22.2 Steven Hayes, PhD: RFT, ACT, Evolution, The FLIP, and Mental Health

[00:00:00] Something you said that I wanted to ask you about, because RFT in particular, it's really expanded the way that I view as a whole mental illness. And you mentioned that this process of the kind of expansion of consciousness that comes with initially the ability to even form and retain memories around age four and five, I kind of shifted in my beliefs that in order to develop

[00:00:29] some of the more serious or severe mental illnesses, depression with suicidality and suicide attempts or bipolar disorder and the potential to be manic, which to me, it just looks like a totally unchecked mind. The conscious part of you kind of shuts down in the floridly 100% manic person. But to me, it's almost a necessary aspect to have that elevated level of

[00:00:59] consciousness. And it explains to me why we don't see these things emerge to their fullest extent until people get through that stage of puberty.

[00:01:13] Somebody get this guy some help!

[00:01:22] How do you kind of reconcile the concepts of RFT with how you view different mental illnesses?

[00:01:31] Yeah, I think what we're looking at is a gazillion variations of how these features can be combined.

[00:01:45] So, I talked about, you know, principle more than molecules of the universe, but frankly, most of us are going down the same train tracks over and over and over again.

[00:01:54] And in fact, there's a principles in network theory and so forth as to how these attractors work.

[00:02:01] But it's sort of, you know, to be able to deal with the potential chaos of a mind like that, we simplify and that's important for us.

[00:02:09] We draw principles, rules, central ideas, and they can become quite central like ruts in a road and your tires fitting so deeply that it takes something to jostle out of them.

[00:02:22] And each time you practice, there's a neurobiological groove that just made that next thing more readily done.

[00:02:29] And so, I think of the things that we call mental illness and mental disorders as a biopsychosocial combination.

[00:02:39] It isn't just cognitive, we're talking about this one aspect, and that spills over into all the psychological things.

[00:02:45] Some of it is all the way down to epigenetics and into brain circuits and so forth that are formed by that, but sometimes also sit underneath that.

[00:02:55] And social and cultural processes, you know, the ruts you're in are probably related in some way or another to the ruts your parents were in,

[00:03:02] or people who are significantly part of your upgrading or your particular cultural group, neighborhood, family, religious group, and so on.

[00:03:11] So, what we're going to need to do when we have a particular person in front of us, if we really want to help them, is not so much categorize which disorder they're in.

[00:03:24] And because the tools we have to do that by features, we've been trying to do it with signs and symptoms, are so crude that when you look at the individual journey,

[00:03:33] if you take anything like manic, like major depression, like whatever, PTSD, you name it.

[00:03:40] If you actually look at the particular features that are contributing to it over time within person,

[00:03:46] and you do that with many, many people who have the same label.

[00:03:50] And then you say, well, how much of the differences in the features here are due to the person or due to the random variation in the features they gave that label?

[00:04:01] You'll come up with percentages, like 80, 85, 90% of it is personal.

[00:04:07] And what that means is, and I'm talking a little bit geeky here, and I can go through the math about it and what that means as far as the turn that I'm trying to help the field make,

[00:04:18] away from bell curves of arbitrary collections into longitudinal understanding of the individuals we're working with clinically.

[00:04:27] You need to understand the particular way that things combine for that particular person to have the features that put you into a normative category, these labels that we're used to using.

[00:04:37] And when you're there, I'm not sure that you'd call it an illness.

[00:04:42] I think of it more like a kind of a cul-de-sac or aberration that is a logical extension of the combinatorial power of things that could move positive or negative.

[00:04:53] Let me give you an example.

[00:04:55] If you take something like what we call schizophrenia, there are some interesting things developmentally.

[00:05:02] If you move from one language community to another in the age of around four to eight, your probability of developing that diagnosis just jumped up by half or more.

[00:05:15] Why?

[00:05:16] Because at a critical developmental period, you were incredibly alone, didn't feel understood.

[00:05:22] Your sense of self was rocked in a really profound way.

[00:05:25] The other children around you couldn't even understand a single word you said.

[00:05:29] You know, in animal models, when we were trying to vet the chemicals, the medications that became so-called antipsychotics, that's really a marketing term.

[00:05:39] It was the original name was major tranquilizers, and that's a more honest term.

[00:05:44] Aren't they all marketing terms?

[00:05:46] They are mostly marketing terms and even measures.

[00:05:49] You know, the PHQ-9 turns out was developed by the marketer for Zoloft, and then some scientists put their name to it.

[00:05:56] But the marketer wrote the items, and you can see underneath it that there's a, oh boy, you know, it's pretty logical that we probably need to have medications for that.

[00:06:06] But I'm not singing a song against medications, but our point at which we can, you know, measure them in the fish in the open ocean and that one out of four women last year were on antidepressants.

[00:06:16] We've gone too far.

[00:06:17] Because, you know, in reference to the PHQ-9, because, you know, suicide should carry the same weight as how much you're eating and how well you're sleeping.

[00:06:26] I've always thought that was just a travesty.

[00:06:29] Somebody is, you know, actively suicidal.

[00:06:33] That trumps any other of those, you know, measures of depression.

[00:06:37] But anyway, I just had to throw that in there.

[00:06:39] Go ahead.

[00:06:40] Yeah.

[00:06:40] So originally, just to give you a little seed of where I'm going, when we're trying to vet and people didn't have any idea, you know,

[00:06:48] we sort of stumbled into why some of these medications, we call them, but chemicals were helpful in terms of, or it seemed to be at least short term,

[00:06:56] in terms of dampening down some of the excesses that can happen with chronically and severely mentally ill folks.

[00:07:02] They were looking for those that would not restrict escape from aversive stimulation, but would restrict avoidance.

[00:07:13] And there's a little group in there and the traditional work on psychobiology that was done this long, long ago.

[00:07:20] And they would just have rats in a cage and chemical to chemical to chemical to chemical.

[00:07:26] And it was just like feeding them and using these behavioral preparations.

[00:07:31] So now you look at escape and avoidance.

[00:07:33] You want to still have escape, but you didn't want to have avoidance.

[00:07:37] Well, if you look into things like, you know, trying to escape from emotions, that's deeply ingrained in many, not all, but many individuals with an SMI, a CMI diagnosis.

[00:07:55] And if you know details of their developmental history, you can see some of those features.

[00:07:58] Plus there's underlying neurobiology that made it more likely.

[00:08:01] I mean, there's that cluster often of things that, you know, they're not both sensitive and specific.

[00:08:09] Otherwise, there'd be a biomarker for SMI, CMI that everybody would use, but they're not.

[00:08:14] That's not what it's like.

[00:08:15] But there's a general tendency towards being able to associate things over longer periods that are negative and to be more likely to respond to aversive events.

[00:08:25] And that's true for drug addiction, for anxiety, for depression.

[00:08:30] They all have more likelihood around those clusters of gene systems.

[00:08:35] So here we are.

[00:08:37] Bottom line, what I'm saying here, what we're trying to do with managing this through medications properly used, smaller dose, taper off, always combine it with biopsychosocial,

[00:08:53] get people the social support they need, try to catch it early, you know, with wise combinations.

[00:09:00] And it's in our research literature.

[00:09:02] We know a lot about how to help that.

[00:09:05] We can help people learn how to sit with their own emotions and thoughts in a different way.

[00:09:11] And to be able to step forward in a different way that reduces re-hospitalization.

[00:09:17] We have randomized trials with tiny interventions of ACT, reducing re-hospitalization over a year, you know, like four or five, six hours, a tiny amount of work, just a little bit enough.

[00:09:27] You're still, of course, with you're still delusional.

[00:09:31] You're still hallucinating.

[00:09:32] But you're out of the hospital because that next step that just takes you too far where you have to be hospitalized and most people don't want to be, they want to, etc.

[00:09:41] So I'm giving it too long of an answer, but here's the way I think about it.

[00:09:46] We are complex networks.

[00:09:48] We're evolving systems.

[00:09:49] Our job as helping professionals and as individuals is to learn how to evolve our life.

[00:09:55] And that includes also our relationships, our family at all levels while taking care of our body.

[00:10:03] Life is asking you how to learn to be more open, aware, and actively engaged in a meaningful life while extending that to your relationships and taking care of your body.

[00:10:13] Every single change process that's been validated and replicated is in that sentence, to my knowledge.

[00:10:21] If there's any of it or not, let me know.

[00:10:23] Email me.

[00:10:24] Because I've done the work and we've looked at every single mediator that's ever been found and replicated in the history of the world for a randomized trial for a mental disorder.

[00:10:34] And they can all fit into that sentence.

[00:10:38] So that doesn't mean we have the cure, but it does mean we have an overall model that will allow us to begin to untangle the specific journey that person was on enough to be able to bump it forward in a different way.

[00:10:55] And it's going to change.

[00:10:56] If you've got signs and symptoms and you've got one of these eight things and one of those five, the combinations are going to be so numerous.

[00:11:05] You know, there's 600,000 ways that you can become PTSD.

[00:11:09] There are almost 11 million ways you can have a DSM diagnosis.

[00:11:12] If you had specifiers, the 161 septillion combinations that can give you a DSM diagnosis, nobody can manage that.

[00:11:21] But you can manage a smaller set.

[00:11:24] You as a therapist, you as an individual of how do I handle my own emotions, thoughts, attention, sense of self, overt behavior, motivation, and my relationships in my body in a way that will allow me to be open to my past.

[00:11:42] Present here, allocating my attention in a way that fits my purposes and to decide what that purpose is and to build habits around it.

[00:11:51] But that's not so complicated, but it's another way to say the sentence I just said.

[00:11:56] And so let's focus on it.

[00:11:58] Let's learn it.

[00:11:59] Let's support each other in it and stop all of this silly stuff about the island archipelago of this therapy, that therapy, this therapy.

[00:12:11] Let's learn from each other and do it in a way that psychiatry, psychology, social work, but not just that.

[00:12:18] The coaches, the teachers, the business owners can get on the same page and begin to create a world that's more that allows us to be whole and free.

[00:12:28] Yeah, I mean, it was a very unifying theory for me because, you know, you quickly realize, despite what is in the textbooks about some of these conditions, you know, OCD is not here and schizophrenia is here and here.

[00:12:44] And PTSD is over here and depression.

[00:12:47] There is so much symptom overlap that you don't really see these pure forms of illness.

[00:12:55] What does bind everybody together is this relationship and within their own internal consciousness, this constant conversation that is going.

[00:13:04] And you can use that construct to, I think, better explain some of these illnesses.

[00:13:13] I mean, is there a biologic component to mental illness?

[00:13:16] Absolutely.

[00:13:17] You see that.

[00:13:18] I don't know if you saw the HBO documentary somewhat recently, Six Schizophrenic Brothers, where six out of 12 siblings all have schizophrenia.

[00:13:29] But as they go through the progression, the younger ones get it earlier and later on in life, they figure out that the older ones were sexually abused.

[00:13:40] And then they bestowed that same sexual abuse upon the younger siblings.

[00:13:45] And so there is this kind of crossover between the genetic profile that somebody is born with and the epigenetic influences that their environment has the ability to change the expression of that code.

[00:14:01] So I just think that it really has helped me to connect with any patient by going back to that very basic, kind of like how you talked about in coming up with the theory, going back to the basic question, like, what is a word?

[00:14:15] What are these kind of this jumbled mess of different sounds that creates this narrative that I can communicate with somebody else?

[00:14:24] So I just think it's so helpful to be able to touch and get to any patient's condition, even if they're experiencing something that I don't have any personal experience with.

[00:14:36] In addition to that, I know that you're a big evolutionary thinker.

[00:14:40] I like to fancy myself the same way.

[00:14:43] And I regularly walk patients through this imagined experience of living in a cave and talking about what kind of thoughts would you have experienced 10,000 years ago, 100,000 years ago?

[00:14:57] Like, you know, maybe you see a paw print in the sand and your mind will automatically produce this could be a predator that could eat me or it could be prey that I could eat, both directly increasing my likelihood of survival.

[00:15:10] And one of the parallels or the things that I really think strikes home with a lot of patients is I talk about social standing within the tribe.

[00:15:20] If I tell an absolutely horrible joke that offends everybody in the cave and I get kicked out of the cave, I'm kind of fucked.

[00:15:29] My survival is pretty seriously threatened without all the technological amenities or if I don't find another tribe pretty expeditiously.

[00:15:38] And this helps me to provide a viable evolutionary and RFT-based explanation for why I may experience the feeling of doom and gloom in modern times.

[00:15:52] When all my friends go to the movies together, I don't get invited.

[00:15:56] I feel like my survival is threatened.

[00:15:59] But quickly, as that feeling or thought reaches my frontal lobe, my center of consciousness, I recognize how silly it is.

[00:16:08] Now, not only did I have to consciously experience the feeling of fear about my survival, but very quickly, internally, so many of us then experience feeling stupid about how I feel.

[00:16:21] A form of, you know, cognitive dissonance.

[00:16:24] And it leads us to tend to seek out avoidant behaviors, I think.

[00:16:28] I've got a big follow-up question to this, but first, like, how do you incorporate evolutionary biology into the concept of RFT and the practice of ACT?

[00:16:40] Well, RFT evolved because of the social primates that we are learning, you know, no other creature.

[00:16:46] If I just sort of gave this an arbitrary name and called it a cup, and then even to an infant, once they begin to settle in, not at birth, but somewhere around that 12-month period,

[00:16:56] if I said, where's the cup, you know, they'd take their little wobbly head and they'd try to find this.

[00:17:01] You learn it in one direction, you drive it in two.

[00:17:03] And then next thing you know, they're into networks and they're changing what you do.

[00:17:07] This is my little ditty for what the RFT is about.

[00:17:10] And so that came from, I believe, the fact that we as social primates, the reason I believe this is even young infants will try to do this before they're having language.

[00:17:21] They will try to reward cooperation and they will understand the intentionality.

[00:17:26] They have some theory of mind about why the adults around them, the creatures around them are doing things.

[00:17:31] And if I had a name for this, and many, many animals on the planet do have characteristic sounds, gestures, whatever.

[00:17:39] And, you know, if a chimpanzee sees a snake and hoots, it's characteristic.

[00:17:44] You hear the hoot, you run.

[00:17:46] There's prairie dogs, et cetera, where there's squeaks, hidey holes, keeping them away from the eagles, et cetera.

[00:17:51] But for us, it's integrated and arbitrary.

[00:17:54] It can be done socially.

[00:17:56] We can make things up because we're the band that having given in our little band a sound or whatever that goes with this, like, let's say instead of a cup, it was something like apple.

[00:18:09] And then across the ravine, I could say apple.

[00:18:11] I'd have some chance of it being brought back to me.

[00:18:15] So the object name would lead the name object by my mates.

[00:18:22] As that begins to happen and becomes internalized, as soon as infants you see it, as soon as they begin to learn, every parent has seen this.

[00:18:31] They don't know what they're looking at.

[00:18:32] But you get this explosion of language because, you know, you learn by being taught mama, dada, et cetera.

[00:18:38] Next thing you know, they know stuff you never taught them.

[00:18:41] That's because you were using words for things they didn't have names for.

[00:18:45] And they could recognize, oh, I know what this is.

[00:18:49] I have no idea what that is.

[00:18:51] And if they just hear pen, they'll derive because this is not a pen.

[00:18:57] This must be a pen.

[00:18:59] So you get from same to relations of difference from there to opposite.

[00:19:03] Then you're off to the races.

[00:19:05] Good and bad.

[00:19:06] Time, place, person, hierarchy, features, et cetera.

[00:19:11] All these different relations.

[00:19:12] Now, from the kind of evolutionary part of it, and that's a little bit of what's called multi-level selection.

[00:19:19] The group benefits because within the band or tribe, there were some who began to internalize and learn in both directions.

[00:19:28] And it gives you wonderful opportunities to ask for things and get it.

[00:19:33] Or to begin, as you get more sophisticated, probably took some thousands of years, but to use it for problem solving.

[00:19:40] If I do this, then I'll get that.

[00:19:42] Just do it in your mind without actually having objects.

[00:19:45] You know, the person who's feeling shame at violating a group thing, if I do this, I get that, will turn into, you know, if this continues, I'll be totally alone.

[00:19:54] I'll never be able to be part of the group.

[00:19:57] You know, that one instance of not going to the movie theater can turn into probably how a primate would feel if they're about to be cast out from the tribe, which would mean almost certain death.

[00:20:10] There are some wild monkeys that might make it.

[00:20:13] You're not a monkey, but, you know, I'm just using the word.

[00:20:16] But it's pretty dang risky.

[00:20:18] You don't want to be on your own.

[00:20:20] So I think we can understand how powerfully, I mean, most of these traumatic experiences are really sheer or aversive.

[00:20:30] We focus on that.

[00:20:32] Why?

[00:20:32] Well, evolutionarily, when you talked about it, could be a paw of a predator or a prey.

[00:20:37] Man, it's a lot more important not to be lunch as compared to whether or not you get lunch.

[00:20:45] If I have to weigh those two, the possibility that it's a predator is going to be 10 times more important than the possibility that it's prey.

[00:20:54] But with my mates, maybe we could work together and explore the possibility that there's prey out there or maybe even here, in here, in the cave.

[00:21:03] So we're scanning for danger.

[00:21:05] We're overemphasizing it.

[00:21:07] It's being flipped.

[00:21:09] You talked about the underlying neurobiology of epigenetics.

[00:21:11] You know, the vast majority of your DNA is regulating the part of the DNA that's actually producing proteins.

[00:21:21] And it's doing it in gene systems.

[00:21:23] It's not simple stuff like you learned in high school biology with brown eyes and green eyes.

[00:21:28] It's, you know, heck, there's 724 loci for how high you are, how tall you will grow to be.

[00:21:36] And it only accounts for something like 5 or 10 percent of height.

[00:21:39] So you think of how complex these networks are, the two very basic things, like how tall you are, that are just biological things, you know.

[00:21:49] In the same way, let me give you a positive thing before I stop.

[00:21:54] Our sensitivity to environments is a statement that UCLA made that I like, which is cells are systems that have turned experience and context into biology.

[00:22:07] You know, that we have evolved, evolvability.

[00:22:10] We are the ones who, based on our behavior, are taking that vast part of our DNA.

[00:22:17] And because of how RNA works, that combination, we're regulating which features are going to be read and turned into biological things.

[00:22:29] So, for example, if you were to just meditate half an hour a day for eight weeks,

[00:22:37] Herb Benson, with the relaxation response, did this, you know, just focus on a single word repeatedly, like one, one, one.

[00:22:44] You don't need a special mantra.

[00:22:46] You don't need all the woo-woo.

[00:22:48] You can just do that.

[00:22:49] Read Herb Benson's.

[00:22:50] He's a Harvard guy, a late Herb Benson.

[00:22:54] A so-called relaxation response.

[00:22:56] If you were to do that for just eight weeks, approximately 12% of every cell in your body has changed in terms of which parts of your DNA are being read and used.

[00:23:10] And it's in every cell in your body.

[00:23:12] 12% of your body is different.

[00:23:13] Every single cell.

[00:23:15] If you're due something like 15 minutes of sitting and focusing, something like 2% or 3% of your body, every cell is being up or down regulated through epigenetic processes.

[00:23:29] And that's only looking at the ones that are easy to measure, like, you know, methylating cytosine so that you can't read genes that include a cytosine as a molecule.

[00:23:39] Well, there's about 25 different epigenetic processes.

[00:23:42] And that's why looking at methylation is easy.

[00:23:46] You can do a little test.

[00:23:47] Boom.

[00:23:48] You know, DNA folding is harder, et cetera, et cetera.

[00:23:52] So we've got this incredibly sophisticated body that evolved to be able to read what's going on.

[00:24:00] Why?

[00:24:02] To keep from dying.

[00:24:05] That's the game.

[00:24:06] And then now it's hooking up to your psychology and you're feeling something.

[00:24:10] You're bereft.

[00:24:12] You've been cast out.

[00:24:13] You're feeling ashamed.

[00:24:16] Yeah, that's how, that's psychological reflection of something that was so critical to you as part of being a social primate.

[00:24:26] But then goes back to things that all the way down, like if you have a strong enough thing and you have a history that where you just freeze in place, we're now into, you know, parts of our evolutionary history that are, you know, what lizards do.

[00:24:42] And that can happen to you.

[00:24:43] You know, like if, you know, you probably heard the phrase being scared shitless.

[00:24:47] You know, soldiers will literally poop their pants because their parasympathetic nervous system will get engaged in such a way that you start doing things that lizards do to sit for an hour without moving when there's a cat nearby.

[00:25:00] You know, where you just shut down.

[00:25:03] Okay.

[00:25:34] And that's what we're talking about.

[00:25:35] We're talking about with our parents.

[00:25:37] And of course, their parents and their parents.

[00:25:41] And we're not doomed.

[00:25:44] We could do things here and now that will actively change every cell in your body.

[00:25:51] In a matter of minutes, it can begin.

[00:25:53] In a matter of days, it can be grooved.

[00:25:55] You know, so you're not helpless.

[00:25:59] There's something you can do.

[00:26:01] And the job of us as clinicians and practitioners and scientists, but also as people is to learn how to take more responsibility for our life in the meaning of that word that fits how it was originally written.

[00:26:18] Response, able.

[00:26:20] There's something you can do.

[00:26:24] And if you're feeling helpless, let's take that feeling and allow it to empower the possibility.

[00:26:30] If you're listening or come to the end of this podcast, and there's something in here that somehow seemed interesting, look at the literature that's out there on psychological flexibility as a place to start.

[00:26:43] You can go to the World Health Organization website and get the most downloaded book.

[00:26:47] It's for free.

[00:26:48] And the entire website, it's an act self-help book called Doing What Matters in Times of Stress.

[00:26:54] It's a cartoon book with some audio tapes you can get in 30 different languages.

[00:26:59] It's a vast resource out there.

[00:27:02] And I'm just mentioning one.

[00:27:04] The science of lifting up your life and of walking yourself out of the cul-de-sac that you found in.

[00:27:13] No, it's not very mature.

[00:27:15] No, it's not sure thing.

[00:27:17] But it's there to be used.

[00:27:20] And there's dang good evidence that if you can put it into your life, into your head and your heart and your hands, it'll lift up your life to learn how to be more open, aware, actively engaged in a life that's meaning driven and extend that to your relationships and take care of your body.

[00:27:41] You can learn that.

[00:27:42] It's not so complex.

[00:27:47] It's not so complex.

[00:28:19] It's not so complex.

[00:28:24] It's not so complex, but it's not so complex, but you can use more in the surface.

[00:28:42] those same eight weeks spent meditating, you know, there are functional MRI studies that show

[00:28:50] changes being made in the brain. This is not just, as you said, this hippy dippy out there

[00:28:56] conceptual ideas. There is evidence behind this, the connection between, you know, what's called

[00:29:03] your default mode network or what some people may consider to be the mind in that default mode

[00:29:09] network. It changes when you meditate just five minutes, a couple of times a day for eight weeks.

[00:29:15] So, you know, of course there is biology and some of that, that is not modifiable, but why spend so

[00:29:23] much time focusing on that things that you cannot change kind of like why spend so much time trying

[00:29:29] to control your mind, which is to me, I think one of the biggest differences in, in my understanding

[00:29:35] of ACT versus CBT is you're letting go of the element of control. To me, the biggest difference

[00:29:45] in the human environment now versus tens of thousands of years ago in cave dwelling days

[00:29:50] is this massive amount of information that we're exposed to based on the theory of RFT.

[00:29:57] It will drive our minds to the fucking brink of insanity in the most simplistic terms. If you have

[00:30:07] more inputs that are related together in all these various ways to create novel outputs, then there's

[00:30:14] going to be a lot more outputs than there were in those cave dwelling days. One example is, you know,

[00:30:21] last summer being in between patients oscillating between that conscious engagement in my environment,

[00:30:29] documenting a patient encounter, and then the more subconscious kind of daydreaming.

[00:30:34] I recognize my mind piping up with concerns about that submarine that fell to the bottom of the

[00:30:40] Atlantic going to visit the Titanic shipwreck. And what would I do if I was in that submarine?

[00:30:45] How would I respond? Or how could I help in the search for this, you know, lost submarine, which

[00:30:51] unfortunately had already imploded at that point. And then you've talked about the idea that, you know,

[00:30:58] you're crossing a bridge in your car and you have the thought, what if I swerve off the bridge?

[00:31:03] Something that I've talked to so many patients about that are so distressed by that thought

[00:31:08] and typically automatically try to avoid or suppress it. To me, it's my mind trying to protect me.

[00:31:15] But I think in part, it's definitely driven by this massive expanse of information.

[00:31:20] I know I've watched newsreels. I know I've watched videos on my phone of things like this happening,

[00:31:26] whereas 50 or 100 years ago, you would not have been as aware of this possibility. You wouldn't have

[00:31:33] the actual video evidence that has played in your mind. And those are single examples of all the

[00:31:42] massive amounts of bullshit information we're exposed to that we never would have been exposed to

[00:31:47] 50 or even 100 years ago. What is the role of this massive expanse of information or inputs

[00:31:55] in driving our minds, you know, binary ordering zeros and ones, super computing processor, all these

[00:32:04] outputs? How does that, do you think, relate environmentally to worsening mental health outcomes?

[00:32:10] It clearly does. And we can understand some of it. And I've done some research around this. And I think

[00:32:17] the difficult thing I have to tell everybody is it's likely to get worse, not better. And those of you

[00:32:23] who are listening to this, you're concerned about your children and so forth, the best single way is put

[00:32:29] some of these flexibility skills you've been talking about into your head and heart and hands,

[00:32:34] and allow your children to see how it's been of use to you. And then yes, do some work and try to put

[00:32:42] it into their hands. And if there's some barriers there, you know, like you use the word mindfulness,

[00:32:46] you're there in the South. I used to be at North Carolina Greensboro, and it's not just a Southern

[00:32:51] issue. People are worried, oh, well, you know, this means we're putting Buddhism in there and I'm a

[00:32:57] a devout Christian or whatever. There are contemplative practices in every single religious group from the

[00:33:05] Ignatian way that our current Pope is doing, I was raised as a Roman Catholic, to just silence and or

[00:33:12] saying a rosary or, you know, focusing on the parables and the values that are included within them.

[00:33:20] You find a way to rein in the problem solving mind that is now being hyper activated. And frankly, it's being

[00:33:32] hyper activated for money, because the algorithms now are being used to show that if you respond to, let's say,

[00:33:41] a conspiracy theory will feed you more. If you respond to like horrifying images of what might happen in the

[00:33:48] world, we'll feed you more. And though I said it's going to get worse, I've just completed a study in my lab

[00:33:55] with Neil Fletta Cowden was the student, one of my last PhD students, showing that fake news, what we did

[00:34:04] is we taught chat GPT to make up arguments in the style of different newscasters left, right, and in the

[00:34:11] middle. Fake news, literally just make it up, is actually more persuasive and more interesting,

[00:34:20] generated by a large language learning model than the actual transcripts of things that those same

[00:34:27] people said. Now add into it the fact that you can already get visual images that are almost

[00:34:36] indistinguishable from real images that will back up what you just said. And we know with how fast it's happened

[00:34:44] when you remember your chat GPT moment or your Dali moment when you first went and said, okay, create a picture

[00:34:51] like this, and by golly, it was good enough to put on the Christmas card or send to your aunt as her special

[00:34:57] birthday card or whatever it was. It's so much better now. It's only a couple years later. Now go out

[00:35:04] another four, five, ten years. I mean, there will be no way that you could even know whether or not the

[00:35:12] sounds you hear, the images you see are made up or so. All right. You know people are going to milk that

[00:35:20] for money. Of course they will. And we'll gladly pay the money and lives will be ruined as a result.

[00:35:29] So we're not going to stop the tech. What we're going to have to do is evolve modern minds for this

[00:35:35] modern world. And I think what that's going to mean is learning how to be more open, aware, and aptly

[00:35:43] engaged in a meaningful life. Extending that to our culture, taking care of our bodies,

[00:35:49] and maybe more things. But let's get together on that journey. Because frankly, if you take something,

[00:35:56] a little evolutionary fact, here's the evolutionary fact. Take cooperation and say, do we have enough

[00:36:02] cooperation and compassion and kindness in the world or we need more? Almost every single person

[00:36:06] listening to me will say, we need more. Okay. Here's a fact. If you're selfish, if you're grabby,

[00:36:12] if you're stealing, you're lying, you're cheating, etc., you can have more just for you quick

[00:36:17] than you can by, in a moral and cooperative way, raising all boats of the particular groups that

[00:36:26] you're in. There's a dynamic there between balancing selfishness and cooperation. Just focus

[00:36:36] on the individual. Selfishness always beats out compassion, morality, etc.

[00:36:42] focusing on the groups. Compassion, morality, cooperation always beats out selfishness.

[00:36:49] What are the conditions under which compassion are less likely? It's one where we start feeling

[00:36:56] threatened by and competitive towards the people around us. And just listen to the newscasts.

[00:37:06] Listen to the politicians. Listen to the feed that you're getting and the movies that you're watching

[00:37:14] or the things that your kids are looking at. And see if you don't see in there things that look like

[00:37:22] they're scary, divisive, harsh, judgmental, emotional, negative. And now know that the more of that,

[00:37:33] the less of ability of us to cooperate as the social creatures that we are, the reason that we took over

[00:37:43] the planet is we know how to cooperate. We're not faster than the saber-toothed tiger. We're not stronger

[00:37:52] than the elephant. We're not better at any of it except our capacity to cooperate and work together,

[00:38:03] including this amazing thing we've developed called human language and cognition that we're talking

[00:38:09] about with RFT. So my message to you would be when you find a way to have peace of mind with purpose

[00:38:16] in your own life. And you can put it into the lives of others. Statistical fact,

[00:38:23] if you change in any important way, your friends are likely to change, their friends are likely to

[00:38:29] change, and their friends are likely to change. It's three steps out. That's a statistical fact.

[00:38:35] So the person's listening to us right now, even if it's 100 people, or something more like

[00:38:42] 100,000 people, if you've got a lot of friends and friends and friends and friends. So can we together

[00:38:50] learn how to put the things into our life that allow us to live inside a modern world

[00:38:56] where we're exposed to all these things and have a sense of equanimity,

[00:39:00] a peace of mind, and still be able to find our purpose, putting that into our families and

[00:39:06] taking care of our body as well. Yes, we can do that. That's modern minds for the modern world. If we

[00:39:14] don't do it, we're going to reap the wind because our problem-solving mind is the source of both of

[00:39:21] these things, and it's been put on steroids by science and technology, which is wonderful and awesome

[00:39:27] and also awful, just like that sense you had when you first looked at the pictures and now the

[00:39:35] movies that are entirely artificial, and no matter how closely you look at it, you can't distinguish

[00:39:40] whether or not that's real or computer generated. Okay, that's the world we're going to live in,

[00:39:47] and it's going to be robots around us doing our bidding. It could be a wonderful world,

[00:39:52] or it could be a freaking dystopian nightmare. What's going to decide the difference? It's going to be

[00:40:00] how we learn to manage our own experience in the interests of the world that we're trying to create,

[00:40:07] and with that, my friend, I have to stop, and I hope I've been useful to the listeners.

[00:40:13] Absolutely. I think that's a good place to wrap in terms of touching on all the political

[00:40:18] divisiveness as we're just a few days after the presidential election. My kids have changed the

[00:40:24] way that I think about these things, I mean, drastically in the last couple of years.

[00:40:28] Well, I didn't get a chance to talk to you about the default mode network, the flow state and

[00:40:33] athletics, the thing that you posted about your son with his black belt, which was so touching,

[00:40:38] but maybe in the future at some time, we'll have another chance to talk, and I appreciate you going

[00:40:44] over with your time, and good luck with that windshield. Peace, love, and life. Be well.

[00:40:49] Take it easy. Thank you. Bye-bye.

[00:40:51] So I wanted to take a minute after my conversation with Stephen Hayes about RFT or relational frame

[00:40:58] theory to give a little bit more background about the more widely used clinical application called

[00:41:05] ACT, or Acceptance and Commitment Therapy. So ACT was built from RFT and involves a set of six

[00:41:13] processes, acceptance, diffusion, contact with the present moment, self as context, values, and committed

[00:41:22] action. You could also use the more simplified Triflex model, which involves being open, being present,

[00:41:30] and doing what matters. Or if you want to boil it down to three words, it is a therapy that works on

[00:41:39] building psychological flexibility. ACT uses a lot of metaphors. It's one of my favorite things about it,

[00:41:46] and you'll hear Dr. Hayes and I using a lot of metaphors in our conversation. The reason for that is because

[00:41:52] each bit of language that any of us use has personalized meaning and significance to each individual,

[00:42:02] which can lead to miscommunications. Metaphors have the ability to cut through that.

[00:42:09] And generate a pure form of understanding communicated from a therapist to a client or

[00:42:15] just from a human to another human. One of the things that I really like about ACT and think is makes it

[00:42:22] better and more applicable to a wider audience or patient population, it is not predicated on trying

[00:42:29] to change your thoughts. The overall goals are to decrease the power that the mind has in our day-to-day

[00:42:39] conscious lives and empower that conscious part of us in making decisions, utilizing the information of

[00:42:48] our minds, but not getting so caught up in it that the information from our mind goes totally unchecked

[00:42:56] and leads to unchecked behaviors. So briefly here, I will use some graphics, put some things up on the

[00:43:04] screen to help with the understanding, but I'll walk kind of around what's called the hexaflex of ACT.

[00:43:11] And so we can start with acceptance. Acceptance is not tolerance. Acceptance involves accepting that you

[00:43:20] have this mind that will constantly go, that is more active when you are less consciously active,

[00:43:27] and that is putting information together that you and I consciously wouldn't have a chance in hell

[00:43:35] at putting together. One of the best metaphors for acceptance involves this idea that there can be

[00:43:43] this radio. And if you can imagine your least favorite music playing, sometimes that radio is

[00:43:49] playing your least favorite music. And that radio is up here just outside of your reach. You cannot

[00:43:55] reach the dial. You get up on a chair and the radio extends a little bit further away and you recognize

[00:44:01] that I cannot change this channel. So the question is, are you going to accept that that radio is playing

[00:44:08] and go do the important things in your life that you need to do? Or are you going to stay caught up in

[00:44:15] trying to control something that has major limitations in your ability to control it, especially

[00:44:22] directly? Things that can help are the use of a mantra. If acceptance is difficult around a certain

[00:44:32] topic or subject, for example, the loss of a loved one is not typically a problem that can be solved.

[00:44:38] Even though our minds try to solve that problem. And it may involve instigating a mantra,

[00:44:45] emphasizing how important that person was in your life and the lessons that you'll take forward,

[00:44:50] but also emphasizing that you need to continue on your individual journey in life and honor that

[00:44:59] person's memory the best that you can. There's another great picture I'm going to flash on the screen

[00:45:04] about acceptance of something like the weather, which I think we could all agree that we've had

[00:45:11] this experience where it's raining and we find ourselves or we find our minds trying to control

[00:45:18] the fact that it's raining or making all of these catastrophic trains of thought. It's raining,

[00:45:24] therefore I won't be able to do the things I wanted to do today. I can't believe it's raining when I

[00:45:29] don't want it to be raining. And it's another good metaphor for us trying to control things that we

[00:45:35] don't have the ability to control. So that's my brief overview of acceptance. The last thing that

[00:45:42] I'll add here is the pathologic process on the other side of it. Being fully accepting is great. I don't

[00:45:48] think anybody ever really gets there. But the opposite extreme, the inflexible extreme,

[00:45:55] is being avoidant. Something that we all do. And a lot of the times we don't even realize that we do it.

[00:46:03] We try to hold our stresses out here. We try to turn away from them. But the reality is that we're

[00:46:11] holding on to them, that we are limiting our ability to go after what's important in a very physical sense

[00:46:17] that I don't have this hand and I can't even look over here because then I will become more aware of that

[00:46:25] thing that I'm trying to avoid. The next act process to talk about is cognitive diffusion.

[00:46:32] And this is a very specific, repetitious way of building resilience to your mind. It's almost like

[00:46:43] every time you defuse, you have a dropper and you have one of those silver buckets. And you defuse 10 times

[00:46:51] and it barely looks like there's anything in there. You defuse 100 times, dropping a bit of liquid in

[00:46:57] there every time. And you see a tiny thin layer, thin film of liquid on the bottom. Once you've done

[00:47:04] it a thousand times, it's very obvious that there is liquid, that there is resilience to your mind

[00:47:10] building up. And so cognitive diffusion is a healthy separation. It is not a disconnection.

[00:47:18] It is not an avoidance of your mind. And the most simple and straightforward way to do it, I think,

[00:47:26] is to take a thought like, I'm not good enough, and to give that a label. These types of thoughts tend

[00:47:36] to just pop into our awareness consciously and they are produced from this deeper center of our brain

[00:47:43] brain. That will, as Dr. Hayes and I talked about, order things as good or bad. I'm not good enough.

[00:47:50] And if I was good enough, my mind would never make me aware of it because that is not a problem

[00:47:56] negatively impacting my survival. So I'm not good enough. When you recognize that you're having that

[00:48:04] thought, you label it. I just had the thought that I'm not good enough. It seems simple. It seems

[00:48:11] straightforward. But I promise you, the more you do it, the more you're going to create this healthy

[00:48:18] distance from your mind and be able to use your mind for benefit without getting pulled down or

[00:48:27] feeling stuck by your mind. Now, the pathologic process of inflexibility surrounding diffusion is

[00:48:35] fusion. When you notice or in the past, you may recall that there are times that you had a thought

[00:48:43] or you experienced an emotion and reaction to an environmental trigger, and you totally bought into

[00:48:49] that thought. It became an absolute truth. It became something that you needed to do something about

[00:48:55] right here and now, even though it was a worry about the future or the past. The next act process

[00:49:02] involves contact with the present moment. This is where mindfulness and meditation comes into play.

[00:49:09] The way that I describe this to patients, it's just practicing sitting with your mind while you're

[00:49:16] consciously disengaged from the outside world. The benefit of this is that you understand what your

[00:49:26] mind does. You spend time specifically practicing, trying to breathe, trying to focus on one word,

[00:49:34] not so that you can relax and be focused. Those may be side effects, positive side effects to your

[00:49:40] meditation. But to me, I think it's really a window into your mind, into your subconscious,

[00:49:47] a way for you to, in a very safe and secure setting and environment by yourself in a quiet place without a

[00:49:58] lot of distraction to see where your mind goes when you're consciously disengaged. Then you go the next

[00:50:06] step, bringing your mind back to the very simple, minimal conscious engagement task of breathing or of

[00:50:16] repeating a word of meditating. Again, something that is been proven and shown to change the way that

[00:50:25] different parts of our brains are connected to each other. You're talking about the connections between

[00:50:31] the limbic system and the upper cortex in this conversation, the frontal lobe. And the pathologic

[00:50:38] alternative to contact with the present moment is finding yourself living in your mind, reminiscing or

[00:50:47] ruminating about the past and trying to predict everything that's going to happen in the future.

[00:50:52] I'm not saying that you shouldn't spend any time reminiscing about the past or trying to predict the

[00:50:58] future. Those are very important things. But as somebody mentioned to me the other day,

[00:51:04] they were at a mindfulness retreat. They were afraid they were going to miss their flight.

[00:51:09] And they noticed that they were having the thought about missing their flight 37 times.

[00:51:16] And they said, yeah, it's good to be prepared. We don't want to miss our flight.

[00:51:20] But how much did the 36 times after the first recognition or realization,

[00:51:26] how much did those really impact you? Or did they just add anxiety and stress

[00:51:31] in a situation where you already knew the importance of making it to your flight on time?

[00:51:36] The next process is called self as context. And this one's a little bit thicker of a

[00:51:44] concept, but it essentially involves understanding your mind and the way that it works and the thoughts

[00:51:51] and the emotions and the urges and the cravings that it generates based on your experiences in life.

[00:51:59] These could be as simple as the order of your birth and the role in that early family as either an older

[00:52:08] sibling or a younger sibling, as a firstborn to your parents or a third, fourth, fifth, sixth born child.

[00:52:15] It is a way to remove some of that excess judgment that can turn against us, against ourselves,

[00:52:22] by understanding why we feel the way that we feel in certain situations.

[00:52:27] Now, this one can be dangerous because you will never put together the entire story of your life.

[00:52:34] But it's a way of making sense of some of those more fucked up thoughts that you may have.

[00:52:42] One of the best metaphors for this is, you know, if you watch a documentary about Madagascar,

[00:52:48] it does not mean that you fully know and understand Madagascar.

[00:52:53] And the same thing is true for the content of my story.

[00:52:58] I may be able to present content-based facts about who I am.

[00:53:03] I am a psychiatrist.

[00:53:05] I am a dad.

[00:53:07] I am a Kentuckian.

[00:53:09] But when I reduce myself to the content of my story, I'm doing myself a disservice.

[00:53:17] We don't really understand what it was like to be 10-year-old me.

[00:53:22] I haven't always been a psychiatrist.

[00:53:25] I haven't always been a dad.

[00:53:27] My experiences in life are only understood through the entirety of the context of past experiences.

[00:53:37] Who I am cannot be boiled down to a few specific words.

[00:53:41] And so the pathologic alternative to self as context, this process of psychological inflexibility,

[00:53:49] is self as content.

[00:53:51] Or reducing myself to the story that I've created about myself.

[00:53:56] These are all factual contents about me, but they don't tell my full story and they don't

[00:54:01] allow room for growth and change.

[00:54:04] These may extend into characteristics about ourselves.

[00:54:08] If I am strong and I am unemotional, and that content, if it's held on too tightly,

[00:54:15] you may find that you're not able to be emotional in a very emotionally appropriate situation.

[00:54:21] You may be able to present content facts about Madagascar, but you don't understand what it

[00:54:28] is like to be there, to experience Madagascar in the flesh.

[00:54:34] The next act process is values.

[00:54:38] And I will throw in engagement with the process.

[00:54:44] And what I'll do is I'll show you this act matrix and show you how you can use diffusion

[00:54:49] to help to elicit values.

[00:54:52] So we start in this bottom left corner.

[00:54:55] And I may have the thought, I am sitting here at my home in a shed outside of the back of my

[00:55:01] house.

[00:55:02] And I can look through this window and I can see my kids playing out there.

[00:55:07] And I'll notice that I have the thought or the feeling, I'm a bad dad.

[00:55:12] Consciously, I don't agree with that.

[00:55:14] I could put lists on a piece of paper of the ways that I am a good dad and the things that

[00:55:19] I do and the things that I say and how I interact with my kids.

[00:55:22] But I experienced that thought, I'm a bad dad.

[00:55:26] Now, over time, I've learned to defuse that.

[00:55:29] I just had the thought that I'm a bad dad.

[00:55:33] And then I bring that bottom left box over to the bottom right box.

[00:55:39] All these things that are happening for me internally.

[00:55:41] And I use the diffusion of the content of that thought to help me to understand what's

[00:55:48] important to me.

[00:55:49] Now, that one's pretty obvious.

[00:55:51] My kids are really important to me.

[00:55:53] But then you go the next step and you create this imagined experience internally.

[00:56:00] I'm 80 years old and my kids are going to get up on a podium and they're going to say

[00:56:06] three words to describe me as a father.

[00:56:09] What do I want them to say?

[00:56:11] What feels best for me to hear them say?

[00:56:15] Once I have elicited those values about what's most important to me to chase in life, these

[00:56:24] things that are not totally unchanging, but they're a lot more unchanging than the goals

[00:56:31] that I have in life.

[00:56:33] And actually, my goals have got to be secondary to my values.

[00:56:38] So if I want to be loving and caring and provide a healthy amount of discipline for my kids,

[00:56:47] those are three things that no matter what happens to my goals, which by the way, exist in the

[00:56:54] outside world.

[00:56:55] I can always fall back on the values.

[00:56:58] I can find other goals, other committed actions, other ways to instill those values that I want to chase

[00:57:08] after as a dad in myself.

[00:57:10] The pathologic process of inflexibility with values is not knowing your values, not doing what matters, setting

[00:57:21] somewhat arbitrary goals or setting goals, setting up outcomes in the outside world that may be important to other

[00:57:30] people, but are not necessarily that important to you deep down.

[00:57:34] And so the last process that we'll quickly review is committed action, setting goals, setting outcomes that are based on the

[00:57:43] values that are based on the process of getting to that outcome or getting to that goal.

[00:57:50] Goals are in the outside world.

[00:57:52] They have got to be secondary to the characteristics that matter in here.

[00:57:58] Those characteristics may be different as a dad versus as a professional versus as a husband or a spouse, et cetera, et cetera.

[00:58:08] But if you take time to elicit your values and then you set your goals based on those values and allow the goal to be

[00:58:16] flexible because the goals in the outside world, you could create the most innovative idea or project at work.

[00:58:26] And you may have a boss that doesn't appreciate it the way that you do.

[00:58:30] That has nothing to do with your time, energy and effort that you've put into it.

[00:58:36] It has to do with something that is uncontrollable in the outside world or very limited in your ability to control the thoughts and

[00:58:44] feelings and appraisals of others.

[00:58:46] So why do we want to get caught up in these things that we can't control?

[00:58:52] Anyway, I hope this has been helpful to add to our discussion about relational frame theory

[00:58:58] and help understand why RFT is so important to understanding the processes of ACT, which, by the way, each of these six processes,

[00:59:09] if you can create flexible change in any of these six areas, you will start to get better.

[00:59:17] And it won't be necessarily this huge jump with minimal work, but you put in the work over time and you see your flexibility increase.

[00:59:29] You see your ability to exist in this world and not have your internal world rocked by external circumstances by which you have very little control.

[00:59:42] Life gets easier.

[00:59:45] Hopefully this has been helpful.

[00:59:47] Thanks for watching.

[00:59:48] Thanks for listening.

[00:59:49] Subscribe, like, do all those stuff, all those things that will help me build the channel and help me get these messages out to more people.

[00:59:57] Thanks again.

[00:59:59] Disclaimer.

[00:59:59] This podcast is for informational purposes only.

[01:00:01] The information provided in this podcast and related materials are meant only to educate.

[01:00:04] This information is not intended as a substitute for professional medical advice.

[01:00:07] While I am a medical doctor and many of my guests have extensive medical training and experience,

[01:00:10] nothing stated in this podcast nor materials related to this podcast, including recommended websites, text, graphics, images, or any other materials,

[01:00:16] should be treated as a substitute for professional, medical, or psychological advice, diagnosis, or treatment.

[01:00:19] All listeners should consult with a medical professional, licensed mental health provider, or other healthcare provider if seeking medical advice, diagnosis, or treatment.

[01:00:25] Or, put more simply,

[01:00:27] If you need help like this guy, call your own doctor.

[01:00:30] Thanks again for watching and or listening.

[01:00:33] If you're passionate about the subjects that I discuss on the channel, do me a favor and like, comment, subscribe.

[01:00:42] Do whatever you can to make your voice heard.

[01:00:45] That these are problems that must be addressed in our society.

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[01:00:56] Feel free to reach out on social media or email us at renegadesyke at gmail.com.

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