ACCEPTANCE COMMITMENT THERAPY MISSING THE POINT?
Today’s “Australian Doctor” online newsletter, highlighted an article by Amanda Shepeared
about former Melbourne GP, Dr Russ Harris, an ardent supporter of Acceptance Commitment Therapy, a form of therapy that has been in existence for several decades. This form of therapy was never once mentioned during my 5yrs of intense Psychiatric training, neither was it among the numerous therapies we looked at as part of our study of the history of Psychiatry. If decades old, it must have survived in relative obscurity until recently revived by Dr Harris.
Here is the article, followed by the comment that I submitted to Australian Doctor.
Stop chasing happiness, author says:
Society’s focus on positive thinking is unsustainable and potentially problematic, believes Melbourne GP Dr Russ Harris, who advocates acceptance commitment therapy.
Dr Russ Harris is feeling anxious. On a scale of one to 10, the former Melbourne GP — widely recognised as a pioneer of a form of psychotherapy called acceptance commitment therapy — rates his current anxiety level about a six. It’s a pretty surprising admission. After all, Dr Harris has spent most of the past decade travelling the country, speaking publicly about acceptance commitment therapy, running workshops for GPs, appearing on television and at international conferences, not to mention helping everyday people conquer their own inner demons. So why is he feeling so anxious at the moment? The feeling has been prompted by talking to Australian Doctor on the phone. “I suffer from social anxiety. About 40% of the population experience significant social anxiety,” he says. “An easy interview like this puts my anxiety about a six. But that’s okay. Anxiety is only a problem if you keep fighting it.” He says he has learned to accept that social anxiety is part of his make-up. “When I am giving public talks, I go around and show people how my hands are dripping with sweat.”
Acceptance commitment therapy (ACT, pronounced ‘act’) is founded in learning to accept that life has both negative and positive experiences. A form of psychological therapy that has been around for several decades as an alternative to cognitive behavioural therapy and more traditional forms of therapy, it has gained the acceptance of the American Psychological Society. Dr Harris says people can become stuck in a cycle that places an intense focus on the pursuit and preservation of ‘happiness’, which establishes an unrealistically high bar for an average person’s mood. We are not, says Dr Harris, designed to be constantly happy.
Aiming for happiness at all costs, people may avoid or try to shut out negative aspects of their life, he says. This escapism can take many forms, including avoidance, but can have serious implications when it involves the use of drugs, alcohol or other addictive behaviours. For Dr Harris, it’s no surprise that we chase happiness. “We all enjoy happy feelings … however, like all other feelings, feelings of happiness don’t last. No matter how hard we try to hold on to them, they slip away every time.” The ephemeral nature of happiness means a life spent in pursuit of those feelings is unsatisfying, he says. “In fact, the harder we pursue pleasurable feelings, the more we are likely to suffer from anxiety and depression.”
He speaks from experience, having had his own battles with depression and anxiety. Dr Harris qualified as a doctor in 1989, at the University of Newcastle-Upon-Tyne in the UK, before migrating to Australia in 1991, where he set up a general practice in Melbourne. “I was very miserable in my mid-20s,” he reveals. “I had a great job, status, income, but I had a very harsh inner critic and a lot of social anxiety.” In his quest to understand his own depression, he became increasingly interested in the psychological side of health, and less interested in his general practice. “As I started exploring, I found out that about 90% of my patients were suffering [psychologically] in some way or another,” he says. “I gradually started doing less and less general practice shifts and more counselling, and it evolved from there.” Dr Harris says he researched many different forms of therapy, from Buddhism to CBT, and found middle ground in ACT. “It seemed to have the best of both worlds,” he says.
This led him to pen his first book The Happiness Trap. He pitched it to every publisher in Australia but was rejected everywhere he went. It was finally picked up by New Zealand-based company Exisle Publishing, and, in 2007, his book hit the shelves. It has become a bestseller, with more than 150,000 copies sold, and has been translated into 22 different languages. Dr Harris says the publisher couldn’t be happier as the book is their best selling title. In fact the publisher laughingly calls it the company’s Harry Potter. “It’s not quite up there with Harry Potter, but it’s been a big success,” he says.
.Exisle Publishing’s Benny Thomas describes the book as a “true winner” that has sold all over the world. “We get a lot of unsolicited manuscripts at Exisle but there was something about Russ’ proposal that grabbed my attention immediately,” he says. “It seriously was the best self-help book I had ever read, as the message was clear and practical but also gentle and kind.” Dr Harris has trained in the US with Steve Hayes, Kelly Wilson and Kirk Strosahl — the creators of ACT — and now focuses his time on training Australian health professionals and spreading the message about the therapy. He has already trained more than 14,000 people and hopes to reach many thousands more before he is finished. Aside from his resounding success with The Happiness Trap, Dr Harris has written a swag of other books. And next month, he’ll release an illustrated version of his most successful work, produced with author and illustrator Bev Aisbett. This latest offering, The Happiness Trap Pocketbook, takes a different approach to most other self-help books, using quirky illustrations instead of pages of text. As he explains to Australian Doctor, he hopes this version of the book will capture more audiences who could benefit from ACT. These include teenagers, and people who are time-poor or have difficulty reading. “People who are very depressed or stressed can also find it hard to focus and concentrate on a large book with lots of text,” he says. “There’s nobody on this planet — with the exception of the Dalai Lama perhaps — who wouldn’t benefit from this book.” If ever there was a need to understand why he wants to widen his net, look no further than page 12 of the new book, which lists some “sobering statistics”, including:
One in 10 people has clinical depression.
One in five is depressed at some time.
One in four has or has had an addiction.
Thirty per cent of the adult population has a recognised psychological disorder.
Dr Harris believes that society’s views on happiness need to change.
“It’s the whole culture really. If you’re not feeling good and positive, there’s something wrong with you and of course that trickles down to children as well,” he says. He is particularly concerned with how these attitudes translate to children, especially the idea that children are being raised to believe they are “all winners”, and there are no losers or failures in life. He describes it as a David and Goliath battle that will need radical change to be successful. But he isn’t giving up. “Our culture doesn’t really teach us to accept the normal pain of human existence,” he says. “Children have to learn that disappointment is a normal human emotion, along with failure and even boredom. When my seven-year-old says he’s bored, I say ‘good’. We need to accept that these feelings are normal, and not automatically a sign that something is wrong.”
Dr Harris concedes it has taken some time for the medical profession to accept ACT as a legitimate form of psychological therapy. But he says there are now more than 70 randomised control led trials that demonstrate its efficacy. “ACT has been around for about 30 years, but it has only really started becoming popular in the last six or seven years,” he says. “Everyone is so focused on positive thinking and being happy, happy, happy, but it’s not sustainable and creates more problems. “Anyone who is interested in happiness had better get used to accepting pain.”
Has he managed to conquer his own demons? “I didn’t conquer them; I just made peace with them.”
In a paper published in the journal Psychotherapy in Australia a few years ago, he described the way he would summarise ACT on a T-shirt. “It would read: ‘Embrace your demons, and follow your heart’.”
Psychotherapy in Australia 2006; 12:70-76.
Australian Family Physician 2012; 41:672-76.
There’s a big difference between positive thinking and rational thinking and Cognitive Behavioural Therapy (CBT), originally named Rational Emotive Therapy by Albert Ellis, teaches the latter, not the former. The mischaracterisation of CBT as a treatment that falsely & simply uses positive affirmations in the face of harsh realities, is harmful to the reputation for excellent results achieved by this psychotherapeutic method. CBT calls for reconstruction of catastrophic thinking, commonly called “stinking thinking”, which carries a high risk of triggering, deepening or perpetuating a depressed mood, into rational thoughts that are consistent with the available evidence. The thoughts achieved may still be unwelcome but their power to cause mood to plummet, is greatly reduced or eliminated. Acceptance without a search for evidence for what one is trying to accept, is likely to frequently be unsupported by evidence and may involve dismissing or failure to consider novel strategies that may greatly alter the status quo. ACT runs the real risk of paralysing corrective and innovative thinking by shutting such thoughts off in light of a problem prematurely labelled resolved.