Using acceptance to move through “symptoms”

Ron Unger again contributes a piece today.

Changing focus is a key part of recovery: to recover from a “symptom” it is often necessary to quit focusing on trying to get rid of the symptom, at least in any direct way!

This is true of a great many kinds of mental health “symptoms.” The problem is that the things people do to control the “symptom” in the short run usually make both the “symptom” and the person’s life worse in the long run.

Let’s look at “anxiety” as one example. A man may perceive himself as having “too much” anxiety. In response, he avoids doing or thinking anything that creates more anxiety. As a result, he fails to learn that he could actually survive doing or thinking those things, and as a result of avoidance and hiding, he feels smaller and weaker and of course, more anxious. Also, because he is focused on reducing anxiety rather than getting on with his life, he becomes hypervigilant for more signs of anxiety, so he notices anxiety more often and it seems to get worse, etc. He may even take pills to avoid feeling the anxiety: this may work briefly, but when the pills wear off anxiety is even higher, plus as a result of using pills to manage the anxiety, he feels even less competent to manage the anxiety without the pills.

“Depression” is another example, it works much the same way. Depression involves a feeling that what one is doing is not worth doing. A person who identifies this depressed feeling as a problem might set a goal of having depressed feelings less often. One way of having the feeling that what one is doing is worthless occur less, is to more rarely exert oneself or do anything involving effort; so instead, one avoids activity and stays in bed or watches TV. Unfortunately, as a result of such avoidance one fails to experience any reward that might have actually come from activities, and the sense that one’s overall life is worthless only grows. One also might get hypervigilant for more depressed feelings, resulting in noticing them more and even more avoidance of exertion in response. Pills may ward off depressed feelings for a bit, but increase one’s sense that one cannot function if depressed feelings are present, which in turn makes relapse more likely when pills are discontinued.

Problems with “hearing voices” involve the same dynamics. A woman for example who identifies hearing voices as a problem may become willing to do almost anything to “make the voices go away.” This might mean overuse of distraction to avoid noticing the voice (which might lead to problems in concentration, and then as concentration fails paradoxically, she may find she has less ability to focus away from the voice!) Or, she might at times go the other way, and obey voice commands as a way to get the voice to be quiet for a bit. Both avoiding the voice, and giving in to its commands, makes her feel weaker than the voice, and unable to face it. And since the voice is what is believed to be the problem, she becomes hypervigilant to notice when it might be present, which of course increases the frequency of hearing it. She might also take pills to weaken the voice, but these may also result in voices that are even worse when she quits the pills, and reinforce her sense she is not strong enough to face the voice.

So what might work better? In all these cases, the solution is to quit seeing the “symptom” as the problem, and instead focus on making wise choices in response to “the symptom.”

So the anxiety is no longer the problem, instead the focus is on making wise choices when feeling anxiety – continuing to go forward without avoidance if the anxiety upon examination appears unwarranted, or changing course in appropriate ways if a realistic hazard exists that needs to be taken into account.

The depressed feeling, or sense that what one is doing is not worth doing, is no longer the problem, instead the focus is on making wise choices despite having depressed feelings. So if careful examination suggests that one’s actions really do have value, one persists despite the depressed feelings, while if it appears that one’s actions really do lack value for some reason or other, then one shifts to more appropriate actions that might have greater value.

The “voices” are no longer the problem, instead the focus is on making wise choices regardless of what the voices say. So the emphasis is on making good and thoughtful decisions, and opinions expressed by voices can even be considered in such decision making, though not allowed to dominate. With the emphasis on wise decisions, there is no need to either “get rid of” or “distract from” or to “give in to” the voices.

This change of focus toward making wise choices, and away from trying to control “symptoms” is not inconsistent with some effort toward long term reduction in “symptoms”, as long as that effort is not the primary focus. So one might notice that with less stress (such as less stress about trying to get rid of the symptom!), and better sleep and diet and more social support, one is likely to have fewer anxious and depressed feelings and fewer intrusive voices. Making changes in such directions are consistent with wisdom and with empowering the person, compared with the short term overly-symptom focused responses mentioned about which tend to amplify the long term problem and to disempower the person.

Notice that this change in focus is consistent with what are called “acceptance based therapies” which involve learning to accept “symptoms” rather than try to get rid of them. It is also consistent with efforts to resist being seen as “mentally ill” since it involves a shift from “I have to get rid of this voice which is part of my illness” to a perspective more like “my challenge is to make wise decisions in my life, which is the same challenge everyone faces. Whatever unique way my mind works toward such a decision is fine as long as the outcome is good.”