When “Positive Thinking” Doesn’t Work, Try ACT Instead
Has anyone ever told you to “think positive?” Over the last eighteen years of living with autoimmune arthritis, many well intentioned people have encouraged me to think positive. While positive thoughts are certainly appealing, I have personally found that attempting to force positive thoughts is an exercise in futility.
After working with a psychologist and psychiatrist, I’ve been able to cope with the pain, stress and unknowns of my health conditions through a different means. Acceptance and Commitment Therapy, also known as ACT, is a mindfulness and action based approach that I’ve found particularly helpful for facing life with chronic illness.
Why does positive thinking not work for some people?
Before delving into ACT, I will explore the limitations of “positive thinking.” Let’s do a thought experiment: think back to a time when you were really angry and someone told you to “calm down.” Did hearing you should “calm down” make you feel calm? We all know that telling someone in an argument to calm down is completely futile. Why? Because as much as someone who’s out of control emotionally may wish to feel calm, they don’t have the ability to simply feel something just because they want to.
Telling someone in pain to “think positive” feels similar to telling someone who’s angry to “calm down;” the end goal is noble, but the strategy to get there is inadequate. Positive thinking can be useful in some specific contexts, such as when we are fixating on something negative and missing the big picture. In those cases, remembering to be grateful helps us attune to the positives in our lives. But simply saying “think positive” won’t usually do the trick!
What is Acceptance and Commitment Therapy (ACT)?
In Russ Harris’ fabulous book The Happiness Trap, he explains that: “In ACT, acceptance always comes first. First you make room for your feelings and allow them to be exactly as they are. Then you ask, ‘What can I do right now that is truly meaningful or important?’ This is very different from asking, ‘How can I feel better?’ Then, once you’ve identified an activity you truly value, go ahead and take action” (page 108).
While ACT is often framed as a “mindfulness based approach,” it is qualitatively different than how mindfulness is often packaged and sold to people with pain. The idea isn’t to use ACT therapy as means to escape or get rid of your pain or negative thoughts. You don’t “do ACT therapy” as a tool or strategy to feel better. In ACT, you simply learn how to notice and acknowledge thoughts and then move on to living your life.
What does acceptance really mean?
For those of us who live with pain, acceptance can be a tricky concept. Acceptance in the context of ACT does not mean resignation, or simply throwing your hands up and saying, “Nothing will ever get better, I will always have this pain so I have to just accept it.”
As Russ Harris says in The Happiness Trap: “Acceptance doesn’t mean you have to like your uncomfortable thoughts and feelings; it just means you stop struggling with them…Acceptance literally means ‘taking what is offered.’ It doesn’t mean giving up or admitting defeat; it doesn’t mean just gritting your teeth and bearing it. It means fully opening yourself to your present reality—acknowledging how it is, right here and now, and letting go of the struggle with life as it is in this moment" (page 58).
It reminds me of the difference between “pain” and “suffering.” As an occupational therapist, I learned that pain is a physiological phenomenon, and suffering is a psychological phenomenon that occurs as a result of our reaction to our pain. ACT allows me to alleviate the struggle with my experience of pain, which thus reduces my suffering.
Acceptance doesn’t mean you can’t hope for a brighter or less painful future for yourself. It does, however, mean that you orient yourself to your present reality and possibilities for meaningful action rather than attaching or clinging to a potentially brighter future.
My personal experience with ACT therapy
So, I’m the first to admit that ACT therapy was not initially intuitive for me. I went to therapy to feel better and wanted the therapist to tell me how to “get rid of” negative thoughts. When my therapists first started talking about an acceptance-based therapy, I was like, “Um, that sounds like settling. No, thank you.”
However, I trusted that they were onto something. After years of being sold different methods of “feeling better,” all of which were inadequate in some way, I was now being told a different story. What if I was asking the wrong questions?
What if the right question isn't: “How do I feel better about this difficult hand of cards I’ve been dealt with my health?” but instead: “What would happen if I learned how to simply acknowledge my thoughts and feelings rather than seeing them as problems to be solved?”
By nature, I’m a future-oriented, busy, active person. So, slowing down and acknowledging my thoughts, rather than racing to fix them or move on to solutions, took a lot of practice! However, my life has ultimately changed for the better as a result of learning ACT therapy.
Unlike “positive thinking,” ACT therapy doesn’t see thoughts as good or bad, positive or negative. ACT frees me from the oppression of the expectation that if I just did X or Y or Z, I would feel better. It’s basically annihilated my attachment to the idea of feeling better, which paradoxically...makes me feel better.
I don’t recommend going into ACT therapy with the explicit expectation that it will “make you feel better.” The attachment to the expectation of feeling better will not work in your favor. However, I do feel better equipped to face the many ups and downs of life with chronic illnesses after engaging in ACT therapy, which is a nice bonus! I’d love to hear from any of you who have also tried this evidence-based therapy approach - let me know in the comments.
Other than back pain and fatigue, what is the most common symptom that AS patients experience?