Evaluating Self Help: The Mindfulness & Acceptance Workbook for Anxiety

There’s no shortage of self-help books on the market. There is, however, a paucity of research on whether those self-help books are actually helpful to the people who use them. In an ideal world, every self-help book would be submitted to scientific scrutiny to determine if people actually benefit from using them. Unfortunately, this happens only rarely.

Even a self-help book that is based on well-researched cognitive behavioral principles and written by leaders in the field is not guaranteed to be effective.  For example, one recent study found that college students with greater rumination exhibited more depressive symptoms after using Greenberger & Padesky’s Mind over Mood, a well-respected cognitive behavioral self-help book for depression. These findings suggest that evidence-based psychotherapy interventions don’t always translate into effective self-guided techniques that people can use on their own, and in some instances can actually be harmful.

The Mindfulness & Acceptance Workbook for Anxiety

Over 5 years ago, I wrote a few blogs posts about Forsyth & Eifert’s The Mindfulness & Acceptance Workbook for Anxiety in 2 prior blogs for which I used to contribute. The first, on my blog Scientific Mindfulness, reported on pre-publication research I heard about at a conference. (Unfortunately, it appears the other post has been taken down.) The first author of the workbook, SUNY-Albany professor John Forsyth, PhD, conducted 2 studies on his ACT-based self-help book. He gave copies of the book to people for free, and had them complete online self-report measures at various intervals.

Dr. Forsyth recently posted a summary of this research on his personal blog in anticipation of the upcoming 2nd edition of The Mindfulness & Acceptance Workbook for Anxiety that will be released April 1, 2016. One paragraph in his blog post caught my attention:

Reductions in anxiety and fear did not happen by going after anxiety and fear directly. It was just the opposite. By first focusing on the skills needed to live a more valued life, readers then experienced a decline in their anxiety, fears, and depression, and ultimate improvements in their lives. This is an important message––one that supports the approach we offer in this workbook.

The workbook emphasizes ACT skills to help people engage in meaningful living, and it appears that those skills—rather than interventions aimed at alleviating anxiety and worry—appear the most effective.  Said another way, the findings suggest that people using the workbook improved more from doing things that were important to them than from any particular technique. This is quite profound, if you think about it, and very different from how many people approach anxiety. Attempting to directly suppress or control anxiety-related thoughts and feelings can often backfire.

Because it’s one of the rare self-help books that has been researched specifically as a self-help book, I find myself recommending The Mindfulness & Acceptance Workbook for Anxiety more than any other self-help books, and I was excited to hear there’s an updated edition coming out. I encourage readers to check it out.

Anxiety Treatment at Portland Psychotherapy

Pain, values, compassion, and a dying dog

“Grief can be the garden of compassion. If you keep your heart open through everything, your pain can become your greatest ally in your life’s search for love and wisdom.”

 — Rumi

Just about three years ago, I wrote a blog post titled “Pain and values: two sides of the same coin” about our amazing dog Dalai. That post turned out to be one of the most popular pieces I’ve written. I wrote about the simultaneous, and I would say inseparably linked, love and pain that was consistently present for me when I was with Dalai, who was somewhere around 17-18 years old at the time. Because so many people have talked to me about that piece, I thought I would share an update and also some new thoughts I have on the topic of pain and values. If you want to read the original piece, you can find it here.

Dalai is still here, and so is the pain.

Believe it or not, Dalai is still with us, and at around 20+ years old, I’d say that little old lady is doing something right! She comes to work with us every day, usually riding in a trailer pulled behind the bike. She was diagnosed with thyroid cancer about a year ago and has been on palliative care since. With the help of our amazing veterinarian, Heather Dillon, DVM, we’re able to manage her physical pain quite well and Dalai still has a wonderful quality of life.

And though I feel incredibly fortunate that Dalai is still with us, so too is the pain, anxiety, and sadness I feel when I think about what is to come. In fact, it’s difficult to admit, but there are even times when the pain is so intense that I notice having the thought that I wish it was over. Then of course I feel incredible pain at having that thought and the cycle goes on.

Compassion as palliative care

In my last post about this, I focused on the idea that I can’t move in the direction of my values if I’m not willing to experience painful thoughts and feelings – If I’m not willing to have those painful thoughts and the sadness that shows up when I’m with Dalai, I can’t care for her in the way I would choose to during this time in her life. The only way to get away from these difficult thoughts and feelings is to not be around her. And while it’s still very painful for me to be around Dalai, I’m not willing to give up one moment I could have with her just to avoid that pain. And in these past few years as both she and I have been working through the process of her aging and dying, I’ve learned a few things about how I want to be with that pain. So I thought I’d share something that for me has become an essential component in that equation of values and pain– compassion.

Just as my loved ones and I have been very intentional over these past several years about attending to Dalai’s physical pain as best we can, it’s also been helpful for me to attend to the emotional pain that those of us who love Dalai feel as we see her dying. Compassion, which literally means “to suffer together”, is a willingness to be present to suffering (another’s or your own) and a desire to ease that suffering. Compassion, including self-compassion, is my palliative care. It is what I am using to help ease the suffering my loved ones and I are feeling. Even though I help people develop self-compassion and be intentional about their values for a living, I found that although I wasn’t avoiding being with Dalai in order to avoid feeling the pain, I wasn’t fully present to it either; it was more like, “Well, that’s there and there’s nothing I can do about it, so I’m just not going to think about it.” And that can be helpful at times. But that isn’t how I treat others that I love when they are in pain and it felt incongruent with my values to treat my own pain in that way. So, over the past couple of years I have focused more and more on using compassion exercises in my own life, as a way to not only ease the pain I am feeling, but also honor it.

Quick self-compassion break

One of my favorite compassion exercises that I’ve incorporated into my life is Kristen Neff’s Self Compassion Break. The self-compassion break exercise gives me a way to treat myself with gentleness and kindness and also connect to the common humanity that is suffering. It is very quick and you can do it anywhere, which is great given that pain does not conveniently just show up when I have time to do a 30 minute compassion meditation. You can find an audio of the exercise here and a written script here. So next time you notice struggling with painful thoughts or feelings, especially when you know they are linked with something you care very deeply about, you might consider giving this exercise a try. And If you’re interested in reading more about compassion, my colleagues Jason Luoma (who also happens to be Dalai’s guardian too!) and Melissa Platt and I have a site dedicated to our work in that area called “ACT With Compassion” that you can check out here.

Thomas Merton once wrote that “Compassion is the keen awareness of the interdependence of all things.” When I am practicing compassion, I also often notice being more connected to all beings, including that little old dog at the heart of this all.

How to Read Your Emotions Part II: Put on Your Spec’s

Reading your emotions is all about perspective. Perspective is just a place from which you are looking at something – it’s a point of view from which you observe things as they happen. Your experience of an event can be dramatically different depending on how you view that experience.

If you’re watching a movie but sitting behind someone with an enormous hat that blocks your view, you’re likely to experience frustration because you’re missing out on the movie. You might politely ask this individual to remove his or her hat, and sometimes that works. But if they refuse, the situation can become even more upsetting and you might be tempted to start an argument. After all, people “shouldn’t” wear big hats in movie theaters! While you might feel you are justified in arguing, making a scene usually isn’t actually much fun for anyone (no, your date will not be impressed). If the point of your evening is to have fun enjoying a movie, then the simplest solution is to change seats.

But notice that whether or not your view is blocked by a hat, the movie itself is exactly the same. For that matter, changing seats doesn’t mean the person with the hat suddenly stops existing. The important difference is in where you’re sitting – it all depends on your perspective. The same is true of your emotions: don’t try to change them, get a better view.

The ability to take perspective on one’s emotions isn’t a matter of understanding – it’s a matter of repetition and practice. The more you do it, the better you’ll get. One of the best ways to develop your emotional perspective-taking skills is through practicing mindfulness meditation.  Mindfulness is the practice of taking perspective on your feelings, thoughts, and sensations. It can also help you learn to take other people’s perspectives, develop a stronger sense of self, and become more accepting of your psychological experience (see my earlier blog post on the perils of judging emotions).

Just like it’s hard to read a book that is an inch away from your face, it’s hard to read your emotions without creating a little space. How and from where you look at your emotions can be much more important than what emotions you are looking at. By “stepping back” from your emotions you create a new vantage point that will help you see more clearly. As you’ll see, that perspective gives you an advantage.

How to Read Your Emotions Part I: Don’t Judge a Book by Its Cover

Sometimes when you first start having a feeling, your brain will very quickly make up its mind that the emotion is somehow dangerous or bad. Then it tries to escape from the emotion or control the emotion by turning your attention elsewhere and getting you to do something that makes the emotion go away. Because our brains are trying to protect us from harm, this well-intentioned judgment about our feelings comes from a good place. However, somewhere along the way our brains got a little confused about what is actually harmful. Emotions themselves are not harmful, our brain just says they are. 

Doing something that makes fear go away can work to keep you safe, but it’s only a stand-in for the real solution, which is to get away from the actual danger. Put another way, fear isn’t ever harmful, but masked figures holding knives often are. It’s much more important to get away from any danger in the world than to get away from any fear you are experiencing. In fact, when you are attuned to your environment, fear is just awareness of danger. In that sense, fear is probably a handy thing to experience – if you aren’t aware of real danger, you are less likely to respond and more likely to get hurt. The lesson is — don’t be so quick to judge fear. It may be your friend.

The same goes for other emotions: Sadness isn’t bad, it’s just awareness of loss, and loss is bad. Anger isn’t bad, it’s just awareness of conflict, and conflict isn’t great for relationships. Anxiety isn’t bad, it’s just awareness that something is important to you, and caring about things is good. For that matter, joy isn’t good, it’s just awareness that something wonderful is happening, and wonderful things are good. Emotions are there to be felt because they say something about the world in which you are living. Don’t leave your emotions on the shelf – check them out!

You can’t really blame your brain too harshly for making snap judgments – that’s what it evolved to do. Go ahead and thank your brain for its noble intentions of keeping you safe. But when it comes to your emotions, remember that they’re meant to be an open book.
For more on how to observe emotions without getting caught up in judgments, see How to Read Your Emotions Part II: Put on Your Spec’s.

Chinese Finger Traps: What a Novelty Item Can Teach Us about Acceptance

Let’s start with the obvious. In most cases, human beings want to minimize pain and discomfort. This is doubly true for emotional pain. While some people enjoy extreme temperatures, endurance sports, and pushing their body to its limits, it’s very rare that anyone enjoys anxiety, panic, or depression. Unfortunately, the inner experiences we want to escape—our thoughts, feelings, and bodily sensations—are often the hardest to get away from.

Acceptance

People talk a lot about “acceptance,” but what does it really mean? I practice a form of treatment called Acceptance and Commitment Therapy; in practice, though, I don’t use the term acceptance much because the word is easily misunderstood. For this post, I won’t bother trying to give a definition of acceptance. Instead, I’d like to explain a metaphor I commonly use with the people I work with.

Introducing the Chinese finger trap

When I was a child, my pediatrician had a drawer of cheap toys I could choose from at the end of my appointments. Almost invariably, I chose a Chinese finger trap. If you’ve never seen one, finger traps are woven bamboo tubes (check out the picture above). You place your index fingers in either end, and when you try to pull them out, the tube constricts, trapping your fingers. When you push your fingers inward, it causes them to loosen.

I don’t just talk about this metaphor. I reach into a nearby box and pull out a few finger traps. I sit with the individual across from me, and we alternate between pulling and away and pushing our index fingers into the finger traps in effort to highlight the contrast. At the end of the session, I give them the finger trap to take with them, to serve as a reminder to check-in with their own experience between sessions—what happens when they struggle against pain?

Struggling with pain is like trying to get out of a Chinese finger trap

When we try to get away from emotional hurt or from bodily pain, the pain may tighten up on us, like the woven bamboo finger traps. Sometimes the struggle to change what we are feeling can make things worse, not better. Our life narrows down to a focus on what’s painful. We tell stories about it, and worry about it, and justify it, and explain it, and all we get for our troubles is more, not less, pain. But when we lean into our discomfort, as when we gently press our index fingers into the finger trap, we create some space.

Here’s a thought experiment: think about an uncomfortable experience. It could be a physical illness, a break-up, work stress, anxiety, depression—whatever. Now imagine someone told you that the pain would be gone in 5 minutes—would that allow you to experience that pain with less struggle? For most people, the answer is, “yes.” There’s very little we cannot experience in the moment, when we sit and really experience it as it is in the present. It is our attempts to struggle against the pain and our stories about it that amplify the pain.

This is the message I want to impart: “Leaning into discomfort doesn’t free you—you’re still in the trap—but you gain some wiggle room. A desire to pull away is natural—it tends to be our default—but it often gets us stuck.”

When we accept, we let go of the struggle against what we’re feeling—in this very moment. In the next moment, we get a choice about what to do next. Acceptance frees us from the struggle with pain and allows for new possibilities. When your entire focus is getting away from pain, this leaves few alternatives. If you’re willing to accept pain—even for a single moment—you’ve expanded your options.

Anxiety Treatment at Portland Psychotherapy