Fear of Recurrence: Part 3 (Values)

Thanks to everyone for the feedback on my recent posts about acceptance commitment therapy (ACT). I’m so glad you’re finding it helpful in dealing with your fears and negative thoughts. This week I want to talk about the ‘commitment’ part of this type of therapy. First, here’s a good quote that summarises some of the ideas around the ‘acceptance’ bit:

“The ACT model flips a lot of conventional psychotherapy wisdom on its head. And arguably the single biggest flip in ACT is this: thoughts and feelings don’t cause problems. From an ACT perspective, no matter how unpleasant, painful or difficult a thought, feeling, sensation, urge, craving, memory, or emotion may be, it is not inherently problematic, in and of itself. These “private experiences” only become problematic, toxic or life-distorting in a context of fusion or avoidance. If we change the context to one of defusion, acceptance, and contact with the present moment – (more commonly known as “mindfulness”) – then that very same thought, feeling, sensation, urge, craving, memory, or emotion is no longer toxic or pathological. It may still be very painful of course; but it’s no longer life-distorting; it no longer needs to hold us back form living a rich and full life.”

So, in summary, if you’ve ever read a self-help book, attended a personal development course or had cognitive behavioural therapy, you will have been encouraged to label your thinking ‘dysfunctional’ or ‘self defeating’. ACT doesn’t do this. All of our thoughts and feelings are normal, human and to be expected. You are not broken just because you’re terrified of cancer. Who wouldn’t be terrified? You are not going to stop being terrified of cancer. What ACT can teach you is that it’s possible to live a rich and full life in spite of those fears. The key is to recognise that all of our thoughts are just stories that we tell ourselves. They have no power unless we give them power. ACT therapists call this ‘fusion’, where an idea becomes so real to us that we can’t recognise it for what it is; just another story.

We also don’t need to invest time and energy in running away from these thoughts, filling your mind or your body up with things that distract you from fear. For some people this approach leads to addiction, alcohol or drug abuse, over eating, over training or just obsessive busyness. ACT therapists call this ‘avoidance’.

If you’ve been practicing any of the things I’ve suggested in my last couple of posts on this topic then you have hopefully gained a better understanding of what ‘fusion’ and ‘defusion’ feel like. If you haven’t bothered to do any of the exercises then please go back and try them. You can’t learn to do anything new without practice. Theoretical knowledge is interesting, but it’s not the same as developing a new skill.  It’s the difference between researching cars and learning to drive.

Hopefully you’ve now got at least a few examples of things that frightened you until you grounded yourself, recognised that your mind is a great story teller and, for the most part, is just trying to keep you safe. You’ve made room for the upsetting thought and just observed it. It’s important to note that ACT doesn’t try to get rid of these thoughts. True, sometimes defusion causes them to float away on their own, like leaves on the surface of a stream, but often they keep floating about or they circle back and return on another current. It doesn’t matter. They’re just thoughts. We can accept them and decide whether or not they are useful to us.

But what’s the criteria for ‘useful’. How does making space for our thoughts lead to having a rich and full life? Well, it doesn’t. Not on its own. In order to have a rich and full life we need to take action. Defusion will help you to respond to upsetting thoughts and feelings but to complete the process you need to do something meaningful and important to you. The best way to do this is to act in accordance with your values.

Try this. Write down your top five values. Don’t read any further until you’ve stopped and actually written them down.

No, really.

How did you go? Some people struggle to find five. Some people struggle to limit themselves to five. If you’re fortunate enough to see an ACT therapist with a set of values cards they can take you through the exercise that I did with Kerry Wagland at the Gosford Oncology Clinic. She uses a huge set of colour coded cards which she asks clients to sort. At the end of that process you come away with a long list of values, including your top five. Here’s mine:

1. Health (hardly surprising that this should be number one for me right now).
2. Helpfulness; helping others
3. Mindfulness
4. Relationships; friends and family
5. Creativity

It’s been so useful for me to have this list. When I get that free floating anxiety that comes with the end of treatment, or a specific fixation on something to do with my body (Is that a lump? Does that headache mean metastatic disease? Why are my bones so sore? And on and on and on) I ground myself, close my eyes, put one hand on my chest and one on my abdomen and BREATHE into the anxiety. I make room for it. I accept that it’s normal to be frightened after cancer. And then………

This is the important bit……

Then I ask myself if the thought is useful. Does it help me live a life consistent with my values? If it doesn’t I just let it float. If it does then I harness the motivation. Either way I thank my mind for trying to keep me safe. When it comes to fear of recurrence some of those thoughts are particularly useful in helping me to live a life consistent with my highest current value; health. I used these events to remind myself of my commitment to daily yoga, to eating well, to fasting two days every week and to doing all of the other things that I’ve now incorporated into my new, healthier life.

I also hope I’m using these thoughts to help others, by writing about them, by talking about them and by sharing what I’ve experienced using ACT. Sometimes my ‘helping others’ value is not helped by these intrusive thoughts. In those cases I just let the thought float, and then take some action that I know will benefit someone else.

Each time I breathe into my fear of recurrence I’m practicing behaviour that’s consistent with my third value; mindfulness. The whole ACT model incorporates mindfulness and this helps me to remember to enjoy my life today. The past is gone. The future can’t be predicted. Perhaps I’m here in five years, or ten years, or twenty years and perhaps not. My value of ‘mindfulness’ reminds me to enjoy all of the wonderful things about my life today and not to waste whatever time I have worrying about the future.

All of these activities help me to address my fourth top value of building great relationships with my family and friends. The people that love me can see me taking really good care of myself. This is the greatest gift I can give them. I’m also a lot more fun to be around than someone whose constantly worried about cancer. Like so many people that have experienced this horrible disease, I’ve discovered a new depth to the relationships I have with my husband, my daughter, my mother and the friends that have stuck by me. I’ve also discovered I can let go of those relationships that involved people with different priorities and agendas. They are just not part of my journey any more.

My final top five value, creativity, is the one that benefits most from ACT. You might remember that I used my love of gardening previously to illustrate the difference between doing something because you love it, and doing something to distract you from ‘negative thoughts’. The first is joyful. The second is soul destroying, because not only do you find that you can’t outrun your fears, you also discover that using a previously enjoyable activity to try to avoid your fears just destroys that activity for you. I suspect this might be part of the reason that people with clinical depression lose any enjoyment of life. We cannot run away from ourselves.

Prior to learning ACT I would have thrown myself vigorously at the garden in an attempt to overwhelm my fears. Now I accept my fears as normal. I make room for them. I head out into the garden for the pure joy of it, and not to escape or avoid anything else. I garden mindfully, enjoying the smell of the soil and the feel of the plants. ACT puts me in the garden, rather than using it as an attempt to overwhelm distressing thoughts (which never really works, or never works for long).

If you’d like to read more about values or ACT then here’s Russ Harris’s web site:


His first book ‘The Happiness Trap’ provides a good, easy to read overview of ACT. His later work ‘The Reality Slap’ deals specifically with how we respond to trauma and will be very useful to anyone dealing with a cancer diagnosis.

A final few notes about values. There are not good, bad or better values. Your values are specific to you and will be influenced by your upbringing, your experiences and your own approach to having a good life. Values are a bit like ice cream flavours. I can’t tell you why I like caramel better than chocolate. I just do.

Values are not fixed. I really DO wish that health had been my number one value for all of my adult life. I might have avoided cancer. But when I was younger it was a much lower priority than things like achievement and financial security and building a professional reputation. You’ll notice that none of those make my current list.

Values are not rules. They are broad areas of interest and significance. If you google ‘values’ you can find lots of lists of common values to help you decide which ones are priorities for you. If you describe your values with words like ‘should’ or ‘must’ they are not values. Similarly, values are not about how other people should behave. They are just about what you find important right now.

My favourite values exercise is to think of people I respect an admire and to list the values that make me feel this way about them. Then I think of behaviour I find annoying in others and see what this tells me about my own values. I don’t like greed or untruthfulness, for example. No surprise that integrity and generosity both make my long list.

Don’t get too caught up in picking the ‘right’ values. Get a list. Give them all a score out of 10 and then use that to narrow it down to a top five. You’re not throwing any value away. You’re just trying to give yourself and easy guide for taking committed action. Do this and you’ll be a whole lot closer to the rich and rewarding life that all of us want.


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