Mindful Behaviorist – An Acceptance and Commitment Therapy story about improving my behavior by keeping track of negative habits.

Have you ever tried to change your habits by keeping track of them?

A few  years ago, because of my own mistake, I ended up without health insurance for a month.small spiral stairs in winter

This may, to less fortunate people, appear to be rather minor, especially since I was not sick and had no reason to suppose I would need medical care.  However, I immediately began to catastrophize.  Images of car accidents, hospitalization, loss of my house and impoverished old age filled my mind.  And of course the fact that this situation was my own fault positively encouraged rumination.

I was complaining a lot to my husband and became very irritable with him.  I was ashamed of acting like this.

What should a behavior therapist do when this happens?  I got out an old journal, in which I had last written jottings about the garden several years earlier.  I decided to set up a chart so I could track how much anxious/irritable behavior I had shown each day.  I also asked my husband to track me.  (I am grateful to be married to someone I can trust to do this with kindness but reasonable accuracy.)

First I had to set up a scoring system.  I decided that saintly/enlightened people (who would not be disturbed by misfortune),  and people who are naturally laid-back and relaxed or in denial, would score 10 out of 10.  This did not seem like a realistic goal for me.  In order to avoid discouragement, I planned to give myself a score between zero and one.  One would be a good score, with no obvious signs that I was distressed or unfounded criticism of my husband.  We were tracking how I behaved, not how I felt or what I was thinking.

I looked back at the journal as I wrote this post.  My husband always scored me higher than I scored myself.   My worst day was a 0.3 from him, when I overreacted to his spending (not a lot) of money on the house without telling me first.  How could he spend when my financial future was so uncertain?

In the beginning I was nervous about driving, but did it anyway.  I live close to my office, but sometimes had to drive a distance.  (At that time I had a client with Body Dysmorphic Disorder whom I used to meet at a department store makeup counter miles away for exposure treatment.)

With repeated exposure to driving my fear of accidents grew less.   I was even able to laugh when I realized that I would be eligible for my new insurance to pay the local trauma center within a few days.  Why was I thinking about this, when I had had two fender-benders in a long driving career?

By the end of the month the lack of insurance still concerned me intellectually, but it was not disturbing emotionally much at all.

What were the important points about change I learned from all this?

First, the importance of recording.  When you track something, you want to “do well” at the activity being tracked.  (The exception, of course, is if your standards are so high that you abandon the whole project in disgust after a few days.)

Second, the changes were important to me.  I believed I should do better than to complain to and snipe at a person I love because my own life was somewhat off track.

Third, the focus was on what I did and not on what I was thinking.  It wasn’t particularly helpful to me to challenge my thoughts.  I was already fully aware that they were irrational.

Because what I was focused on was not how I felt but how I acted,  I actually could control the score I got.  Once I figured out that my making a visible effort to change was actually strengthening my marriage, I started to feel rather proud of myself.  I would rise above mere worry about insurance! My anxiety and irritability went way down.

Catastrophizing easily creeps back into my thoughts.  But this experience confirmed for me that if you act differently, thoughts and feelings will follow.

Those of you familiar with Acceptance and Commitment Therapy (a newer type of Cognitive Behavior Therapy) will recognize that this story illustrates some key ACT principles.  I will write more about this in the next post.

Mindful Behaviorist – first post

cognitive therapist worcester cbtThis is a the first posting for my new blog, the Mindful Behaviorist.

What does the blog’s name reveal about how I do therapy with adults?

Let’s look at being behavioral first.  To me, this means that I have a “toolbox” of things I can teach clients to DO (not just think about).  These may include:

Ways to track how your mood is connected to what you are actually doing at any given moment, plan how to do what makes you happier and avoid “ruminating” over negative thinking;

Ways to face (in a gradual, tolerable way) what you fear the most;

Concrete ways to develop a repertoire of coping skills for times of crisis, and check whether you are practicing and using them.

 

Behavioral therapy involves “homework”. – I may ask you to keep a chart of behaviors, because what we monitor tends to change more easily.

I teach behavioral skills because there is good research evidence that they work.  I use them on myself when I need to change something I’m doing.

I also teach clients to challenge negative, fearful and self-destructive thinking.  People often believe the negative things their minds “tell” them.  We work together to find a more realistic viewpoint.  However, because it’s often very difficult to get rid of deeply rooted negative beliefs, even if you KNOW they are not accurate, I also teach clients to practice mindfulness.

 

People who have tried mindfulness or meditation sometimes think they failed because they were still distracted by their thoughts and feelings and couldn’t “relax”.  But relaxation, a nice side effect of mindfulness, is frequently not present.  Mindfulness is not about stopping what goes on in your mind, but noticing it.   It does not require a huge time commitment.  Fifteen minutes a day will make a difference.

 

Mindfulness also helps us to become more in touch with the present moment.  Then we can listen to our own “gut” feelings, not just to the (often painful) chatter that goes on in our minds.  This helps us to start moving towards what we really want to do.  And new experiences, achieved by acting differently, change what we believe about ourselves, others and the world. These are the principles of Acceptance and Commitment Therapy, a form of Cognitive Behavior Therapy which I find extraordinarily helpful.

 

When treating young people, I work also with parents (as appropriate to the client’s age).  Parents can be the best coaches for kids.

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