TUESDAY, FEBRUARY 22 , 2022. THE WASHINGTON POST EZ EE E5
Tips on using ACT techniques
Many people can try using
ACT approaches on their own,
however. Three experts offered
these tips:
Learn to accept all of your
emotions.
Trying to control or suppress
difficult emotions often doesn’t
work and might even worsen
distress in the long run, ACT
experts say. ACT aims to help
people accept (but not necessari-
ly approve of) all of their emo-
tions instead of avoiding or grap-
pling with them.
That’s in contrast with cogni-
tive behavioral therapy (CBT),
which seeks to help people iden-
tify and change negative or inac-
curate thinking. While CBT can
be quite effective, it didn’t suit
Jennifer Gregg, a psychology
professor at San José State Uni-
versity who said that she uses
ACT in her own life. “That’s how I
manage my own tough mo-
ments,” she said.
“A lot of what traditional psy-
chotherapy approaches do is try
to help you see the distortions in
your thought processes or the
ways that you might be thinking
yourself into a corner,” she said.
“All of the logic I could bring to
the way I was thinking really
didn’t change what I was feeling
that much, and it didn’t really
help me think about what I want-
ed to do differently next.”
By defining what gives her life
meaning, she can “move toward
those things rather than spend-
ing all of my time trying to
control my thoughts and feel-
ings,” she said.
Avoiding one’s emotions also
can be counterproductive and
lead to misuse of alcohol or
drugs, Ho said.
ACT doesn’t aim expressly to
eliminate bad feelings, but to
help people open up to all of their
emotional experiences to live
more effectively, Sandoz said.
“Most people who come to
therapy want me to help them
get rid of something: painful
memories, hard thoughts, diffi-
cult feelings. But that is not what
I do,” she said. Instead, she tells
them: “We are going to inten-
tionally look at and welcome in
those difficult experiences. We’re
going to talk about things that
bring up painful memories.
We’re going to talk about things
that bring up those hard, existen-
tial questions. And when we do
that, we’ll then be practicing
being with that experience in a
different way.”
Sandoz said she hopes that
clients will move from a rigid,
debilitating thought, for exam-
ple, “I want to go to college, but
I’m too anxious about it,” to a
more expansive and psychologi-
cally flexible one: “I want to go topsychological wellness in terms
of the absence of something — the
absence of a painful feeling, the
absence of a painful memory,”
said Sandoz, who is also a psy-
chology professor at the Univer-
sity of Louisiana at Lafayette.
When people struggle, they be-
lieve it’s abnormal, she said.
What is ACT?
ACT, pronounced like the word
“act,” defines emotional health
differently. “Psychological flexi-
bility is really how we in ACT
conceptualize psychological well-
ness,” Sandoz said. “What we
mean by that is people being able
to live their lives meaningfully
and effectively, regardless of what
they’re thinking or feeling, re-
gardless of what memories are
coming up, regardless of how
they’re thinking of themselves,
regardless of how much anxiety
they may be experiencing or sad-
ness or hopelessness.”
Steven C. Hayes, a psychology
professor at the University of Ne-
vada, originated ACT during the
1980s, but it still hasn’t fully
entered the public consciousness.
Research has shown that it can
work to treat anxiety, depression,
substance abuse, pain and other
conditions. In one review of 36
randomized, controlled trials,
ACT proved as effective as cogni-
tive behavioral therapy in treat-
ing anxiety and depression, spe-
cifically by increasing psychologi-
cal flexibility.
ACT diverges significantly
from the rest of Western psycho-
therapy, which tends to label neg-
ative emotions as symptoms or
problems to overcome. ACT
teaches acceptance of negative
feelings instead of trying to resist
or wrestle with them.
While life has moments of joy,
it’s unrealistic to expect happi-
ness all the time, ACT experts say.
Indeed, Americans’ love affair
with the happiness myth — that
we should constantly strive for
positivity, productivity, success
and a pleasurable life — started to
feel hollow for many during the
pandemic.
But people who feel unhappy or
pressured can still take purpose-
ful action, said Judy Ho, an associ-
ate professor of psychology at Pep-
perdine University in Southern
California. “Even if that stress is
intense, you don’t have to wait
until things get better to do the
things that are meaningful to you.”
Those with long-standing anxi-
ety, depression, thoughts of self-
harm or suicide, or other serious
issues should consider working
with a mental health professional
who can lead them through ACT
or provide other treatment, Ho
said.
THERAPY FROM E1
How ACT can help those
seeking a meaningful life
ble this response might be.
Kevin Crombie, an exercise
neuroscientist at the University
of Texas at Austin, and colleagues
tested this idea with 35 women
with PTSD. After being taught to
associate a particular geometric
shape with a mild electric shock,
the volunteers repeatedly saw the
same shape without the shock to
learn that the stimulus was now
safe. A few minutes later, half the
volunteers did 30 minutes of jog-
ging or uphill walking on a tread-
mill, while the other half did only
light movement.
The following day, those who
had exercised were less likely to
anticipate a shock when they saw
the “trigger” shape, Crombie
found — a sign that they had
learned to no longer associate the
trigger with danger. Volunteers
who showed the greatest exer-
cise-induced increases in BDNF
also did best at this relearning.
Exercise also stimulates the
release of endocannabinoids,
molecules important in modify-
ing connections between brain
cells. This may provide another
way of enhancing the learning
that underlies successful treat-
ment for depression, PTSD and
other mental disorders.
Physical activity also moder-
ates the body’s response to stress
and reduces inflammation, plau-
sibly helping people with mental
illness. “We have just scratched
the surface,” Hovland says.Helping body and mind
Changing the structure of the
brain isn’t the only way physical
activity can be beneficial for men-
tal health. The habit of exercise
itself can help, Smith says.
For people with mental health
issues, simply doing something —
anything — can occupy their at-
tention and keep them from ru-
minating on their condition. One
survey of the published literature
found that placebo exercise —
that is, gentle stretching, too mild
to cause any physiological effect
— had almost half the beneficial
effect on mental health as strenu-
ous exercise did.Regular workouts also give ex-
ercisers a clear sense of progress
as their strength and fitness im-
proves. This sense of accomplish-
ment can help offset some of the
burden of anxiety and depres-
sion, Gordon says.
Even light activity — basically
just moving around now and then
during the day instead of sitting
for hours at a time — may help.
In one study of more than
4,000 adolescents in the U.K.,
Aaron Kandola, a psychiatric epi-
demiologist at the University Col-
lege London, and his colleagues
found that youths who undertook
more light activity during the day
had a lower risk of depressive
symptoms than those who spent
more time sitting.
Exercise has powerful benefits
for people with mental illness
that go beyond its effects on the
illnesses themselves. Many strug-
gle with related issues such as
social withdrawal and a reduced
capacity for pleasure, Firth says.
Standard medications reduce
some symptoms but do nothing
to address these other problems.
Exercise — especially as part of a
group — can help boost their
mood and enrich their lives.
Even more important, people
with serious mental illnesses
such as severe depression and
schizophrenia also are more like-
ly to have significant physical
health issues such as obesity,
heart disease and other chronic
diseases. As a result, their life
expectancy is 10 to 25 years lower
than that of unaffected people.
“Reducing those health risks is
really paramount at the mo-
ment,” Kandola says. “That’s the
big appeal of exercise: We already
know it can improve physical
health. If it does have mental
health benefits as well, it can be
quite an important addition to
treatment.”Bob Holmes is a science writer who
lives and exercises in Edmonton,
Alberta. This article originally
appeared in Knowable Magazine, an
independent journalistic endeavor
from Annual Reviews.BY BOB HOLMESMental health disorders such
as depression and anxiety aren’t
easy to treat. Medications help
many but have a high failure rate
and may bring nasty side effects.
Talk therapy is time-consuming
and expensive. And neither ap-
proach is suited to preventing the
disorders from developing in the
first place.
But many people overlook an-
other option that, when it works,
can be one of the most effective,
least disruptive and cheapest
ways of managing mental health
disorders: exercise.
It’s hardly news that exercise is
good for your physical health,
and has long been extolled as
beneficial for mental health, as
well. But researchers are now
making progress in understand-
ing how exercise works its mental
magic.
Exercise, they are learning, has
profound effects on the brain’s
structure itself, and it also pro-
vides other, more subtle benefits
such as focus, a sense of accom-
plishment and sometimes social
stimulation — all of which are
therapeutic in their own right.
And while more is generally bet-
ter, even modest levels of physical
activity, such as a daily walk, can
pay big dividends for mental
health.
“It’s a very potent intervention
to be physically active,” says An-
ders Hovland, a clinical psycholo-
gist at the University of Bergen in
Norway.
But that knowledge has barely
begun to percolate into practice,
says Joseph Firth, a mental health
researcher at the University of
Manchester in the United King-
dom. Just ask a hundred people
receiving mental health care how
many are getting exercise pre-
scriptions as part of that care.
“You wouldn’t find many,” Firth
says.A tool against depression
Some of the strongest evidence
for the mental benefits of exercise
centers on depression. In 2016,
Hovland and his colleagues
searched the published literature
and identified 23 clinical trials
that tested the effectiveness of
exercise in treating depression.
Exercise was clearly effective and,
in a few studies, on par with
antidepressant drugs, the re-
searchers concluded.
And exercise offers several ad-
vantages. For one thing, antide-
pressant medications generally
take several weeks to show their
full effect. Exercise can improve
mood almost immediately, mak-
ing it a valuable supplement to
front-line treatments such as
drugs or therapy, says Brett Gor-
don, an exercise psychology re-
searcher at the Penn State College
of Medicine. Plus, he says, exer-
cise can counteract some of the
unpleasant side effects of antide-
pressants, such as weight gain.
In addition, exercise has few of
the negative side effects common
with drugs. “Many people who
have mental health concerns are
not enthusiastic about starting a
medication for the rest of their
lives, and are interested in pursu-
ing other options. Exercise might
be one of those options,” says
Jacob Meyer, an exercise psychol-
ogist at Iowa State University.
There’s now emerging evi-
dence that exercise also seems to
help in treating or avoiding anxi-
ety disorders, including post-
traumatic stress disorder (PTSD),
and possibly other serious psy-
chotic conditions, as well. “The
more we do these studies, the
more we see that exercise can be
valuable,” Firth says.
But researchers are still figur-Exercising can boost
the brain, mental health
ing out how muscular exertion
acts on the brain to improve
mental health. For most biomedi-
cal questions like this, the first
stop is animal experiments, but
they aren’t as useful in studies of
mental health issues.
“Psychological health is so
uniquely human that it can be
hard to make a good jump from
animal models,” Meyer says.Just scratching the surface
Scientists have some ideas how
exercise enhances mental health,
says Patrick J. Smith, a psycholo-
gist and biostatistician at Duke
University Medical Center in
North Carolina, who wrote about
the subject in the 2021 Annual
Review of Medicine with Duke
colleague Rhonda M. Merwin.
It doesn’t seem to have much to
do with cardiovascular fitness or
muscular strength — the most
obvious benefits of exercise.
Something else must be going on
that’s more important than mere
fitness, Smith says.
One possibility is that exercise
buffs up the brain as well as the
body. Physical exercise triggers
the release of a protein known as
brain-derived neurotrophic fac-
tor (BDNF). BDNF encourages
the growth of new brain cells —including, possibly, in the hip-
pocampus, a brain region impor-
tant in memory and learning.
Since the hippocampus tends to
be smaller or distorted in people
with depression, anxiety and
schizophrenia, boosting BDNF
through exercise may be one way
physical activity might help man-
age these conditions.
Sure enough, studies show that
people with depression have low-
er levels of BDNF — and, notably,
one effect of some antidepres-
sants is to increase production of
that molecule. Researchers have
not yet shown directly that the
exercise-associated increase in
BDNF is what reduces depressive
symptoms, but it’s a promising
possibility, Hovland says.
Exercise may also help anxiety
disorders. The brain changes
prompted by BDNF appear to
enhance learning, an important
part of some anti-anxiety thera-
pies — so it’s possible that exer-
cise may improve the effective-
ness of such therapies. One PTSD
therapy, for example, involves ex-
posing patients to the fear-caus-
ing stimulus in a safe environ-
ment, so that the patients learn to
recalibrate their reactions to
trauma-linked cues — and the
better they learn, the more dura-ISTOCK
Exercise can have profound effects on the brain’s structure itself,
and it also provides subtle benefits such as focus, a sense of
accomplishment and sometimes social stimulation, researchers say.and that feels so far away and so
overwhelming and it can be hard
to get moving at all,” she said. “So
I encourage people to start with
the most simple needs,” includ-
ing taking care of one’s physical
needs.
“The world is different today,”
Sandoz said. Sometimes, “the
only thing that we can do is add
to our learning. That’s what heal-
ing is.”
If people are struggling, San-
doz said, they can ask them-
selves: “‘Okay, the learning I’ve
had so far didn’t prepare me for
this. What new learning can I
offer myself? What new experi-
ences can I give myself?”
When people take steps de-
spite their distress, they might
start feeling better as a byprod-
uct, Ho said.
During the pandemic, ACT
therapists have seen clients
move in novel directions. Some
have questioned their former
values, including career success.
New values are trending, includ-
ing spirituality, community, so-
cial justice and adventure.
There’s a greater sense of ur-
gency, too, Sandoz said.
“Some people are recognizing
values that maybe they’ve always
had on the back burner,” she said.
“It always felt like they’d get
around to it at some point, and
suddenly, it feels like, ‘Oh, this is
right now. People are dying. If I
want this to happen, I really need
to acknowledge and admit this
value now.’ ”concrete goals that flow from
them. “If you just think about
your values, it can be a little
stressful unless you tie it to really
specific actions and things that
you know how to do,” said Gregg,
who has done research on ACT.
For starters, someone who
prizes community can text a rela-
tive who isn’t doing well, Gregg
said. A person who seeks knowl-
edge can start reading a periodi-
cal that offers fresh perspectives.
The ultimate goal is to move
toward “ bigger or more extended
patterns of action that we might
call valued action or committed
actions — these larger goals that
are connected to very clear pur-
poses,” Sandoz said.
Sandoz knows that it can be
tough to pursue goals fully dur-
ing the pandemic.
“Sometimes, the only action
that we see is the biggest perfect
behavior that we can engage inan “observing self,” which can
sound abstract, but refers to an
abiding, detached awareness
that notices and watches events
unfolding in one’s own life. Ho,
who counsels clients using ACT,
said, “The observing self is much
like an audience watching a play,
where they care about the story,
but they’re not so attached to it.
Yet they’re still engaged in that
conversation.”
By taking time to observe
what’s going on externally and
internally (how one is thinking
and feeling), people can decide
how to proceed more thoughtful-
ly, the experts say.
Clarify your values and take
committed action toward a
meaningful life.
ACT doesn’t aim to only in-
crease psychological flexibility. It
also emphasizes the pursuit of a
meaningful life in accordance
with one’s most cherished values,
Ho said.
Choosing one’s values creates
a north star to guide the journey.
“Values clarification is about re-
ally connecting to who I want to
be today,” Gregg said. “What mat-
ters to me? What difference do I
want to make?”
People select values that give
their lives inherent meaning.
Those values might include cre-
ativity, compassion, faith, re-
warding relationships, knowl-
edge, mentoring and profession-
al accomplishment, among many
others.
Values must be connected tocollege, and I’m anxious about
it.” With the latter, a person can
more readily accept her anxiety
and start taking concrete steps
toward attending college.
Change your relationship
with your negative thoughts.
Most people look at the world
from their thoughts and believe
that everything they think must
be true, Ho said. ACT teaches
people to look at their thoughts
as a mental event. Thoughts
don’t always reflect reality. In-
stead of telling oneself, “I’m
worthless,” a person can say, “I’m
having a thought that I’m worth-
less.”
That small linguistic cue can
create some healthy distance.
“Those thoughts and feelings
are not you,” Gregg said. “I can
just notice that these are feelings
and that they are separate from
me. From that stance, I might be
able to let them come in, let them
be there without needing to solve
or reduce them or make them go
away.”
When people step back to ob-
serve a thought, the notion
might simply pass on its own,
leaving them less likely to be
consumed by it, Ho said.
In contrast, when a person
gets entangled in a negative
thought, “it tends to dominate
everything,” Sandoz said. “It’ll
feel like I have to do something
here. I have to make this anxiety
go away, or I have to prove to this
person how right I am.”
ACT therapists also speak ofERIC PETERSEN FOR THE WASHINGTON POSTDuring thepandemic, ACTtherapists haveseen clients move innovel directions.