Tag Archives: Acceptance and Commitment Therapy

Book: Stuff that Sucks (2015)

This is my 300th post!!!!

I’ve been attending an online course and came across this book by Ben Sedley:

Stuff that Sucks: A teen’s guide to accepting what you can’t change and committing to what you can

It’s a small, easy to read book, based on Acceptance and Commitment Therapy (ACT). I’d recommend this to any younger teenagers especially. Of course it isn’t and can’t replace therapy, but generally many parents and adolescents have found it helpful for general teens related struggles.

One criticism it receives is that there isn’t much of “practical application”, they said it tells you what stuff sucks, but didn’t tell you what you do about these stuff that sucks. I would disagree on that one, and would suggest those people to read again, because the answer/approach is in there… perhaps not obvious enough though!

减肥是终身事业?

照片取自这里

她的减肥事业,从青春期开始。其实从小也胖,但因为长得可爱,所以也不觉得自己的体重或身型有什么问题。直到十五、六岁的时候,发现周围的朋友身材都纤细,穿什么都好看,哪怕长得比她还矮的,拍照看起来也比她“高挑”。就这样,她开始觉得自己胖,下来的几十年,就在各种瘦身、减肥、节食、运动、产品和配套中渡过。

她给我发电邮的时候是她已经过了40岁的生日,从事物理治疗,结了婚,有个儿子。她和先生想要多一个孩子,可是多次流产、人工受孕也一直失败,医生说她必须减肥才能再试,否则就得放弃剩余的冻卵。挣扎了快两年,她看到我的网站和视频,就来联系我了。

她说,因为自己的身型,尤其在生了儿子以后,她已经自卑很久了。周围不再有朋友,因为她完全躲开大家,深怕自己的身材成为大家的笑话。而她的事业也不发展了,“没有物理治疗师可以这么胖的”。每次照镜子的时候,她就觉得自己恶心,渐渐地也不照镜子了。这些社交问题、工作问题、自卑心理等,常常使她陷入低落的情绪,而最能快速使她脱离低落情绪的方式,就是吃… 她常常可以一口气把6、7个包子吃完。尤其在独处时,她更是会不断的吃,可能把一条面包、几包薯片、巧克力等都往嘴里塞,来安抚自己的情绪和自卑感。不用说,撑饱以后,马上的自卑、恶心、嫌弃、罪恶感就会涌现… 然后不断地陷入这样的恶性循环…

第一次跟她见面做评估的过程中发现,她很不自信(敢言,assertive),总是“别人优先”而忽视自己的感受。她没有办法拒绝别人的要求,她的生活充斥着许多她不想做、不愿意做的事,不管在家里还是工作都一样,而每次她无法更敢言地拒绝他人,过后就会躲在车里或家里吃,来安抚自己的情绪。

她希望我可以帮她减肥、可以再次人工受孕,她也希望自己可以开始运动、可以控制饮食而不是被饮食所控制,她也希望自己的健康状况可以改善,尤其因为肥胖而引致的各种问题,她希望自己的自信可以有所提升,更爱自己一些,不再那么自卑,并且能够继续发展她的事业。

我用接纳与承诺疗法(ACT)开始和她治疗,然后才开始用催眠(Hypno-CBT),这个过程中,她变得更自信,更敢言,而这个自信不只是对他人,也包括对她自己,比如当心里想“再吃一个包子吧!明天再减!”,她有能力坚决的对自己说”NO!!”。这个过程中,她发现她原来不只无法对他人说不,她也无法对自己说不,总是太过随波逐流的活着,没有主见,没有目标,没有坚持… 除此之外,咨询开始的一个月后,她的体重每星期稳定持续减少 0.5-1kg,主要因为她不再被食物所控制,而且有能力更经心的感受真正的“饥饿”和经心的享受食物和进食,而不是盲目的“吞”!她还发现当她经心的进食时,其实原来她一点也不爱吃包子,以前却可以一次过吃下至少6-7个。她变得更了解自己的感受和身体的感觉,学会更疼爱自己,做对自己的身心有益的事。三个多月后,她对我说,这个治疗和探索的过程让她发现,其实她根本不想要多一个孩子,她想要专注的把儿子带大,这才是她真正想要的,所以虽然体重减轻了,她或许在两三个月可以再次尝试人工受孕,但她在更了解自己后,有能力做出她自己想要的决定,而先生也支持她。

很多人减肥很希望快速地看到成果,用许多极端的方式去节食或花很多钱去瘦身中心等,但是很多时候一旦停止,体重就快速反弹,甚至比先前还重还胖。我不反对人们断食、节食、运动,但是很多时候,减肥需要的是一个身心的重新调整和治疗,包括从身体,也包括从心理,而不只是只从一个层面下手,效果或许不快,但它会持久,因为就像心理治疗过程中你学到的任何技术,它都会帮助你变成自己的治疗师,继续应用这些技术帮助自己…

Why Practise Mindfulness?

Do you feel unmotivated and find it pointless when you were told to practice mindfulness and/or meditation?

Do you think that it is a waste of time? Especially when you have such a busy schedule and so much to do, how can you still sit still and do nothing?

Do you sometimes feel like “I have to do something”, not “do nothing” to become better?

Over the years I have often received questions like this when I suggested mindfulness meditation practice. And people from all backgrounds, walks of and experience in life often respond in those ways mentioned.

So, what are the benefits of practicing mindfulness meditation?

  • Learning to become less reactive in your life and in your mind. You see that you do not need to keep thinking about those things that pop into your mind
  • Worrying less!
  • Usually sleeping better at night after starting to practice regularly
  • Feeling calmer in the day too if you are able to generalise it beyond the practice itself, i.e. becoming more mindful in life.
  • Calming and feeling peaceful after doing it. (but it’s not the purpose usually, the process is more important)
  • Helps lowering stress level
  • Feeling less anxious when you practice it more
  • Improving attention span, whether it’s for your learning or work! You don’t get distracted so easily as you used to be.
  • Helps memory and learning
  • Reducing chronic pain
  • Better sense of coping in general
  • Developing a more open and non-judgemental attitudes towards most things in life (which might cause irritation and stress previously)
  • Developing a problem-solving attitude instead of a “worrier” habit
  • Helps regulating emotions (emotion doesn’t go out of control so easily)
  • Quite often helps feeling more connected too!
  • Increasing clarity in thinking and perception
  • If you have other illness(es), it aids recovery and enhances your coping abilities
  • The “I have to keep doing” could be the cause of your problems. Sometimes, “not doing” could be the answer!

Don’t you think that for these many benefits, or even if it’s just for half of those benefits, it’s worth to spend 10 minutes or so each day or every other day to just practice mindfulness meditation? Isn’t it much better than many other things that you are trying to do?

It might feel “boring” and “really uninteresting” and “not my kind of thing”. Believe me… I had been there too, being an active person and labelling this sort of things as the “elderly stuff”, just like many others. But no, just stay open and curious, notice those thoughts and judgments, notice those sensations and feelings, notice any changes and stillness…

Now I’m going to practice it myself after writing this!

Where the voices come from

Sometimes I get this question from patients’ family, asking why the patient is hearing voices, how did it happen and what else do we know about these voices.

Here I’m referring to auditory hallucination commonly seen in people suffering from schizophrenia and psychotic disorders.

Yes they hear voices in their head, usually talking to them, quite commonly saying harsh and mean things to the sufferer. Sometimes they hear a few different voices having a conversation, and it’s not difficult to guess, the conversation is about the sufferer.

“Look! She has no friend! She looks so ugly and stupid!”

“Indeed. I wouldn’t want to befriend someone like her.”

“She should just kill herself. Nobody likes her anyway. Why is she still living?”

I mean, who with a sane mind would say such things to others? Nobody. How was these produced?

In 1993, McGuire and Murray published a research article “Increased blood flow in Broca’s area during auditory hallucinations in schizophrenia“. Let me break it down a little for you… The functions of Broca’s area has a lot to do with “speech production”. As compared to another area of the brain, the Wernicke’s area, is responsible for the comprehension of speech.

Locations of Broca's Area and Wernicke's Areas. (NIDCD, 2010) | Download  Scientific Diagram
Locations of Broca’s and Wernicke’s. Picture taken from researchgate.net

So what does this mean?

When the patients are hearing voices, which do not sound like their own voices, the “speech production” area of the brain has increased blood flow, less so in the “speech comprehension” area. We can’t conclude anything from here obviously, but it becomes clearer to the researchers that those voices are produced by the brain itself, almost like their own’s thought processes (which we all do: talking to ourselves or having inner talks), but “presented” as somebody else’s voice.

So it seems likely that it’s their own thoughts. At least that’s what research has found. And I believe many clinicians would agree with me — often we see those voices are actually the patients’ core beliefs, worries, and are what they were told (by their parents, significant family members, teachers etc) when they were much younger. As a therapist, when I look at it this way, it opens up a lot more possibilities to help people who are suffering from auditory hallucination. And indeed, quite a number of techniques in mindfulness-based approach and cognitive therapy have been found useful.

Why people come for Therapy

There are many different types of therapy, and there are many reasons people approach those therapists for help. Here are some reasons:

In general, for any psychotherapy:

  • Feeling moody, low, and/or depressed
  • Feeling anxious
  • Lacking confidence
  • Worrying too much
  • Not able to sleep/rest well
  • Relationship related problems
  • Feeling hopeless and lost
  • In need to talk to somebody and get some advice
  • Combination of all the above (common!)
  • Obsession and compulsion related
  • Eating related disorders
  • Anger related problems, being irritable
  • Schizophrenia and psychotic related symptoms
  • Being diagnosed as Personality Disorders (e.g. Borderline is more commonly seen)
  • Being diagnosed as developmental disorders (e.g. ADHD, autism spectrum disorder, learning disability)
  • Wanting to be assessed to see if anything is wrong (just like when you go for medical check up; this is not common, but I’ve seen a few now!)
  • In need of guidance during their self-discovery and self-improvement journey (this is rare! But glad that I’ve seen a few too!)
  • In need of guidance after being diagnosed of cancer
Taken from google image.

For hypnotherapy:

  • Wanting to remove a piece of memory
  • Wanting to forget something or someone
  • Wanting to recall something or someone
  • Being in pain
  • Wanting to be more confident
  • Looking for the root cause of some recent problems
  • Feeling lost, uncertain with the future
  • Hoping to release some emotions
  • Hoping hypnosis is the solution to their problems that couldn’t be solved otherwise
  • Wanting to achieve something great
  • Wanting to increase motivation to… (e.g. work, study, lose weight, workout)
  • Wanting to focus better
  • Wanting to change a bad habit (e.g. smoking, not exercising, nail-biting)
  • Wanting to improve general wellbeing and sense of happiness
“… And on the way out, you won’t notice my car parked in a no parking zone.”

The Intention/Belief behind a Behaviour

I talked about letting go of thought VS chucking it away in a 2016 post: Let it go OR Chuck it away. Now, let’s look at this:

Winnie the Pooh & Piglet

The behaviour that Pooh and Piglet do are the same, i.e. they both don’t think about the scary dream. But what Pooh is doing, is “letting go”, whereas piglet? He’s trying hard to chuck it away.

Quite often people overlook this key distinction, they think they copy the same behaviour, and will then achieve the same results. But the beliefs and intention behind the behaviour are important too. Are you worrying about the dream so you don’t think about it? Or do you not care about it so you don’t think about it?

Similarly, on anxiety, are you practicing relaxation because you think anxiety is bad and you can’t tolerate it? Or are you practicing relaxation because it helps you perform better when you’re less anxious? It’s the beliefs and intention behind that differ, the behaviour done or presented is the same.

It’s like on “acceptance” (a word I tend not to use with clients). Do you accept the pain because it doesn’t really matter anymore, or do you accept it because you have no choice (is it still acceptance?)?