I sometimes wonder if the people that developed Acceptance Commitment Therapy (ACT) based their model on Buddhist or yogic philosophy. There’s some striking similarities. One of the most obvious is the use of mindfulness as a technique.
It seems that mindfulness, all on its own, is enjoying a popularity surge at the moment. It’s the subject of books, TED talks and articles. Most people are at least passingly familiar with the idea of being present, paying attention to what’s right in front of you, or around you, rather than the chatter that’s going on in your mind.
When you’re dealing with the fear of a serious illness returning, mindfulness brings you from your fears about the future all the way back to the present. It reconnects you with the activities you enjoy and the people that you care about. In the context of ACT, it helps you to turn your attention to your values, and to take action consistent with those values.
Russ Harris explains that when you’re dealing with a distressing event (or you’re upsetting yourself by imagining one) mindfulness is not a relaxation technique but a way to anchor yourself.
Here’s a simple mindfulness exercise. As you’re reading this, pay attention to the device that’s displaying it. Look at the different textures on the surfaces of that device. Are they reflective or dull? What colour? What brand? Are you holding the device in your hand and, if so, what does it feel like? Or if it’s on a surface in front of you, what is that surface. What is it made from? Now look around the device. What can you see? What can you hear? What can you smell?
If you’re similar to me then mindfulness exercises feel like moving out of your head and back into your body. I have a mild sense of waking up or reconnecting with my world. Please don’t misunderstand me. There’s nothing wrong with using imagination to create dreams, explore ideas, imagine possibilities. The aim is not to be mindful all of the time, but to spend more time being mindful.
One of the easiest ways to do this is to focus on your own breathing. Try this now and then use it the next time you start scaring yourself with thoughts of illness or death. Put one hand on your chest and the other on your belly. Take five gently breaths and focus on your exhale being longer than your inhale. (This also helps to prevent you hyperventilating. Suck in too much oxygen and you definitely will not feel calmer.) Breathe through your nose if you can. Notice how your breath feels cooler going in and warmer going out. Try to breathe all the way down to the hand on your belly. Notice the way your hands rise and fall with your breath. Hold yourself gently and kindly.
As you do this, remember that you’re not trying to get rid of your anxiety. You’re just trying to anchor yourself during a storm. Those difficult thoughts and feelings will keep trying to frighten you. Notice them. Thank your mind for trying to warn you and protect you. Recognise what a great story teller you are.
Now shift your focus to your five senses. What can you taste? Many people experience a metallic taste when they’re stressed. What can you hear? You might not be able to hear anything other than your own heart or breathing or you might be able to hear music, or birds, or traffic. Just notice it without judgement. What can you smell? What can you feel? It might be just the air on your skin or the places where your body comes into contact with your chair and your clothing or you might notice the air temperature or a breeze. Finally, what can you see? Look around you and notice the detail. Where are you?
I think that part of the reason yoga and meditation are so good for reducing anxiety is that they both incorporate mindfulness. It’s a powerful way to put ourselves back into the present moment. When applied to ACT, mindfulness also allows us to think about what it is that we really value, and what type of action would make our lives more meaningful. Nobody expects you to come up with strategic plans while you’re frantic about the future but mindfulness can give you, quite literally, the breathing space you need.
Once you’ve weathered the storm you can revisit your values and put together plans to achieve things that are consistent with them. You’ll probably keep having scary thoughts. Cancer is terrifying! But these techniques will help you to have a rewarding and meaningful life in spite of your fears.
I don’t plan on writing a post about how to make plans and carry them out. I think most people are now very familiar with the SMART model and ACT incorporates it as part of the ‘Commitment’ part of the acronym. Here’s a link to the Wikipedia entry if you’re not already using SMART or you can google ‘SMART planning model’ for more information:
There’s whole books written on this model and there’s no doubt that people using it are generally far more likely to achieve their goals than those that don’t but this is not universally true. Not everyone needs or wants a structured planning model and critics would argue that being too structured can blind you to the surprises and opportunities that life puts in front of us. I suppose the acid test is how effective you already are at setting and achieving goals. If you feel like you’re going around and around in circles then I’d recommend going through the SMART process, writing things down and then checking in regularly to measure your success. Like so much of life, the key is to actually DO rather than just understand.
Even if you think you’re pretty good at achieving your goals I’d encourage you to give the SMART model a try. You might find that it helps you to take effective action and to achieve more than you already do. I used to use SMART in a work setting and find that after years of use I now naturally slip into this framework when I want to achieve something. Revisiting it from the perspective of ACT has made me keen to try using it for something other than work. I’ve always been a lot more ‘free form’ in my personal life, perhaps because work was so structured.
This is the end of my four part series on dealing with fear of recurrence and I hope you’ve found it useful. ACT is a collection of interrelated tools that have been proven to be very effective in dealing with everything from PTSD to giving up addictions. For me, learning about this model and putting these methods into practice has resulted in a significant improvement in my life. I am calmer, happier and clearer about what I want my life to stand for. Even though ACT practitioners are very clear that the model is not designed to reduce or eliminate troubling thoughts, I have, like many people, noticed a reduction in them as a side benefit of practicing these techniques. I’ve also found that Russ’s book for couples ‘ACT with Love’, has strengthened my marriage and increased my considerable love and affection for my husband.
If you’ve read about ACT and thought it was too simple, or too difficult or just not you then I’d encourage you to at least try some of the techniques. It’s possible that you’re right. It’s also possible that you just might expand your skills and improve your life. Surely that’s worth a bit of your time.
Here once again is the link to Russ’s web site.
I would highly recommend his book ‘The Reality Gap’ to anyone facing a cancer diagnosis or dealing with significant anxiety about anything. Just remember that reading the book and expecting your life to change is like reading a cook book and expecting to eat. ACT only works if you do it. Yes, some of it will feel awkward and strange and even a bit stupid but that’s how you’re always going to feel any time you’re brave enough to try something new.
As I write all of this I’m thinking about 2015. It’s the first day of that year. I love the new year. For me it’s always a time of reflection and gratitude. It’s also when I decide on what I’m carrying forward and what I’m leaving behind. I spent this morning reducing my Facebook ‘friends’ list down to those people that I actually spend real time with and those that I would spend real time with if they lived closer. Gone are the friends of friends, the occasional acquaintances and the people I never really knew at all. ‘Unliked’ are all those pages that push stuff into my timeline and eat up the first couple of hours of my day. This is all part of a desire to spend less time online and more time leading my new, improved and very valued life.
Cancer has made one thing very clear. My time on earth is limited. The most important question I can ask myself is ‘How do you want to spend that time?’ For me, this year will involve more yoga, more painting, more cello, more gardening and, most importantly, more face to face time with the people that I love. I’ll be spending less time ‘liking’ or ‘commenting’ on the posts of people that probably wouldn’t invite me to a party if they threw one. Facebook is a wonderful tool for communicating with lots of people but it has become a time vampire. I suspect I may have become just a little bit addicted to it. Time to get back to life. Nothing takes you away from mindfulness as quickly as Facebook.
I wish I had never had cancer but I am very grateful for the person I’ve become because of it. Thank you to all of you that have shared the roller coaster with me. Thank you for your time, your comments, your kindness and your advice. My plan is to live until I’m 86 and to never ever have cancer ever ever ever again. Wish me luck.