 As we spend the next few weeks in Mental Health Awareness Month, I invite you to consider how you can change your relationship with the thoughts inside your mind. While many of us would like to delete some of our thought content from time to time, it turns out that trying to not think about something or trying to suppress it may have the paradoxical effect of increasing the thought.(1)
That Song in Your Head I like to think of this idea as having a song in your head that you don’t want in your head. I bet you’ve had one, annoyingly looping around your thoughts. Maybe it’s a jingle from a commercial, the echoes of your kids’ favorite program, or just a song from a random space in time that plays in the background of your mind much longer than you want. How do you get rid of it? Can you just tell your mind, “Stop thinking about that song”? Can you grit your teeth, plug your ears, and force it out? Or maybe you try to give it away and tell your buddy, “Hey, remember that annoying song?” Now you’ve just doubled the pain. You might try to listen to another song...and then, it dubs its way into the original song! So how do you get rid of that song in your head? The more we pay attention to the song, the louder, stronger, faster it may present itself and the more likely we are to experience the urgency of wanting to do something about it. The answer is that you change your relationship to it and stop attending to it or trying to force yourself not to have it. You accept that it is there and that it is annoying, and you go about your day. Once it’s gone, you may realize you got rid of it — and there it is again! Acceptance and Commitment Therapy Now, I’d like you to think about the song in your head as similar to the thoughts you may have about yourself that are hurtful or painful. Maybe you have a thought that you are “too much” or “not enough.” Or that you will never succeed or that things are hopeless. Acceptance and Commitment Therapy (ACT) teaches us to just notice those thoughts or stories about ourselves, to make some space for them to just be thoughts without necessarily being the definition of who we are and what is important to us. Debating with yourself and others about whether they are true or not may paradoxically increase the feeling that they are. The more airplay you give to the thought, the more you will be spending time with it, and the louder and stronger it may seem. There is also no need to shame yourself for having a thought you don’t want. We don’t blame ourselves about a song being there, right? Judging ourselves for having thoughts we don’t want is adding pain on top of pain — what ACT calls “dirty pain.” So for a mental reset in this month of mental health awareness, I encourage you to notice a thought that cycles around like a song in your head and just let it be that: a song that will fade away as you attend to other things. Change your relationship from trying to fight with it to giving it some space to be there and drift away without judging yourself for having it. As Steven Hayes, the founder of ACT, shares in his TEDx talk, this approach will allow you to make space to focus in the direction of who and what is important to you and how you can bring what you love and joy into the world and share it with others. Check out my website or reach out to me via my contact page. I offer free, 30-minute consultations to new clients. 1 Wegner, Daniel M.,Schneider, David J.,Carter, Samuel R.,White, Teri L. Paradoxical effects of thought suppression.Journal of Personality and Social Psychology, Vol 53(1), Jul 1987, 5-13
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 I recently watched an interview with Brené Brown during which she shared many incredible thoughts. The one that stuck most with me was that “joy is the most vulnerable emotion” and that, for many persons, the experience of joy triggers a “dress rehearsal for tragedy.” This idea means that, for some people, what brings them joy also elicits thoughts about loss or not having joy. Part of this connotation may have to do with how we learn early in life to organize our mental world in opposites (e.g. hot and cold, light and dark, or on and off). For those in recovery, it is the very experience of joy that may help lead them into the reason to recover in the first place. Joy, like love, lets us know how to move toward who and what is important to us. Joy is an emotion we want to share and use to connect with others. So if joy triggers a “dress rehearsal for tragedy,” how do we help persons with eating disorders experience it and not cause more pain in the process?
Understanding Harm Avoidance and Self-Directedness One thing that has helped me understand persons with eating disorders over the years is the temperament trait of Harm Avoidance and the character trait of Self-Directedness, as assessed by the Temperament and Character Inventory developed by C. R. Cloninger and applied to the study of eating disorders. Persons with eating disorders, both recovering and recovered, tend to have elevated scores in Harm Avoidance and lower scores in Self-Directedness. Harm Avoidance is a trait of wanting to be prepared for the future, making sure the details are all sorted out, and not wanting to break the rules or get in trouble. There is a tendency towards worrying and anxiety. The higher you are in Harm Avoidance, the more prone you are to be fantastic at planning and details and the more likely you are to worry about the future and want to follow the “rules.” Persons with higher Harm Avoidance may also tend to excel in professions where they need to pay attention and remember that instructions and details will mitigate risk. You want a good dose of Harm Avoidance in your surgeon, your CPA, your engineer, and your architect, for example! Self-Directedness is a changeable character trait that describes the ability to direct one’s behavior towards who and what is important to them as well as their own values and goals. Persons with eating disorders tend to score lower on Self-Directedness. When making decisions about what to do or what choice to make, they will make those decisions to avoid harm, relieve problems and pain, and not break the rules rather than do what feels like the best decision for them. Persons with low Self-Directedness may people-please or be compliant because they don’t want conflict or for people to be mad at them. There is nothing wrong with this strategy in and of itself; we all need to make decisions to avoid problems and pain. However, things become problematic when you are too focused in that direction and are not making decisions based on what you need and what you value. When you seek to increase Self-Directedness, you can override the temperament trait of Harm Avoidance and choose, with intention, to move in a direction that feels right for you and what you believe in. The good news is that you can change Self-Directedness and also manage your temperament trait of Harm Avoidance. Steven Hayes, founder of Acceptance and Commitment Therapy, has studied the processes by which people get well and states that doing what you love and sharing that with others is the secret to moving out of psychological problems. Watch his TEDx talk for a more in-depth look at psychological flexibility. Five Ways to Practice Joy Back to the experience of joy. It is not surprising to me that joy elicits a “dress rehearsal for tragedy,” especially for Harm Avoidant persons with lower Self-Directedness. Joy may feel risky, undeserved, and/or not appropriate because not all the problems have been solved yet. It may be a reminder that good things are transient and will not last, that it’s best to get ahead of the game and plan for the inevitable. Yet it is the experience of joy and sharing it with others that will help lead the way out of psychological difficulties. There is the double problem with eating disorders in that this way out requires one to feel emotions with the body -- the very thing that is so hard to be present in -- to even access the experience of joy. If you are struggling to experience joy yourself, I feel for you. No doubt it will be hard and may not feel okay or natural at first. I promise that I have seen persons in that same space transform when they begin to allow those small moments. If you are supporting someone with an eating disorder, giving permission and helping to create moments of joy can be perhaps some of the most important supports you give. Here are five ways you can practice or help someone else practice the experience of joy:
This blog is dedicated to all the wonderful attendees at the support group for persons 50+ with eating disorders facilitated by therapist Lauren Jouzapatais and me through The Eating Disorder Foundation. You all are a very important part of my experience of joy each Tuesday. I am so grateful for you all. For more information, check out my website or reach out to me via my contact page. I offer free, 30-minute consultations to new clients. 1 Cloninger, C. R., Przybeck, T. R., Svrakic, D. M., & Wetzel, R. D. (1994). The temperament and character inventory (TCI): A guide to its development and use. St. Louis: Washington University Center for Psychobiology of Personality. 2 KLUMP, K., STROBER, M., BULIK, C., THORNTON, L., JOHNSON, C., DEVLIN, B., . . . KAYE, W. (2004). Personality characteristics of women before and after recovery from an eating disorder. Psychological Medicine, 34(8), 1407-1418. doi:10.1017/S0033291704002442 3 Fassino, S., Abbate‐Daga, G., Amianto, F., Leombruni, P., Boggio, S. and Rovera, G.G. (2002), Temperament and character profile of eating disorders: A controlled study with the Temperament and Character Inventory. Int. J. Eat. Disord., 32: 412-425. https://doi.org/10.1002/eat.10099  An international study of over 9,500 people from 78 countries recently published findings that “suggest that public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Interventions that promote psychological flexibility may mitigate the impact of the pandemic.” Are you wondering how to help your loved one suffering from an eating disorder or other mental health issues during the pandemic? Read on for how support persons can promote psychological flexibility with help from Acceptance and Commitment Therapy (ACT). What is Psychological Flexibility? Oftentimes, those who are available and want to offer support wonder how best to do so. As the study above suggests, interventions that promote psychological flexibility may be helpful. So what is psychological flexibility? As defined by Kashdan and Rottenber psychological flexibility “spans a wide range of human abilities to: recognize and adapt to various situational demands; shift mindsets or behavioral repertoires when these strategies compromise personal or social functioning; maintain balance among important life domains; and be aware, open, and committed to behaviors that are congruent with deeply held values.” Steven Hayes and colleagues developed Acceptance and Commitment Therapy (ACT) almost 40 years ago and have been studying the processes by which people can increase psychological flexibility in over 400 randomized controlled trials. One of those core processes in ACT is a focus on who and what is important to you -- in other words, what you value in life. Another core process is committing to actions that take you towards what you value. My Experience Using Acceptance and Commitment Therapy In my clinical experience of using ACT in the treatment of eating disorders and other mental health issues, it always impresses me how much time people spend on the struggle of how to solve the problems in their life and how little time is spent on the things that truly matter. In my view, this imbalance is a call to action for support persons. If we can help loved ones focus on things they can do to move towards a life worth living, we will be promoting two researched, evidenced-based processes that can help increase psychological flexibility. How do you put ACT into practice? Here are a few suggestions:
Before I wrap things up, I want to encourage those who are supporting loved ones to take a look at these same processes. My guess is that you value relationships and family, or you wouldn’t be reading this blog. I absolutely want to give you permission to spend time with who and what you value too, allowing you to promote your own psychological flexibility and mitigate the impact of this pandemic! It is with small steps that we can make lasting changes. A little shift can steer you towards a much different destination. Social support can come in the form of family, friends, online support groups, therapy, and more. Please visit my resource page for some helpful links. For more information, check out my website or reach out to me via my contact page. I offer free, 30-minute consultations to new clients. ¹Gloster AT, Lamnisos D, Lubenko J, Presti G, Squatrito V, Constantinou M, et al. (2020) Impact of COVID-19 pandemic on mental health: An international study. PLoS ONE 15(12): e0244809. https://doi.org/10.1371/journal. pone.0244809 Editor: Joel Msafiri F
²Todd B. Kashdan, Jonathan Rottenberg, Psychological flexibility as a fundamental aspect of health, Clinical Psychology Review, Volume 30, Issue 7, 2010, Pages 865-878, ISSN 0272-7358, https://doi.org/10.1016/j.cpr.2010.03.001. Image credit: Layers |
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