to these automatic thoughts and feelings, to watch them more the way you would from an attitude of meditation or prayer. Mindful and aware of them, learn from them, but not entangled with them and struggling with them.
And then go towards what you value, and I'll take the example of an abusive relationship. When we do this kind of work, we find that people are more willing to do the hard work of changing relationships, of stepping out into the unknown, of ending things when they need to be ended. So quite apart from a passive acceptance, or really what I think is more resignation, what we're talking about is an active embrace in the moment of what your history brings to you. But also an active connection to what you really want in your life, and get your behavior aligned with that.
David:Is that the commitment part? Is that where the work comes in?
Steven:That's the commitment part.