CHAPTER 3 UNDERMINING COGNITIVE FUSION used to think that the brain was the most wonderful organ in my body. Then I realized who was telling me this, —Emo Philips Key targets for cognitive defusion: ¥ Help clients see thoughts as what they are—thoughts—so those thoughts can be responded to in terms of their workability given the clients values, rather than in terms of their literal meaning. Help clients attend to thinking and experiencing as an ongoing behavioral process, and away from the literal meaning of the contents of the mind. In relation to their thinking, people ate a bit like fish who do not know they are swimming “Sees that’ the stuff I'm talking about.” in warer. We swim in a river of thought, but rarely notice this fact. And whether we are aware of it or not, language regulates our behavior. ACT works to weaken the unhelpful influence of language in key contexts by helping us to leap out of the river of thought and begin to observe thinking for what itis: a largely automatic, unin- tentional, and historical process of relating one event to another—in other words, “minding”WHAT IS COGNITIVE DEFUSION? ACT argues that the problem with human suffering as it relates to thoughts is not that we have the wrong ‘thoughts, but rather that we spend too much time “in” them ot “looking from” them, rather than simply looking at them or observing them. Cognitive defusion attempts to circumvent this problem by drawing the client’ attention to thinking as an ongoing behavioral process, and helping clients to spend more time seeing thoughts as thoughts, so those thoughts can be responded to in terms of their workability, rather than their literal ruth, We generally respond to thoughts and feeling as if they directly caused our behavior. For example, in normal discourse, if you ask someone why he or she stood in a corner the whole time at a party, an accept- able answer might be “l was too worried; I thought I might embarrass myselé” By this way of thinking, the thought—'I might embarrass myself”—caused the behavior, withdrawal. However, we can easly think of contexts in which this relationship might be quickly altered; for example, if someone at the party shouted “Fire!” At that point, “I might embarrass myself” would no longer be a reason to stay in the corner, but perhaps a reason to leave it. According to ACT, the idea that the thought caused withdrawal is only one way of speaking about the situation, and perhaps a disempowering one. ACT also views human emotion through this same lens. Thoughts and feelings are always seen in context, and only in certain contexts are particular thoughts or feelings tied to particular behaviors. Attention is turned from the specific content of the thoughts and feelings and onto the person's relationship to or the function of chose thoughts and feelings. Alter the context, and we alter the function of the thought or feeling. Thus, in cognitive defusion, rather than trying to ditectly change the form of thoughts or emotions, or the frequency of thoughts or emotions, the therapist targets the context that relates the thoughts and feelings to undesirable overt behavior, thus creating greater response flexibility. An example of a specific defusion technique can clarify this point (Milk, Milk, Milk exercise, Hayes ct el., 1999, pp. 154-155). Ifa client rapidly says a word over and over again for thisty'to sixty seconds, swo things usually happen: the ‘word temporarily loses some or most of its meaning, and other functions of the word tend to emerge more dominantly, such as its sound or how it feels to move one’s mouth in this manner. You can try it yourself very easily. First, imagine a gallon of milk for a few moments and chen repeat the word “milk” for at least sixty seconds. Listen to and notice what happens. This technique can then be repeated with a selfrefer- ential word that is difficult forthe client—"worthless” for instance. As in some other defusion techniques, the word or phrase is still present, but a nonliteral context is created that diminishes its normal symbolic functions and increases its more direct functions (in this example, its auditory or kinesthetic functions). Stated another way, defusion techniques help clients to see thoughts as thoughts and to be less fused with what the thoughts imply. Additionally, creating defusion is not done through logical argument ot instruc- tion, but rather through modifying the context in which choughts are experienced. As a zesule, the literal fanctions of problematic thoughts ate less likely to dominate as a source of influence over behavior, and more helpful, direct, and varied sources of control over action can gain ground. WHY COGNITIVE DEFUSION? Defusion techniques are most usefull when the client is engaged with thinking in a number of potentially problematic ways. Examples include when the client is holding the literal meaning of a word to be true, when the client is trying to control thinking, when the client is generating reasons to justify behaviots, cor when the client is insisting on being right, even at personal expense. The defusion techniques used in ACT include paradox, meditative exercises, experiential exercises, metaphor, and language conventions. 58 Leatning ACTClients are encouraged to focus on effective action, given the current situation once defusion has been established. The following hypothetical situation illustrates how this might be helpful. johns alarm does not go off, and he wakes up late. He immediately thinks of his wife, and the thought appears: “She ser the alarm wrong” Now, iFhe does not catch that this is a thought, he may begin to look at the situation as structured by that thought. He does not need to be aware of this process in order for it to occur. If he were, in that moment, aware of the process of thinking and of the fact that he just had a thought, he might not sey the next thing he says, which is “You forgot to set the clock again. Now Fm late” His wife now feels blamed. ‘An argument ensues. IfJohn had been able to observe the thought, he might have caught that it was just that—a thought—and been able to respond more flexibly. He might have noticed the thought, and then focused on what would probably be more effective in this situation, and following his values to be open and loving, he might have said, “Honey, do you know what happened with the alarm? Did I forget to set it?” Being able to simply catch the process of thinking in flight and watch it asan observer can begin to create an opening wherein one might be able to step out of habitual patterns and engage in more effective and values-based actions. ‘Therapists learning ACT can struggle with defusion because there is something inherently difficult in using the main tool at our disposal—language—to weaken language. The situation is similar to how oil well fires aze often extinguished. An explosion (itself fie) is ereated at the source of the oil well fire that momentatily useé up all the available oxygen. The remaining oil is left without oxygen, and thus, the fire ceases. Similarly, ACT uses language, and loopholes in its functioning, to extinguish its effects in certain areas of our lives. I’s not that language itself is eliminated, but some of its less useful func- tions are weakened in some contexts, so more flexible ways of knowing can have greater influence over behavior. Te would be nice if fusion could be weakened by simply explaining the dilemma, much as we have done in this chapter so far. Unfortunately this explanation depends entirely upon literal meaning for its impact, and in order to defuse, we must step outside literal meaning. To do this, ACT uses language in nonliteral ways, such as the way a coach might speak to a player, for example, by saying, “See if you can hold that thought like you might hold a butterfly that has landed on your finget” WHAT SHOULD TRIGGER THIS PROCESS? Focusing on this process is most appropriate whenever the therapist finds the client believing, “buying,” “holding onto,” or clinging to a particular thought or word, and these same actions are limiting or prevent- ing healthy movernent in the client’ life. This usually shows up when a clieit seems to be heavily saddled ot “trapped” by a thought or feeling and finds himself or herself unable to take valued action based on the same thought or feeling. For instance, 2 client might say, “I will never be able to find a partner, I am just worthless. Who would want me?” Here, we can see that the client is trapped by the word “worthless.” Held to be literally true, it seems that finding a partner would be impossible: who would want a worthless human being as a partner? However, ifthe client can come to see that “worthless” is a word that is said under certain conditions and given a particular history, and that it is noc something he or she literally s, then “I cant find a partner because I am worthless” has less control over behavior. This does not mean the client has to stop thinking he or she is worthless or start thinking he or she is worthy; rather, if the client ccan see the thought as a thought, then its power to control actions is lost, even if chat thought continues to occur. The following transcript demonstrates the triggering of use of defusion in session (approximately five sessions into therapy). Undermining Cognitive Fusion 59Therapist: Client Therapist: Client Therapist Client: Therapist: Client: ‘Therapist: Client: ‘Therapis: Client: ‘Therapist: Client: You soem pretty blue today. What's happening for you? Tes just allways the same story .. I try to do something to make things better and ic fails .. It always fails Its abways like that. So there's this place where you get stuck when this same story, “I try and nothing works,” shows up, hangs head and speaks softly] Let's face it, 'm doom and gloom. You've mentioned that several times now. You've told me you are doom and gloom. Tam doom and gloom. want to recognize the pain of this thought and the struggle thet is built around it, but Tim wondering if you might be willing to be a litle playful with me for a moment? Sure ... might as well This might sound a litle silly, but would you sing the words “I am doom and gloom for me? {chuckles} What? Let's just work with this for a minute. Give ita try. [sings the words “I am doom and gloom’; unbeknownst to the therapist, he has quite a good voice and sings solemnly and with heartfelt pain} Great ... Could you sing it again? Only this time, sing t with great enthusiasm, as if you are in a Broadway play. [chucldes again] Okay. [sings the words, but from the new perspective] The client was then asked to sing the words from several other perspectives: as a woman, as a small child, as Mickey Mouse. With each new rendition, the therapist could see the client beginning to defuse from the words. Client: Theropis: liens: Therapist: The words just seem kind of funny to me now. Interesting how that works, isnt it? When you are really trapped in those words, it seems that they paralyze you. But now that we have loosened the trap a little, what do you notice? ‘They don't seem to have the same power. They're kind of funny now. From this place, being loosened from those words, I wonder if we can start to work on where you are headed? This is just one example of the many ways'defusion can be brought into session. It is important to note that these exercises are designed to take the meaning out of (deliteralie) the words, not co change the number of times the client thinks them, nor to change them into positive words (e., “I am great and 00d”). Also, defusion should be done with a compassionate nature, which can be playful or serious. It should never be done from a position of one-upmanship or from a position that makes the client feel silly or humiliated for having the thoughts. A 60 Learning ACTWHAT IS THE METHOD? ‘Already, scores of defusion techniques have been developed for a wide variety of clinical presentations For example, a negative thought can be observed dispassionately by having the client watch the thought as if watching an uninteresting, nonprovocative television commercial. The thought can be treated as an externally observed event by the client, who gives it a shape, size, color, speed, or form. The client can thank his or her mind for such an interesting thought; label the process of thinking (e.g, “T'm having the thought that I am no good”); or mindfully observe the thoughts, feelings, and memories that occur in con- sciousness. Such procedures attempt to reduce the literal quality of the thought, weakening the tendency to treat the thought as what it refers to (eg, the experience “I am no good”) rather than what i is directly experienced 10 be (eg, the thought “I am no good”). The result of defusion is usually decrease in the believability of or attachment to private events, rather than an immediate change in their frequency ot their form. EXERCISE: DEFUSION, PART 1 Bring one of your clients to mind, preferably a difficult one. Think of three thoughts this person has about himself or herself, his or her life, or his or her future that are difficult for this client. Try to be specific. Record these below: Thought 1 Thought 2: Thought 3: ‘We will come back to these later in the chapter. In the following sections, we illustrate the major types of defusion techniques, organized by the general therapeutic target. By aztanging them in this way, we hope to show what lies beneath the methods themselves. Defusion is not just a specific technique; it is a functional process, and it is this kind of knowl- ‘edge that moves ACT from a mere collection of procedures to a clinical model. in popular ACT books, such as Get Out of Your Mind and Into Your Life (Hayes & Smith, 2005), we even teach ACT clients how to generate their own novel defusion techniques. The purpose of this section is similar. Thus, these are examples; they are not “the lie” of ACT defusion techniques, nor are they exhaustive. The list is limited only by your own creativity and that of the ACT/RET community worldwide. Before we move into the different defusion techniques, itis important to remember that defusion is, not confrontational, although i can be powerful. It is an excellent technique to help clients observe their minds. However, elients can report feeling confused, disjointed, or “out of sorts” during and after sessions that focus heavily on defusion. These feling states are perfectly acceptable, Artful defusion can often have the quality of a lightfooted dancer or of a judo master. Both of these experts do not meet partner move- rents with force, but rather join with and redirect their partner's movements in more useful directions. In defusion, client verbalizations are bounced around, mixed up, and played with in order to see them. Undermining Cognitive Fusion 61from varying viewpoints and to explore their many qualities. This is done without direct confrontation or refutation. For example, an ACT therapist might appreciate the beautiful creativity of a client's mind by congratulating him or her for coming to a bleak conclusion. In this case, if the client said, “So then I thought I'd completely blown it,” the therapist might respond, “Ah, very nice. That's a good one, Go mind!” Be playful with defusion, but es noted, always maintain compassion. Teach the Limits of Language in Rediscovering Experience “Verbal knowing rests atop nonverbal knowing so completely that an illusion is created that all knowledge is verbal” (Hayes et al. 1999, pp. 153-154). ACT therapists often introduce defusion by point- ing to the limits of conscious thought. Various metaphors and exercises are used to demonstrate that our minds do not hold all the answers; that, in fect, there are ways of knowing that operate beyond the mind. ‘One way to do this is to appeal to the client's experience in areas of his or her life in which what the mind knows may not be enough or even can be detrimental. For example, some tasks involve very well: regulated verbal knowledge, such as how to find a cerzain website on the Internet. Other tasks are less 805 for example, learning how to play a musical instrument or a new sport. Clients also may have had experi- ences with tasks wherein language actually interfered with effective functioning, such as in performance anxiety, sexual behavior, or “choking” on the golf green. The therapist can tentatively suggest, “Although language and rational thought can be helpful in some domains, what if there are other domains of life in which being logical and following what one's mind has to say is actually problematic?” This basic idea can be demonstrated by asking the client to verbally instruct the therapist to engage in physical movement, as in the case of the following transcript. In it, the therapist responds to the eli cent’ instruction by asking the client how to do each move instructed. This exercise nicely points to the arrogance of language because physical movement is generally learned through experience, not through instruction. The basic idea of the exercise is to show the client that some of the things we know how to do are not known through conscious knowledge, but rather were learned through experience (Hayes et al., 1999). Therapist: ‘Tell me how to walk from my chair to the door. Client: Well, frst stand up, and then put one foot in front of the other until you are standing over in front of the door. Therapist: Good. How do I do that? Client: What? Ob, push up with your hands on the arm of the chair until you are standing, and then move the muscles in your leg so that you are stepping forward ... let your weight move with you Therapist: Great. How do I do that? Client: [chuckles] Tell your brain to tell your hands and legs to move. Therapist: How do Ido that? [continues with the client in a playful way, asking, “How do I do that?” after each instruction, until the client says, “I don't know."] And anything you tell me to do, Tam going to say, “How do I do that?” You see, it was a litle bit ofa trick. I asked you to, tell me how to walk, and your mind went to work thinking it knew how to tell me that. All minds do that. But the deal is that neither you nor [learned how to walk by someone telling 62 Leaming ACT