Podcast: Self-Acceptance’s Role In Good Mental Health

Jenn talks to Lisa W. Coyne, PhD. Lisa explains how acceptance, including self-acceptance, can help us handle life’s curveballs. She also explores the connection between mindfulness, our emotions, and how they can impact us and our loved ones.

Lisa W. Coyne, PhD, is a senior clinical consultant at the Child and Adolescent OCD Institute (OCDI Jr.) at McLean Hospital. She is the author of “The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years,” a book for parents of young children.

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Episode Transcript

Jenn: Hey everyone, welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hey there. Good morning. Good afternoon. Good evening. Wherever you’re joining us from and whatever time you’re joining us at, thank you for joining us.

I’d like to introduce myself, I’m Jenn Kearney, and I am a digital communications manager at McLean Hospital. And chances are, if you take a second to think of anybody, who’s overcome a major hurdle or obstacle, whether you know them personally or not, several people should come to mind for you.

And over the next hour, we’re going to talk about how we can be better at overcoming these major hurdles ourselves and how, so to speak, we can accept that hand that’s been dealt to us, whether we like the cards or not.

So, during this session, Dr. Lisa Coyne and I are going to talk about acceptance, how to address life’s hiccups, how to go with the flow and how it all ties into better mental health.

If you are unfamiliar with Lisa, you are in for a real treat. Dr. Lisa Coyne is a psychologist and senior clinical consultant at the Child and Adolescent OCD Institute, otherwise known as OCDI Jr. here at McLean Hospital. So, Lisa, hi, it’s really nice to see you.

Lisa: Nice to see you.

Jenn: Per usual thank you so much for joining us. Your expertise is just so deeply appreciated. I don’t know if you wanted to get started by just talking a little bit about acceptance in general, what it might look like in different people, what those characteristics are, or what the positive impact of acceptance is on mental health, or we can split up those 2 questions.

Lisa: Sure, and actually, can we do something a little different today? Can I start by? Okay, so acceptance is at the heart of one of the therapeutic approaches that we use at McLean and that I teach called Acceptance and Commitment Therapy.

And it is a slippery thing to think about, what it does not mean is to learn to endure, to learn to tolerate, to stuff down all your feelings and get through it, to muscle through it, to say, “I’m fine” when you’re not.

Okay, so what I think I want to do, which would be sort of consistent with learning it more through metaphor, I suppose, would be I want to read you guys a poem, if it’s okay. Alright, and this is one of my favorites, and I just want to read it and kind of let our listeners think about it. And this poem is called The Guest House by Jalaluddin Rumi:

This being human is a guest house, every morning a new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. Welcome and entertain them all. Even if they’re a crowd of sorrows who violently sweep your house empty of its furniture.

Still treat each guest honorably, he may be clearing you out for some new delight. The dark thought, the shame, the malice, meet them at the door, laughing and invite them in. Be grateful for whoever comes because each has been sent as a guide from beyond.

Jenn: I love that. And I also feel like I should snap because you read that so beautifully.

Lisa: Well, folks don’t know this, but I actually have a Master of Fine Arts in creative writing and poetry. And that’s the whole other part of my life that it’s like parallel path. So, I really love the use of poetry. And I love that.

It can say things that we have... It puts to words or tries to put to words things that are really difficult to capture in any other way. So, I appreciate that about it. I hope you guys liked that poem.

Jenn: I feel like the first question should be, is there anything that you don’t do? Because every time that we have something with you, there is something else that gets uncovered about just how like multifaceted and cool you are.

Lisa: Oh no, I’m a total nerd. I’m good at being a nerd. There you go.

Jenn: I wish I was good at being a nerd. So, I know that you had mentioned about like compacting and compartmentalizing. What does that actually do to our mental function and our mental health over time?

Lisa: Right, so it’s a really interesting thing because culturally and socially, we have been trained and taught that, emotions we can sometimes deal with them as though they are toxic and dangerous, right? And that we should be careful who we express them to. And there are places that it’s okay to express them, places not.

And the rules are somewhat different, depending on your gender as well. Like it’s more okay to express certain things if you’re female versus male, right? If we’re thinking about just the binary categories. So, our relationship to emotions, is a little bit fractious, right? And that’s the way we all grew up.

Depends, you know, but at the core of it, from a behavioral perspective, we don’t do things that don’t make sense, right? We have evolved to have these emotions, right? It’s part of being human as Rumi says.

And the thing to remember, I think, is that emotions are information, right? They are like a guide from beyond, because are here to tell us things about what we care about, about what’s difficult for us, about when we need a break, right?

And some of those things that... There’s a couple of pieces here, right? So, all of us in our lifetimes are going to have, we’re going to experience loss, right? We’re going to experience disappointment, failure, self-doubt depression, anxiety, right? Some of us in clinically meaningful ways, that is part of our existence.

And there’s no two ways around that. One of the things that is difficult, if you try to bottle box, suppress emotions, is that you’re almost experiencing like, there’s the pain of whatever it is that you’re coping with.

And then there’s this other added layer of, but I shouldn’t be feeling that way, but I have to hide what I’m feeling, but that’s too much, I can’t do anything in my life unless I can get rid of this emotion. So, I’m going to hide it, suppress it, get through it, be tough about it.

And so, what that does, A is it increases your burden, right? Because it’s taking your mental bandwidth and you’re focusing entirely on trying to control something that is not under your control.

Emotions arise naturally based on our learning histories, based on what’s going on for us in the moment. And if we engage all our efforts at suppressing and avoiding them, it can make them more intense and it can make them stick around longer, right?

And there’s lots of data on that around thought suppression, around emotion suppression and things like that. And one of the reasons that acceptance-based approaches to therapy have arisen, is based on that data. It’s counter-intuitive, right?

So, I did that answer your question Jenn, should I say more about that? Okay.

Jenn: So, when it comes to like actually freeing up headspace, is that something we can do? Is like making clear in our mind an urban myth or is that something that like, how can we actually start incorporating ways to clear our heads?

Lisa: So, I wouldn’t say necessarily like clear your head, but it can reduce your burden, right? So, there’s two pieces here. There’s like the pain of whatever’s going on and then there’s the meanings we make of that pain.

So, for example, if I am trying to write something, I’m trying to write a paper. And I send it in somewhere and it gets rejected. I hurt like a... And then I feel shame, or I feel embarrassment. Then I’ll have the thought I’m not good enough. And then I’ll engage in an argument to prove to myself that those things aren’t true or ignore that I’m feeling like that or distract myself.

And so instead of just kind of softening around the emotion and going: You know what? That was a really hard experience and I don’t like it and I’m going to let myself feel it. I’m engaging all this energy and effort to push it away.

And what that does is it might take my bandwidth away from maybe reading the comments to see what could I have done differently? What could I take from this? What could I learn from this?

And also noticing that this hurts for me because this is something I care deeply about. And again, emotions are information. So, when there’s really strong emotion, it generally means there’s something important in that for you, right?

And so, you can not necessarily clear your head of the thoughts, but you can definitely get some distance from them and you can reduce your effort, your mental effort, of trying to manage things that are unmanageable. And imagine that and it’s really interesting when you think about that poem.

When we feel joy, what do we do? It’s like watching a sunset. It’s like just basking in the light, in the glow and just really appreciating it. But when we feel pain, shame, malice, the things that were mentioned in that poem, we do not do the same thing. Immediately we engage in, “Oh God, I can’t do that. I don’t want to feel that.” And that’s where that effort clicks in.

And it feels so counterintuitive to say: What if you just slowed down and let yourself actually notice that? What would that be like? And it certainly will not take it away, but what if there’s this much living and vitality in a moment of pain as there is there is in a moment of joy?

And that it’s part of what knits us together. Especially during this time, this crazy pandemic, where the numbers are ticking up and everyone is stressed. We are overwhelmed with folks who are looking for help. And you know what? Mental health providers are wanting support too. It’s a really difficult time.

And we could rail against that, but to what end? More effective things would be: how can I think about the things that I really care about, in this situation, knowing that is a context that’s not necessarily changeable?

You can certainly take individual responsibility by wearing a mask, washing your hands, and doing all the things to keep yourself and your family safe, right? Keeping those around you safe? But it’s going to play out the way it’s going to play out. And a lot of that’s beyond our control.

So, a different way to handle this would be to let yourself actually let those feelings in, and then that’ll free up your bandwidth to choose, Well, okay, this is where we’re at, now what? Now what do we want to do? What do we want to make this about? Could this be a time that you enjoy more time with your family?

Could this be a time when you get back into reading or writing or raking leaves or whatever it is that makes you feel like you have some vitality. Baking, cooking, there’s a whole bunch of things and thinking about the things that we care about.

So, it’s a different shift, right? Where you’re freeing up that bandwidth, from trying to control or suppress by not saying... Not enduring, not tolerating, but just making a space for whatever it is that you’re feeling.

Even if it’s a small thing like slowing yourself down for a few seconds in a quiet moment and just checking in with yourself to see what is it that I’m feeling right now? What is it that I need right now? We don’t do that very often, we’re really busy, right? I mean, we’re running from one thing to another, probably most of the days.

So, taking some time to just, you know, few seconds, what is it that I’m feeling right now? Just check in. That’s an act of acceptance, right? And then just really breathing into whatever that feeling is that you’re having or whatever that scary thought is, or painful thought is that you’re having.

Jenn: So, I know that as humans, we’re hardwired to try and avoid pain, right? So, we tend to deflect when we end up having a negative thought, if we are feeling uncomfortable, we’ll skip those moments you just mentioned because you don’t want to acknowledge the discomfort that you’re in. How do we get better at sitting in discomfort and sitting in like “ugh” feelings?

Lisa: It’s a practice. So, we’re kind of funny humans, right? Cause we... When we experience things internally, and we call those private events. And it’s a thought or a feeling that you have that is observable inside by you. We tend to employ the same strategies that work with stuff outside of our skin.

So, for example, like I have two dogs there, thank God asleep and not barking during our webinar like they normally are. But if they started to bark, I could really simply open the door and put them out. No problem, problem solved, right? How do you do that with painful thought?

So, one of the first steps to working your way into acceptance, is stopping to notice, how is what I’m doing about these difficult feelings and thoughts working for me? Has it helped? What is it doing? And if you’re noticing that like, you haven’t been successful at getting rid of them, congratulations, you’re one of us and us being the human species, right?

No one can do that. And sure, you can distract yourself momentarily. And that’s a lovely thing sometimes, right? But if that’s the only thing that you do and life feels intolerable, unless you can get rid of these things, that’s sort of a losing strategy, right?

Because your life then gets constricted to this one, little... This one activity, I just got to get rid of this. I just got to get rid of this. How am I going to get rid of this?

Meanwhile, there’s a whole bunch of things in the world that are just waiting for you. If you can practice noticing, like dropping the rope really dropping the struggle and being like, “You know what? I don’t like these thoughts, these suck. I don’t want to feel this, this hurts. I would... If I could wish it away, I would, and I can’t.”

So, the choice is, you can keep working on those unworkable strategies of suppression or you can turn around and go, “You know what? It is what it is. I don’t want it. And from this space, I can choose something that’s more life affirming for me. That’s more consistent with the person that I wish myself to be. That’s more consistent with those things that I really care about.”

So, step one is, noticing how what you’re doing is working. And if it’s some attempt to control, suppress, minimize, watch how that works, right? Very likely, like I won’t say too much more cause it’s really important that each person notices for themselves.

But the second step is choosing another intention, other than trying to make this stuff go away. It’s choosing something that matters to you. So, like one of mine is like when I get down. Because I’m weary and there’s a lot of hard things going on in the world. I can get stuck in thinking about that, trying not to think about that.

And so, what I remember is, and what that does is it takes me away from noticing the things around me. It takes me away from being an effective person. An effective mom, an effective therapist, an effective writer, scientist, whatever. And so, then I think on, what is it that’s most important? What is a value of mine?

That’s at the heart of why I do what I do and mine…What if mine is to be of service? And so, if I’m busy trying to not feel bad, I’m not working on trying to be of service. And so, I’ll do this little shift and I’ll go, “What could I do that’ll bring me 10% closer to that value? What can I do?” And part of that is letting your feelings be there and choosing another intention.

Jenn: I think it’s super interesting too, that you’ve brought up the phrase, “It is what it is” because there are so many folks and I’m guilty of it myself who say, “It is what it is”. Period, full stop, reactive.

Whereas your you’re addressing it as: It is what it is, and I don’t like it. So, here’s how I’m going to change it and be better for myself. And I think that shift into proactivity is enormous and possibly life changing.

Lisa: It really can be. And we have the story, that usually, and this is like pretty common in most of us, if we’re human and that is: Well, I can’t have the life I want unless I get rid of X feeling, thought, condition, disorder. And we really buy into that story and sometimes when we do, that can be something that becomes a cage.

What if it’s possible, just consider this. Like, what if it’s possible to build a life that you love, feel vital. To feel really engaged and do things you really care about, even if you’re having hard thoughts or feelings. And not in a way that you’re like suppressing them, so that you can do that. That’s that same old avoidance model.

And one way to think about this, a couple of writers that I really like who write about this, Tara Brach is one, she’s a Buddhist psychologist. And I had seen her speak a number of years ago, probably about 10 years ago now.

And she did this beautiful keynote at one of our conferences. And she said a couple of things that have stuck with me and one is, “Suffering begins the moment you start to wish that the present moment is other than what it is.”

So, the minute we start to engage in nonacceptance, suppression, that’s when we begin to suffer. And suffering is different from pain. Pain is sort of the stuff that’s actually happening in the moment. Suffering is avoiding it. It’s all that added layers that we add onto it.

And so, she talks about radical acceptance in her writing. And then she has many books, Tara Brach, B-R-A-C-H. She’s lovely. And there’s another thing that she said: Acceptance is just simply learning to stay and allowing...Acknowledging, allowing, whatever’s going on for you in the moment. And that’s the spirit of that “It is what it is” quote.

And the other thing to remember is, the hard things in life are what connect us, cause we all have them. All of our stuff is different, but we’re all human and we all suffer and we all struggle. And we’re all apt to get stuck in these cages of, “Oh, I can’t have that.”

And we all fall off the path to the life that you want to build. But it’s always possible, even in your darkest moments, it’s always possible to take step towards the things that you really care about.

Jenn: I like to think of it as there’s two camps of people, people who are overcoming obstacles and liars. (Jenn and Lisa laughing)

Lisa: Indeed, yeah, it’s true.

Jenn: Can you talk a little bit more about radical acceptance and what it is at its core and how we can start doing more of it in a way that’s not going to overwhelm us?

Lisa: Yeah, it’s really funny because I have a colleague that I adore, her name is Jill Stoddard and she’s been working on...She wrote this great book called “Be Mighty” for women, who are struggling with exactly these kinds of things.

Jenn: I’m nodding like a bobblehead over here because I’m actually in the middle of the book.

Lisa: Oh, yeah.

Jenn: It’s phenomenal, I highly recommend it. And again, it will be included in all of our references. So please don’t worry about writing it down.

Lisa: Maybe we should have her as a guest speaker on our webinar. I could ask her; she would love it. But so, she’s working on this other series for women about imposter syndrome. Which is something that we, again, humans feel. And it seems ubiquitous. Have you ever felt like an imposter, Jenn?

Jenn: Every time I come in a webinar--

Lisa: Exactly, I’m like, “Why do they keep asking me to do these webinars? I don’t know what the hell I’m talking about.” So, like, it something that pops up for all of us. And so, she asked about...She reached out to a bunch of us and she said, “Can you send like a quote or something about your imposter syndrome?” And I’m thinking, “Yeah, like what did you do about that?”

And I remembered that when I was applying to internships, that I was a grad student. And I really, really, really, really wanted to go to Brown, cause it was legendary in our program as one of the best in the country. And so just the training was exceptional, it had all the things I wanted. It’s where I specialized in OCD and all this, but I was utterly terrified.

I was like, I’ll never...That’s so stupid to even think that I could possibly do that. Like ridiculous, I’m a complete fraud. And it was really terrifying. And I do mean that literally.

And what I had to do was, make friends with the possibility of, and I remember thinking this right in a workshop, an Acceptance and Commitment Therapy workshop, like making friends with the possibility of being a spectacular failure.

Am I willing to be...To allow that possibility of being a spectacular failure in order, in the service of taking a step towards putting in this application? It was so terrifying and also freeing. And I ended up putting in the application to my great shock, that’s where I went for internship and post-doc. But that was an act of radical acceptance.

Think about those moments when you’re like: Should I apply for that job? Am I going to ask that person out on a date? Am I going to try this new thing, whatever it is? Am I going to take this risk? And it’s really about making space for uncertainty. It’s really about making space and noticing like, if it’s a difficult emotion like you’re grieving, you’re sad, you’re feeling disappointed in yourself.

It’s about slowing down and taking just a few moments to notice, “Am I defending myself against this? Am I hiding it? Am I physically tensing up against it?” Cause we react in all sorts of ways to these things, right? Or am I going to allow the feeling? So that I have that bandwidth to then choose to move in another direction?

And again, this is not about making it better, it’s about carrying it more lightly. Cause there are things in life we know that are going to hurt us. What we can do though, is we can…If you’re moving towards this sort of radical acceptance model, it’s about making the burden easier. Freeing your bandwidth to do other things. So, it’s about letting go of the control.

So, there’s a concept that we write about in our books called willingness, right? And willingness is to allow yourself to be willing to experience things that are difficult. And so, there’s a little practice in our book that I’ll kind of share with you guys that might be useful if we think about this. See you want to notice part of what’s hard, right?

And part of suffering is engaging in control, trying to control things that are uncontrollable. So, the first thing to do is to really notice: Like, am I...What am I trying to control? Am I trying to control how I feel? Am I trying to not feel something?

And is that useful? Am I trying to avoid something, a feeling, thought...Am I trying and prove it untrue, if I don’t like it, et cetera? And so, this is an acceptance practice, right?

So, what you would do is you would think about what are the things that I’m trying to control that are uncontrollable? Put them on a I can’t control list, right? If there are things you can control, by all means, go for it, go ahead, and change them and that will make your life a little bit better.

But the second thing to do is to notice the things on the can’t control list and you might ask yourself these questions: Can I be willing to have what I have right now without trying to push it away? Can I allow what’s already here to just be rather than fighting it.

And then step two, ask yourself what you’d be doing in this situation if you weren’t working so hard to control. If you were being your best self, living as the person you truly want to be, what made you do? Then do that. Even if it’s hard, even if you feel pulled towards controlling avoidance, and that’s just a little excerpt from this. Which is all about acceptance.

Jenn: Which is in my Amazon cart as--(Lisa laughing)

Lisa: So anyway, but that’s an excerpt just by the way, an excerpt practice is that, like when you learn Acceptance and Commitment Therapy, to teach it and to use it with your folks who come to see you in therapy.

The way it’s taught is to walk through it yourself, right? And one of the kind of core tenets of this is that, if you’re going to ask...If you’re going to teach folks things, you better know how they feel yourself and you better see if they’re useful yourself.

And so, it’s really, something that’s a really nice philosophy of living, right? It gives you a lot more breathing room, when you have hard things that are going on and helping you always turn towards those things, those activities, those actions, that are most consistent with the person that you want to be.

Jenn: So, we had a couple of folks asking about emotions. So first and foremost, how important is it to name emotions as they come up versus just letting yourself feel them? Is there an importance to having that acknowledgement?

Lisa: So that’s a really good question and there is a little bit of data behind, sort of emotional knowledge, emotional awareness, emotion they call it granularity, which is again, nerding, so here we are with nerdery, sorry, and emotional label. And in general, one thing I notice...Well, that data would suggest that it’s really useful to kind of notice the nuances of what you’re feeling.

And if you can get words around them, that’s great. Sometimes when people avoid feeling things for a long time, their ability to describe and express them, is pretty impoverished, right? And it comes out in unhelpful ways.

Like for example, I’m a big somatic person. So, like when I’m anxious, if I’m not on top of it, and if I’m not actually aware, I’ll just get headaches, or my shoulders will be stiff, or my jaw will be tight and all of that stuff.

Or I’ll be snapping at people around me cause I’m irritable, right? Because I haven’t slowed down and noticed. And if I did, I might be able to more mindfully choose. So, in general, it’s helpful to notice and kind of, at least notice the differences. You don’t need to necessarily put them into words. But you can just notice the quality and feeling the intensity.

Where is it in your body? Where does it live? What thoughts come up when you’re having that, right? Just be really curious about it. And that will give you a more nuanced, I guess, lexicon for describing it and also really noticing and learning yourself. Cause there’s stuff we can learn even about ourselves that we don’t know.

We all have blind spots, right? And you know, for a lot of us me included, sometimes I don’t know that I’m irritable or down until my family says, stop yelling at me (laughs). Or get off your computer, you’re doom scrolling again, or whatever it is that you’re doing.

So, we don’t necessarily stay in contact with these things and sometimes that’s okay, right? And sometimes it’s not helpful. So, I think it’s very useful. And the data would support that kind of being able to label and describe emotions is useful.

Jenn: So, like you and I are kindred spirits. Cause I get lost--

Lisa: You get that too?

Jenn: I get lost in Twitter, and the longer I’m on Twitter, the more irritated I get, and then it gets caught out.

Lisa: And you know what? The dogs are so funny. Cause like, I won’t know that I’m like...I’ll be watching a movie and I’ll be like sobbing at something in the movie, and all of a sudden the dogs will be all over me and I’ll be like, “Oh my God, you can tell.” They’re very empathic. So even the animals can tell, it’s very funny.

Jenn: If you need a good movie to sob at “Peanut Butter Falcon” was one that was on my...

Lisa: So good…So, I love that movie, that was great.

Jenn: That’s a (indistinct) movie but also very much an ugly cry.

Lisa: Oh, and another one, so another favorite is “My Octopus Teacher.” Oh my goodness, people, if you have not watched that and if you want to learn about what it means to be in the present moment and accept discomfort, and accept uncertainty and explore and discover, watch that it’s brilliant and it’s just absolutely gorgeous.

Jenn: So, I--

Lisa: We should do a webinar on our favorite movies. (Lisa laughing)

Jenn: Between this and a book club, we’ve got, Lisa, we’ve got a lot going on. So, let’s pull it back into emotions and acceptance. How do we get better about dealing with emotion over things that we can control, versus those things that we can’t control? And when I read this question, the first thing that came to mind to me, if you live in the Boston area is rush hour traffic.

Lisa: Oh my gosh. Having PTSD from that. So, the first thing to do is to do exactly that in your mind, like when you feel like you’re really struggling notice, is there something about this that I can control, right? Like if you’re sad because you have to chat with somebody, and you’ve been avoiding that chat with that person. Well, what you can control is go chat with the person.

What you can’t control is how that chat is going to go. What you feel during the chat, what you feel after the chat. If you are feeling oppressed, by the many tasks that you’ve been avoiding, what you can control is break down those tasks and start working on them.

What you can’t control is not wanting to do them, discomfort while doing them. And the other stuff that’s piling up, then how you feel about the other stuff that’s piling up. You can certainly work your way through the pile.

So those are things we can’t control, right? So, noticing and really dividing and separating out what actions can we do in our world to make things easier, by all means, if you can do that, great. But, you can’t necessarily control how you’re feeling. Now here’s one that’s tricky, right?

Let’s say you’re anxious. Let’s say you have social anxiety or let’s say you’re struggling with like, you’re a little nervous to go out of your house these days because of COVID or agoraphobia or whatever it is. You could certainly not go out of your house and avoid all of those things and you might feel safe for a time. But the problem with that, is that too is a control strategy.

Because it feeds...The fear feeds the anxiety and a harder decision is to make a decision that’s consistent with the person that you want to be and start approaching your fear, to move through it. Sometimes nonacceptance looks like avoidance, of the thing that’s making us anxious, but continual avoidance in that way will just get us all stuck, right? Life it’s smaller and smaller.

It’s similar with depression. When I’m down, the last thing I want to do is like, get dressed and go for a jog, of course. But if I keep choosing not doing that, day after day after day. If I’m not willing to feel that discomfort of going. Choosing to go, when I at least want to go, it’s just going to feed the depression. It’s going to make it worse.

So, noticing those things, another thing too, I want to just comment on is thoughts. Lots of times when we have thoughts like, “I can’t do this, I’m depressed. I can’t do this, I’m too anxious.” We treat those like literal truths. And in a way, we might just, if we’re buying into them. That’s also going to feed things.

So, another thing we can do is notice and accept that you are having that thought, right? And it is a thought, it is a mental experience that you’re having. And notice that whether or not you’re having that thought, you can still choose what you do in that moment.

And another way to think about acceptance is practicing moving towards the things that you care about. Even if you’re having thought that you can’t, that it’s impossible, that it’s unlikely. That it’s too hard, right?

So, accepting thoughts for what they are, not what they purport to be. Mental phenomenon, not necessarily literal truths. Cause think about it, our brains are constructed so that we avoid imagined possible futures that may never ever occur.

And we can get stuck in thinking, “How can I prevent this thing from happening?” And we’ll spend so much time trying to do that. And meanwhile, our life will go on without us.

And so, noticing: Wow, I’m having a lot of thoughts about like, this could happen, this horrible thing. I could be a spectacular failure, for example. And I’m going to avoid that by not applying or doing anything that might make that possible. And then I’m stuck. And then I never know what might be possible for me.

So that’s again, another way of the act of acceptance, noticing what you’re thinking, noticing the thoughts. And not acting consistently with them, but instead choosing to do something consistent with the person you want to be.

Jenn: So, I know that there’s part of CBT. So cognitive behavioral therapy, a component of it is cognitive reconstructions. So, where you’re changing your thoughts to be something more positive. Is this something that if we’re working on acceptance, should we do it in tandem or is one of them more effective than the other? Or does it not work?

Lisa: So, it’s a different approach and both approaches are useful, but not everyone will find each approach useful. I don’t particularly find that approach useful just because I’ve been trained in this other model, I’ve been treated both models and I prefer this one. But I think that one of the nice things is there’s evidence to back both.

And people should try whichever one they’re more comfortable with and really see how it works, right? Like the difference between that and acceptance...Traditional cognitive behavioral therapy, and an acceptance based approach is, one teaches you to argue with the content of your thoughts, with what you’re thinking.

So, if I think I might be a spectacular failure, I’m going to recognize that that’s catastrophic black and white thinking and maybe I’ll get in, maybe I won’t, maybe it’s dimensional and I’ll…Maybe I’ll address the probability of that, given my history and all of that stuff. Or from an ACT approach, I can just simply let the thoughts be, and work on changing my relationship to it.

And my relationship might have been, “Oh God, that could be true, I’m not going to do that.” But instead noticing, “Wow, I’m having this thought. That’s really scary. Alright, I’m willing to kind of let it hang out and do what I want to do, anyway.”

So, it’s just a little bit of a different approach and folks should try both and see what’s more useful, right? One of the things that for me personally and for folks that tend to like ACT, you can know logically that those thoughts are unreasonable and still the emotions continue to arise, and it still feels hard.

So, in an ACT approach, you’re like, Yeah, that’s really hard and I’m going to choose to do something that feels more vital to me. So, it’s a little bit different.

Jenn: So, what is the relationship between acceptance and setting expectations? Someone in the question and answer section posited that, if we don’t accept parts of ourselves, we might tend to set unrealistic expectations.

Lisa: I think that’s right on. I think I would agree with that. Meeting yourself...I kind of think of this as meeting yourself where you are. And also, being really aware of whether you’re letting yourself off the hook for things.

So, meeting yourself where you are means, like letting in kind of, what you’re up to in the moment and starting with a step from where you are, not where your mind says you should be. But also, we’re really good at subtly avoiding things and kind of telling ourselves (indistinct) about that. And so that’s what I mean when I say not letting yourself off the hook.

Jenn: So how do we help encourage teenage clients if we have them, to try a healthy ways to cope, rather than turning to substances, if they’re trying to tamper negative feelings?

Lisa: That’s a great question. I think by teaching them some of these approaches, right? Teaching them normalizing their experience. Think about how hard this must be for them. Like they have an idea in their heads about what thirteen years were supposed to be.

And there’s massive grief and anger, about not having that, given that we’re in the middle of a pandemic, they have been asked to be incredibly flexible. They’re now cooped up at home. Milestones are being taken from them and all of these things.

And so, doing some perspective taking about what things are like for your teen clients is key. If you’re a therapist, one of the things I like to do is kind of go back in my mind and think about what was I like at their age? What was I thinking? What was important to me? What was that experience like?

And bringing that sensibility of your sessions with your teen clients, that’s really, really important. And remembering they’re the experts on their own experience. We’re not going to teach them about their own truths.

They’re going to teach us, let them teach you and then give them the skills. Like how do you...Like teaching them how does it work when you try not to feel the stuff? How does it work when you struggle with these thoughts? Has that expanded your life, or has it constrained it?

And helping them think about and work on discovering what are the things that are important to them. And sometimes just discovery is the value for them. Like sometimes it is just trying stuff to see what is going to be something that matters to them.

Sometimes they already know, but it’s a variety of things and making it okay to not know, making it okay to hang out in that in between space where you’re like, “I don’t know what I’m supposed to do. Everybody wants me to go to college and major in something. And I don’t know what I want to major in.” So, we’re hearing a lot of that. And so just making a space, I think for that.

Jenn: Is there any way for us to be conscientious of one we’re becoming a little more avoidant than acceptable and how do we start to pull ourselves--

Lisa: Such good questions today from our folks, I’m really appreciating these. So, you have to learn your own tales. Mine is when...Cause we’re all the same by the way, we all get hooked in this avoidance stuff. This is not just like, this is not like psychologists are like, we’re always experts at it. No, no, no, no, no. We’re all in this together.

So, mine is usually I start to be less enthusiastic about things. I start to get more tired. I start to be snappy, little irritable, things like that, snack more, things like that. Things start feeling like a grind.

That’s a sign that I need to check in with myself and just see what’s up. Make a space for it, because I’m not mindfully choosing to, behave in ways that are consistent with what’s important to me.

And so, everyone’s tell is going to be different, but those are mine. So that’s what I would encourage you guys. It’s not going to be a, can I figure it out Kind of tale. It’s going to be a, what am I doing? What am I observing myself doing? And how am I feeling?

Like, am I feeling tense and stressed? And like things are a struggle all the time. It’s probably a sign that you’re getting stuck and maybe avoiding some things that are hard, instead of kind of slowing yourself down, taking a few moments and taking stock.

Jenn: How do we know if there’s a difference between our avoidance symptoms and our burnout symptoms? Cause a lot of what you addressed, I’ve identified it in myself before and then I’ve gone. “I’m I just trying to do too much?”

Lisa: Well, again, a great question because what we have been talking about today is called experiential avoidance. It’s unwillingness to let ourselves feel thoughts, feelings, physiological, whatever it is that’s going on. And that is something that is implicated in burnout.

And acceptance on the other hand and psychological flexibility. Which is a term we hadn’t defined in this particular webinar, but which means willingness to feel your stuff when it’s going on and choosing to do things that you care about. Whether or not that stuff is there, that’s called psychological flexibility. And that’s something that helps with burnout.

So, noticing when you start to go down this path of like, I’m just kind of dialing it in, I’m avoiding what I’m feeling, a bottling it up. I’m fine, nothing’s wrong. It’s all, okay. You know, muscling through it. Those are things that can actually like contribute to burnout. So sometimes you don’t notice till it’s too late and you’re already burned out. But that is definitely a contributing factor.

And so practicing awareness, which again is a very small act of acceptance, just acknowledging like what is going on inside my skin, this moment. That is something that can help you get a handle on it before it gets too big.

Jenn: Do you have any advice for folks who are primarily caretakers. Whether they’re for people older than them or people younger than them, or sometimes even both. I know a lot of people end up experiencing the emotion of being overwhelmed because they’re pulled in so many directions and that can be a bitter pill to swallow in and of itself.

Lisa: Yes, I do. And actually, burnout risk is very high in caregivers and my heart goes out to you where if you’re working on caring for an elderly, or an impaired person or relative in your life. So again, part of it is...That’s a thing that’s normalizing that like this is hard.

This is more than, you might have planned in your life and this might be taking up more of your bandwidth than you’re comfortable with. And simply acknowledging that and letting yourself find...It’s hard.

Cause like on one hand, this takes up so much time, right? The logistics are difficult to work. Like how can I find some time to myself? Right. And so, one of the things that we encourage folks to do, is to take really tiny windows and just practice mindful awareness. Even if it’s for a few seconds, do this little check-in with yourself, let yourself breathe.

If you’re having a cup of coffee, let yourself sit down. Really notice how it tastes and just slow down, give yourself permission to take even brief, small little breaks. Social support is also something that’s really helpful.

So, allowing yourself some time for you to check in with your friends who you maybe haven’t been able to connect with, et cetera. Little acts of self-care can be very, very important. And then three, I would say is, lots of times when we feel like we need to rise to an occasion that’s almost beyond what we can do. We’re very hard on ourselves when we can’t.

And so really engaging, noticing how you’re speaking to yourself, are you kind of beating yourself up for not being enough, not doing enough, for being overwhelmed, and seeing if you can engage a kinder, more compassionate voice as you speak to yourself in that way.

Jenn: So, this actually concludes our session. Lisa, thank you so much for another wonderful session. You are just wealth of knowledge and saying the words, thank you doesn’t even scrape the surface of our gratitude toward you.

And thank you to all of you who are watching. This concludes the session. And until next time, thanks so much for joining us and have a great day, bye!

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Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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