This was one of the first groups I ever tried. I ended up doing it twice, both times learning new things and coming away with different experiences. ACT stands for acceptance and commitment therapy. From what I understand, it’s an approach challenging people to accept their thoughts and feelings and still commit to change.
The two different groups that I participated with were closed, public groups. This means you need a referral from a team member from Mental Health and Addictions. It’s held for two hours once a week, and is mostly tailored for those suffering from anxiety disorders and depression. By the third week, both times, all but 5 members drop out. On my second go, there were only four of us (me included) who completed the program.
The first day you do a baseline psychological test, in which you’ll repeat the last day to see if your efforts in the group yields any improvement. The first time, my results were not shared with me, but the second time, they went over in detail and course of follow-up treatment was decided. I applaud this change.
You also decide the ground rules for the group, and expect these to become lax half-way through, including the facilitators. I swear to hydrogen you’d think one of the facilitators was going to die without that cellphone… *Cough* I’m sorry, what?
The only strict rule that was obeyed was no mingling outside of the group, and if you see someone else who participated, act like you don’t know them. Cordial nods of acknowledgment are always accepted. I fucking hate this rule, particularly for this kind of group. These people (including myself) need as much social interaction as possible to build confidence and practice what they learned. A flaw they still have is getting through the material and allowing for group practice before setting out. Instead, you’re encouraged to try on your own after only vocalizing your goal, and getting feedback. You get some success, but this is probably why so many drop out. Exposure should be gradual, and to many it can seem you’re being thrown into the deep end of a pool when you don’t know how to swim.
So, both times, I clearly stated that if any of them see me outside of these walls they are welcome to approach. The facilitators (both times) were fine with this. I still keep in contact with a few other members. Both times, these people have to be the most empathetic, kind and patient types of people. Even when there were disagreements, it was shared and understood where it came from.
For the first few weeks, you’re asked to jot down a situation in which you start having negative, avoidance related thoughts, feelings and behaviors. You’re also asked to write down any bodily sensations, where your focus of attention was, and how you responded to the situations. You then have to think back and document anything you want to get rid of (thoughts, feelings, sensations, memories etc), what you’ve done so far to try in order to avoid or get rid of, and if it brought you closer to a meaningful life without the cost of time, energy, esteem… Here, let me help you with this homework: none of it worked, don’t defend anything. Around this time, you’re given a brief explanation of the definition of ACT, and mindfulness will be introduced.
This is the biggest contested part of this group, and it happened both times. You’re given a CD with prerecorded tracts that include quick guided body scans, to lengthy guided and unguided meditations. Other than my issues with the CD itself (you can find better, higher quality guided meditations for free online), I think the biggest problem is that mindfulness is marketed as a relaxation technique, and many cannot get over that fact as a bias going in. Not in the concept of ACT: you’re asked to sit in whatever the hell/peace state comes on, emphasis on hell. With anything, it’s a practice. The more you do it, the better you become. I noticed in both groups the tendency to give up quickly is high.
The first time, this was quite problematic for myself. I knew less about my dissociative tendencies, so allowing that pain in caused my brain to check me out (and full blown panic attacks to occur). What would happen is that there was a counting aspect, and it heavily makes you focus on your breathing. I kept seeing a white light: cue my disorder. After much self-reflection and keeping at it, I was able to link the breathing to my cancer trauma (years after the first group). What do they ask you to do just before you go under for surgery? Focus on your breathing and count backwards. What do you see as you go out? A giant, circular white operating table light. I’m disappointed it took me several years to figure that out by myself, and basically doing my own exposure work with hospitals.
The facilitators were not trained in my kind of trauma response other than the basics, and at first, I don’t think I was believed. Mid way, with the exception of one, they reacted quite frustrated with me when I asked about alternatives. It got to the point of my questions and curiosities turned into their frustration projected outwardly. They really didn’t know how to go off-script. This, and not understanding there’s a third component to anxiety: freeze. One facilitator accused me of wanting control over the group, and arguments became so heated between the two of us that another group member told me you act like an old married couple.
I still don’t know what that really means. Trying to work things out with that facilitator in private, it was explained to me it’s not a bad thing. And yes, we did work things out over time. They’ve seen it all (well, with me for sure – ha!), don’t let petty shit get in the way of your treatment and you getting better. It came from my academic background: I’m conditioned to question theory, and when doing supplemental reading I found counter-arguments to the ACT program (I wanted clarified – that’s on me, and I admit mistake. Group isn’t academia, but nor should it be shut up and do as your told, and neither of us knew how to find a balance).
The second time around, and having that same facilitator, this person did apologize admitting that ACT doesn’t really address my kind of anxiety, and applauded that I continued to try despite the distress it caused me, and continuing to be able to air grievances constructively (after both our heads cooled). I learned a lot about myself that first go around, even though it wasn’t what the actual outcome was supposed to look like. The second go, we weren’t discouraged when we found supplemental materials, but it was asked to share at the end and maybe focus on it after we see what they have to offer first. That’s fair. I think it became reasonable that not everything fits everyone, and options are always good.
The facilitators and I worked around that part of mindfulness the second go around since it couldn’t be fairly treated. Welcome to the public system. A lot of the other material couldn’t be applied to freeze, so I felt a bit isolated and shut out. It’s not like me to be that quiet, and even though I was reassured my participation was insightful, it felt forced, and sometimes fake. If anyone out there’s familiar with Goffman’s The Presentation of Self in Everyday Life, you’ll understand when I say I struggle with front stage/back stage performance in the game of life. This was picked up by that facilitator and one other, and to be honest, I lied and said I was fine. I decided I’d go in this time and take what I could that applied the closest to my situation. This is a second thing I learned about myself: how defeated I get. I personalize what is not personal. The supplemental things you learn about yourself is astonishing.
You may be asking well if I have any kind of dissociative disorder or tendencies, I shouldn’t try mindfulness or bother with this group? No. Tell the facilitators at the start, and know your limits when it comes to the meditations. They’ve learned since that first time, and I wholeheartedly believe they give a shit about you, never doubt that. Mindfulness is used in other types of trauma-based therapy, and what was different the second time around was incorporating mindful type practice beyond the CD. Example: being present in the moment and not being on auto-pilot. You ever drive home and you don’t remember the whole route? Stop doing that sort of stuff. What does the shower really feel like? What does the process of making your coffee like? How does food really taste? Being able to identify and not escape. Doing with intent, even basic day-to-day function. Digging deep and figuring out why you’re being triggered. And, as you’re reading, I did the damn group twice with the same, stubborn… Ah. Shall we continue?
The other aspects of the group asks you to figure out your values, and based on what you decide as the most important (and what you want to improve), you create small SMART goals to start going in the direction of the life you want. I struggle still with the values part, but SMART goals are a great learning tool on how to organize the little things to the overwhelming stuff. I’m not kidding. Some start with I’ll clean 5 dishes tonight after supper (not living in disordered chaos). Others more complex such as I’ll walk to the bus stop (leading up to actually taking public transit). Here’s where ACT kicks in, you have to accept the outcome, and whatever comes with it (success or failure). Some of mine were going out and talking to people, stick to my exercise regime regardless of bezo flu, and following up on doing something for another I avoided for months. Some worked out, others didn’t. It’s then changed to make SMART goals that correlate with your values to improve your life. Both times, I didn’t have success here, because I still have difficulty figuring out my core values. They’re in there, sure. I don’t know what’s blocking me from figuring it out. It’s most likely the cause of the worthlessness I can’t shake.
You also learn how to work with your brain no matter what state it’s in, and this kind of mindfulness/behavioral tricks are what I resonated with the most. I will go to this event and I will feel isolation. Emotions and thoughts shouldn’t control behavior, they are separate. Another big one is willingness: open to experiencing your personal experience as is, without trying to change, avoid, escape, or manipulate. I discovered the second time around that I’m sometimes too willing, which I end up in situations that aren’t the best.
The grande finale of this group is you have to decide on something you’re really afraid of, and they’ll face it in group with you. The first time this was successful. One person walked up and down a hill. Another who was afraid to make phone calls ordered the group pizza. For me, I ate pizza with two kinds of meat (my orthorexia was a lot worse then) and I wore a dress (body issues). The second time, since we had so few members and a lack of participation, we ended up writing letters to ourselves that we’re only to open when things are better. I hope I’ll be able to open mine one day, I already forget what I wrote.
Accept and commit to willingness as being vulnerable may cause some cuts and bruises, but lead you on the path to what you want in life.