ACT and Personal Coaching

Many of the individuals and couples we see in our practice are dealing with life problems that transcend medically-based diagnostic categories. These issues are not symptoms of larger problems like clinical depression, but the natural expression of our complicated human lives. Most of the time, our problems are just the result of our efforts to get through life as best we can - efforts which have had both positive and negative outcomes.

Despite the differences between psychotherapy and personal coaching, we have found that our training and experience as clinicians can be a tremendous benefit to our personal coaching clients. Not the least benefit is the fact that effective psychotherapists know that a great deal of our suffering comes from the fact that we are simply participating in the human condition (remember the first noble truth?).

I recently ran across a quote on Kelly Wilson's website that nicely articulates the humanism and far-reaching egalitarianism that underlies Acceptance and Commitment Therapy:

ACT does not allow a neat division between people doing treatment and people needing treatment. It is hard to get what is important about ACT without confronting the fact that in a very deep sense, we are all in the same boat. This means that the principles are scalable. ACT addresses obstacles to effective living that transcend diagnostic categories and even the notions of "sick" and "well." ACT attempts to address very fundamental issues that affect us all.

I've always been impressed by the totally non-pathologizing basis of the ACT approach. Its basic assessment categories are about skills and abilities, rather than diagnostic labels. We have found that ACT techniques are a powerful addition to our personal coaching services as well as a basis for psychotherapy. Here are some of the principles that we believe are central to positive change in both psychotherapy and personal coaching, starting of course with:

Acceptance and Commitment. Our coaching strategies rely on this fundamental principle, which we have learned through many years of helping people in psychotherapy: Meaningful change always requires both a thorough acceptance of ourselves as we are, and a commitment to act in accordance with our deep personal values. This is the basis of the ACT approach to psychotherapy.

Positive psychology figures prominently in both our psychotherapy and our personal coaching program. We have learned that happiness is not really the result of things that happen to us, but can be cultivated in the way we engage our lives. We draw on the growing body of psychological research on this topic to help people live more satisfying lives and realize their potentials.

Mindfulness is what enables us to be in the present, the place in which all change occurs. In taking action which actualizes our most far-reaching goals, the only thing we can ever do is take one step from right here. It can be startling to realize how much of our time we spend in daydreams and preoccupations, completely out of contact with our real life. Mindfulness helps us orient to who we really are, and what we are really experiencing. With this perspective, the path to our personal and professional goals is much clearer.

We've written a bit more about Integrative Health Partners' Personal Coaching Program on our website. Feel free to visit and browse.

MBSR-LD

Image via WikipediaWhat's the best way to help people learn mindfulness? What kind of programs are actually clinically useful? This recent paper on Low-Dose Mindfulness-Based Stress Reduction (MBSR-LD) is a really good example of some of the investigation that is being done these days. The MBSR model developed by Jon Kabat Zinn is wonderful, but people have been learning mindfulness for millennia in many different contexts, and there are many ways of offering the benefits of mindfulness for therapeutic and wellness purposes.

Many of us have found that, in contrast to the traditional MBSR emphasis on required practice ("You don't have to like it, you just have to do it"), an invitational approach to home mindfulness practice is quite effective. This is especially true when the course helps participants clarify their goals and values. When people know why they want to learn mindfulness, and are supported by their awareness of their deepest values, they will engage genuinely and effectively. I've found that it is very important to devote some class discussions to helping people clarify their values and intentions, because we often need help getting in touch with what is really important to us.

Traditionally, mindfulness practices are learned in the context of vow and intention. In a Zen monastery, for example, monks engage in daily rituals which renew their commitments to work for the liberation of all beings. Having entered the monastery, a monk only has to look around to be reminded that s/he is in this place deliberately, because of a deep intention to realize the buddha way. During my recent three-month experience with monastic training, I was very aware that I had this wonderful opportunity to learn and to grow, and that I needed to pay attention while it was available to me.

I think that clients in our mindfulness-based therapeutic programs participate most fully when they find their authentic reasons for doing so. The mindfulness-based clinical programs we offer, whether "low dose" or "mega dose," are only valuable to the extent that participants recognize them as advancing their life's purposes. I feel strongly that MB programs can benefit by paying attention to the lessons of therapeutic approaches like Motivational Interviewing and Acceptance and Commitment Therapy.

The psychological community is on the verge of discovering many effective ways of integrating mindfulness principles into therapeutic approaches. The so-called "Third Wave" of evidence-based psychotherapy is just forming now, and nowhere near its crest. Let's encourage each other to explore the possibilities!

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Acceptance, Avoidance, Attention, and Wisdom

Image via WikipediaIn this week's study group, we were delighted to have a visit from Delany Dean, Ph.D., who was in Chicago presenting her Mindfulness Based Wellness research at the APS conference. A very interesting thread of the discussion took up the issue of attention regulation and avoidance, and I'd like to explore it at greater length here.

The basic instruction for mindfulness meditation often asks the meditator to keep her attention on the breath. Inevitably, the mind will wander on some way, and will perhaps become absorbed for many minutes in some topic. When we notice this happening, we are to gently return our attention to the breath, in a non-judgmental fashion. This process may be repeated dozens of times in a meditation session.

This process is often discussed as a kind of attentional training: learning to notice when our attention has wandered to some unintended subject, and making a conscious choice to redirect our attention away from the "accidental" topic and back to the "intended" topic, the breath.

The question comes up: could mindfulness of the breath be used as a distraction from something that we would rather not think about? If we engage in conscious breathing during the day, especially in stressful or difficult experiences, are we subtly engaging in an avoidance process which is not essentially different from other avoidance activities like watching TV or smoking a cigarette. In other words, can mindfulness training help us to become very skillful at avoiding experiences we'd rather not have?

There is, in fact, a kind of attention to breathing that I call "lifeboat breathing." This is something that we might do when we have had a very challenging and nearly overwhelming experience (like a panic attack): we pay attention to our breathing as a way to exclude certain other experiences from our consciousness. In psychology, we've know about the process of Reciprocal Inhibition for decades now. Engaging in some activities or responses makes it impossible to engage in certain other activities. We cannot be tense when we relax our muscles, for instance. In difficult emotional storms, it is possible to cling to an awareness of our breathing as a way of saving ourselves from an experience that threatens to overwhelm us. Being completely focused on the breath, there really isn't room to also engage in whatever cognitive processes that were so threatening. And so, the breath becomes a temporary lifeboat in a stormy sea.

All avoidance strategies regulate awareness (they would be useless if they didn't). What differentiates mindfulness from the simple avoidance of unwanted experiences? How is mindfulness different from taking a walk or binge eating?

I personally am skeptical of the almost universally accepted idea that mindfulness can be easily defined as a way of paying attention. We say (somewhat misleadingly) that mindfulness is a way of paying attention in the present, for example. But awareness is always in the present. There is absolutely no way to be aware of the past or future. Being "in the present" does not differentiate mindfulness from any other kind of attention or any other human activity. When we say "Pay attention to present moment experience" we are speaking metaphorically, and not scientifically.

So what do we really mean when we say "I'm not in the present moment?" We mean we have become confused about the real nature of our mental processes. We are engaged in thinking (possibly about something that we are imagining as "the future") in a way that obscures the fact that we are just thinking. And so mindfulness is not "coming into the present" (we have never left the present) but coming into a different relationship with our thoughts (we understand them as thoughts and not realities).

The breath is a great help in the process of coming into a realistic understanding of what we are doing, because we very rarely get confused about our breathing. We have absolutely no interest in our past breathing, and are unlikely to become preoccupied with it. In order to pay attention to an outbreath, we have to relinquish our preoccupation with the inbreath. But in mindfulness, the point of attending to our breath is not simply to be aware of the sensations of breathing in, but to know that we are breathing in while we are doing it. And mindfulness of thinking or feeling is a process of knowing our experience to be what it is, just thinking or just feeling, as it is happening.

In mindfulness, our intention is to be open to any experience and to know it for what it is. It seems to me that the curative and liberating power of mindfulness is not the result of simply having greater control over our attention. It is deeply involved with having more wisdom and compassionate insight into the true nature of our experience.

This is a very broad and complex topic, and I don't pretend to have a complete grasp of it, but I would like to assert a few propositions about mindfulness for the purpose of continuing the discussion.

• Mindfulness is essentially a process of reminding ourselves of the reality of our life.
• Mindfulness is a way of developing wisdom (disengaging from our illusions) about our experience.
• Mindfulness is more like waking from a dream than learning to pay attention to some other element of a dream.

Not very scientific, possibly, but I hope an interesting starting point for further discussion.

Mindfulness in Bariatric Medicine

A paper about the use of mindful eating with bariatric patients, which I co-authored with folks from the Center for Mindful Eating, is available here, from the Bariatric Times.

Also in the realm of health and wellness, take a look at this new post by Dr Delany Dean on meditation and hypertension. Delany also has a link to an article about the interaction of breathing, blood chemistry, and blood pressure. The psychophysiology of breathing was a topic that we were discussing in our last study group.