Big Think Interview With Steven Hayes | Big Think

Question: What led you to explore this field of psychology? Steven Hayes: Well, I'm in psychology, probably in the same way that a lot of people go into psychology: you're interested in why there's so much pain and suffering around you. And I certainly saw that at home, growing up, and I decided early on that it was a place to put my scientific interests and also my humanitarian interests, and that you could bring those two together in one field. After becoming a psychologist, I developed panic disorder and that changed a lot in the type of work I do, because I trained as a behavioral therapist and as a cognitive behavioral therapist.

And when I did the methods that I would do with other people when they had panic disorder, I actually didn't quite get what I thought was necessary for me. And I went back to several things that in my experience belonged to more Eastern traditions, traditions of human potential, and then I tried to put that together: I'm a child of the '60s and I grew up in California, so I was exposed. to the type of Eastern

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ing that most people of my generation were exposed to, and in fact I found more in the methods of mindfulness and acceptance that benefited me directly than in the traditions of which I was nominally a part.

That really changed my way of

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ing and led me on a journey of about 30 years of how to delve into the essence of what's within some of our deepest clinical traditions, but also our spiritual and religious traditions, particularly the oriental. traditions. But not only that; All of the mystical wings of the major spiritual and religious traditions have methods designed to change the way you interact with your logical, analytical and linear thinking. And I didn't want to leave that untouched; I didn't want to just be a meditation teacher or something. I wanted to understand it, and we spent a lot of time pulling at its joints and trying to understand why these things might be useful to people, I think particularly useful to people in the modern world who are exposed through the media and the una kind of chatty world that we have created with a lot of horror, a lot of pain, a lot of judgment, a lot of words, and we need to find a place to go that is more peaceful and more empowering, being able to live their lives in an intimate, engaged and effective way.

That's how I got there, or ended up where I ended up. Question: What is ACT and how is it different from traditional forms of cognitive therapy? Steven Hayes: Sure. Well, empirical clinical traditions, especially in the cognitive-behavioral tradition, from the beginning attempted to apply behavioral principles developed mostly with animal models directly to people. And there were many benefits; is still relevant today. You can do a lot of good things for people who suffer from anxiety, depression, etc., by using those methods. I'm old enough to have seen these three steps, and at some point in the late 70s and mid 80s people realized that they needed to have a better way to approach cognition, and they couldn't find it in animal models. .

So they turned to common sense clinical models in which they divided thinking styles into rational and irrational processes, made cognitive errors, etc. And they thought that if we could get people to think more rationally and focus on the evidence and take some of those overly expansive thoughts that are creating difficulties for them and change them, then they would do better. And part of it was... the techniques were useful, but the theory didn't work very well. Over time, we increasingly learned that the components that theory indicates should be included and the processes that should change do not actually explain the results or increase the results.

And it had the potential to have a downside: People can become even more self-centered, even more caught up in their own thoughts. And we are part of a newer type of third generation of tradition that is using practices and values ​​of acceptance and mindfulness, commitment, behavior change practices and putting them together. So the difference between traditional CBT and acceptance and commitment therapy, or ACT, but not just ACT; also mindfulness-based cognitive therapy, dialectical behavior therapy and other more modern approaches to acceptance and mindfulness: instead of teaching people to notice, challenge, question and change their thinking, we teach them to notice what What do you think.

They are thinking and they notice what they feel, what their body does, they learn from it, but then they also focus on their values ​​and getting their feet moving towards the type of life they want to produce to have a life worth living. . . And it turns out, we think, that's a faster and more direct way, a safer way, to move forward in life than to first try to align the cognitive ecology inside this skull of ours with the ability to detect our logical errors and correct them, etc. Meanwhile, time is ticking. There are relationships to have, children to raise, work to do, contributions to make, and you are waiting for the inner world to align.

We think it's more effective to find a way to back off a little; Notice it, see what's there, learn from it, and move straight toward the kind of life you want to produce. And it turns out that these processes do not only occur in therapy, but in this office, in your home, in schools and organizations. And so, the work of ACT has expanded very rapidly from psychotherapy to behavioral medicine, and from there even to organizational work and now to prevention work and to communities and schools. So it's exciting to see psychology touching people where they are, on the streets, in a way that empowers them and in some ways simplifies what people need to learn to be more effective, happy, successful and vital in their lives.

Question: How can a therapist help someone realize their values? Steven Hayes: You know, a couple of things: If someone watching this were to focus on what hurts them the most and then take the time to look inside, what do I care if it's particularly painful? They will probably find an important area that they value. I'll give an example: Most people are deeply hurt by betrayals in relationships. And what your mind tells you to do is: don't be so vulnerable; don't be so stupid; don't open up; Do not be so confident; you can be betrayed. In fact, the reason it hurts so much is that you want loving, committed, intimate relationships; you want confidence.

And what your mind is telling you to do in some way is not to worry so much about it so you don't suffer as much damage. It might be better to really face and get in touch with that caring, and maybe take a more loving stance even with your own pain, and keep your feet moving toward what you really want, because the cost in terms of intimacy and connection and the affection that arises when you try not to be vulnerable, when you are constantly looking for betrayals of your trust, is too great. It makes it very difficult to have relationships of the type you really want.

So there is an example. One, look where the pain is. Turn it around; You will find that that is where the values ​​are. Another is to simply think about the moments in which you have felt more in yourself, more connected, more vital, more full of energy, more fluid and natural. And if you take some of these specific memories and walk within them, you will find that there are things that matter to you. There are things there that, when they really work well, are a kind of beacon, like a beacon in the distance, that you can move towards.

You never fully achieve these things. I mean, I'll give you an example. There are times when you feel especially important to another person, or when you care, love, or accept. Well, loving relationships are not something you can have like a precious little jewel that you put in a box and then keep on your shelf. It's something you walk towards. And there are always difficulties; There is always pain in relationships. But you can keep walking towards that lighthouse in the distance. That process, that journey, is called life. And if you move towards the things you value, life is more vital, more fluid;

It's more empowering. And that's another way: enter into the sweetness of life, capture the places where you were really moved or connected with life, and you will find there a kind of light that can guide you when the cacophony becomes too loud and you get confused and lost, that can direct you toward what matters to you. Question: How is the role of an ACT therapist different from the role of traditional psychologists? Steven Hayes: Maybe it is a little bit, because this psychology is a psychology of the normal. Many of the psychologies that exist are based on the psychology of the abnormal.

We have all these syndromic boxes that we can put people into and so on. The actual evidence on the syndromes is not very good. I mean, there is no specific biological marker, for example, for any of the things that are talked about in the media. Even things like schizophrenia... there are no specific, sensitive biological markers for these things. So yes, there may be some abnormal processes involved in some of them, but a lot of human suffering comes from normal processes that escape us. Just like normal problem-solving processes work very well in the outside world; When applied internally, you very easily enter a mental mode in which you can begin to live when the problem of your story is resolved.

But your story is not going to disappear; It is not the same as dirt on the floor or paint peeling off the walls; It's not going to be solved that way. It's more like learning to wear it, to contact it, to see it. Because it is based on the psychology of normal, the therapist is also part of that. And so when the therapist comes in and works on acceptance, mindfulness and values, they are also working with those same processes. Therefore, a therapist is required not to be a master at it (they don't even have to be good at it), but simply to see its value and be willing to analyze their own difficult emotions and thoughts and find a way to gently bring them to the surface. service of the clients they serve.

So, for example, if a therapist feels insecure in therapy, many therapists will try to put that aside to try to do therapy. Instead, we would ask people to let go of that feeling of insecurity, because after all, the customer is being asked to do the same. That's why it tends to be relatively intense, interactive and horizontal. It's not one up; The therapist is in the same soup. And he has a kind of quality of two human beings in the same situation, actually, working through these psychological processes. And yes, I am working for you; you hired me;

I am working for you as a therapist. But I'm not up here and you're down there. And what you are struggling with, at other times and with other areas that I am struggling with. Question: Why can ACT treat everything from schizophrenia to prejudice? Steven Hayes: Well, and even more than that. I mean, I mentioned that even in this office the same processes exist. We've done research showing that ACT and the underlying processes can help with things like, can secretaries learn new software? Can therapists learn new methods? What about stigma and prejudice between people? So it's not just about the areas of psychotherapy.

And why would it be so, as an empirical fact, these methods have a fairly enormous breadth. And why would it be so: because wherever the human mind goes, these processes of avoiding the inner world to try to regulate its behavior, or getting entangled in its thoughts, interfere with its ability to take advantage of what is around it, or lose contact with its values ​​for fear of knowing more about the places where it hurts; Those types of processes are simply normal psychological processes that are embedded in language and cognition itself. They are integrated into problem solving. And so, if you take the mindset that works very well for 95 percent of your life and apply it within yourself, then it implodes.

It starts to create barriers, and that's true at work, it's true in organizations, it's true in our culture, it's true in our politics. And yes, it is true in our consultations. So come on, the reason why it spreads, we have pretty good evidence for this; I know it sounds a bit grandiose, but the mental cognitive processes we are targeting are those that reduce the repertoire of human beings and make it difficult for them to learn to be more flexible and take advantage of the opportunities presented to them. . And we think it's something that we can have a say in, something to help with in all of these different areas, maybe even in areas like child development or organizations and schools, or maybe even things like prevention or how people interact. each other. each other.

So we've worked, for example, on things like prejudice and stigma, because in the modern world, if we can't solve that, we'll have planes crashing into buildings. And then we have planes flying over countries. The amount of hate, objectification and dehumanization that exists on the planet is no longer something we can tolerate in a world that is emerging from suitcase bombs andthe ability to amplify that hatred to harm others. Therefore, it is widely applied because wherever the human mind goes these processes go. Question: What is happiness? Steven Hayes: You know, there are a lot of different definitions.

I think a dangerous definition is to think of happiness as some kind of warm, happy, bloody feeling in your heart that you have to chase, grab, and hold on to for fear it will go away. I mean, it's fun when you have those feelings, but we know, and the evidence shows, that the more determined you are to have those feelings and chase them, that's a butterfly that flies away the more you chase it. A better way to think about happiness, which is actually something I think you can achieve, is to live according to your values ​​and in a way that is more open and accepting of your story as it resonates in the present, that's more staff. -Affirmative, self-validating and based on values.

The Greeks had a word to describe it; They called it eudaimonia and it is not a bad definition. And I think that definition of happiness is something that will empower human lives. The definition we have becomes very hedonistic and emotion-oriented; The problem is that there are too many quick and dirty ways to pursue that in ways that end up being useless to people. If you avoid the feelings of betrayal and the feeling of insecurity that arise in relationships that do not work when you come across relationships that are out of tune, due to a sexuality that is not connected to intimacy, etc.

Yes, you may feel good, but it is not a good life. If you just have another martini or even more severe forms of substance use, yes, you may feel good, but you won't live well. And if you escape a kind of materialism - the right car, the right woman, the right house, the right trip, the right place, the right job, the right compliments - you know, these things... all the People that They are wise in our culture, throughout the history of our culture, they have written about the dangers of trying to define a meaningful life in that way.

But commercial culture and our media constantly encourage us to think that if we feel good, we live well. And then we will be happy, thank you very much, to sell you goods and services of dancing oivoids and the pill you can take, or trips or cars or clothes or women you can date... whatever it is that, will give you the quick route to that. And it's an empty promise. I think young people know it's empty, but they're not quite sure what to do. And I look at what's on the t-shirts and see another solution, which also worries me.

I see “Just Do It.” "Without fear." -- this kind of repressive response to the treacle that the culture tries to define for us as a meaningful life also exploits you. "Fearless" is not something you should put on your shirt. How about “I can contain my fear and still connect with you”? Put that on your shirt. "It's okay to be me, with all my history." Put that on your shirt. So there is a middle way. There was a guy who sat under a tree a long time ago who is important to a large portion of the human population and he called it The Middle Way.

There is a middle path between indulgence and repression, but the culture has moved beyond it with the cacophony that has been created in the modern world and the commercial encouragement of avoidance and indulgence on the one hand, or suppression and "just do it." ", treating yourself as an object for the other. We have to find a way that is more compassionate, gentler, that allows us to move towards the kind of life we ​​really want to live. Question: Are Americans trying too hard to achieve happiness? Steven Hayes: I think that commercial culture, and also science and technology after all, which gives us greater peace of mind but also makes it harder for us to endure the small amounts of distress that arise from simply living, is probably... the combination The influence of business culture and media culture and science and technology has probably made things more difficult in American culture.

But I think it's built into language and cognition. It was only given some counterweights: the main institutions that exist are our spiritual and religious traditions, which emerged very early, at the time when human language grew and written language created the kind of problem we can have now with language. as if he were running away from us. And those traditions have also weakened in our culture and changed. That's probably right: it's not that we're chasing happiness; I think we have the wrong model of happiness. I mean, defined as eudaimonia, defined as a life based on values ​​of integrity and faithfulness to yourself and what you most deeply want to defend, that definition of happiness... man, that's the kind of life I want to live and I think that that will support and sustain the people.

But this cheap and exciting version, this kind of definition of ease, the feel-good definition of happiness is an empty promise. And I think Western culture has done a particularly bad job of indulging in that view of what happiness is and encouraging people to pursue it. And I think we can see from the growing number of problems we have in the developed world that it's an empty promise. And I'll give you an example, not from the United States, but from Scandinavia, probably the most worker-supportive part of the planet, where they have the highest rate of chronic pain and the highest rate of worker-related disability.

So, right into this idea that any kind of pain and difficulty is so unpleasant that if you say you're in pain, we're going to attack with guns and even pay you full salary to leave your job because "You're burned out, or Within that, what you're going to create is gigantic amounts of chronic pain syndrome. Scandinavians spend 15 percent of their gross national product on disability. Fifty percent of public health nurses are disabled. I mean, and That's where we're headed in America, too, because unless we become wiser about how to deal with life's difficulties in a way that is self-compassionate and empowering, we can create this kind of world in which I prefer to connect to the matrix with whatever pill or escapist tendency we come up with instead of going through a life process that will include loss.

It will include limitations in function. It will include some major difficulties. We need to learn and teach our children how to do it. And the West is doing a terrible job right now. Question: Do you believe in medicating depression and other forms of mental illness? Steven Hayes: Medications. I want good science, and Big Pharma is happy to give us bad science, because the way the FDA is set up and what the requirements are... I mean, these are geeky topics and normal stuff. person wouldn't really know how to evaluate it. But only a certain number of randomized trials are needed.

It is not necessary to have adequate control groups. You can cause the blind to be penetrated; people can know that they are taking the medication, and we know that there is a large placebo effect within medications. That is why science is often inadequate. The best science there is, so I want... then it's okay; We're going over there. And there is decent science. Let's take something like antidepressant medications. There is decent science that says it has an effect, but it is surprisingly small after controlling for blind penetration, people know they are taking the active pills versus the sugar pills, if an active control is used.

It's probably just a few points. As with depression, on the 56-point scale, the estimate is that it probably represents about a two-point difference. But it is a multi-billion dollar industry. And by the way, it has huge side effects. And some of these medications, 40 percent of people who take them, have significant sexual side effects, for example. And that's just one. The level: A single antidepressant drug can be worth a billion dollars to a company. So I want good science and I want it to be marketed realistically. I wouldn't like... I think all these commercials we have... only two countries on the planet that allow pharmaceutical companies to market directly to people, New Zealand and the United States... it's a bad idea, in my opinion .

I think it should be better regulated. And when it is presented to people, it must be presented in a way that is realistic. For example, often people prescribe these medications and we tell them that they have a brain disease; You will have to take these medications permanently. It's because you have a brain disease. Well, brain disease... there would be a specific biological marker for the so-called disease. There is no biological marker for depression. It is not true that we know that it is a brain disease. Is the brain involved in depression? Yes, the brain is involved in what you and I are doing right now.

If none of us had brains, we wouldn't be having a conversation. But that doesn't mean it's a brain disease. And that's why prescribers very often exaggerate, exaggerate, and the people who detail the details are happy to tell them to do it. This idea that there's something wrong with your brain and that's why you're permanently... by the way, these medications are almost never evaluated against what will happen if you take them for three, four, five, 10, 15 years. Sometimes some of the side effects that appear appear only later and sometimes they are very serious, even irreversible side effects. So I'd like it to be more like yes, these medications can be helpful to a point, but what they do in areas like depression or antipsychotics is they give you a little more distance between the things that make you bogged down in thoughts. and feelings.

And so that they can be of some help, open a little window. Now, can we go in there and learn some of these methods directly to do it? For example, antidepressant medications, you still have some depressive thoughts. With antipsychotic medications, the vast majority of people who take them still have some psychotic symptoms. But it gives them a little bit of separation and doesn't control their behavior as much when you have a sad feeling, a difficult thought, a strange perceptual experience. We can teach people those exact skills in therapy, so the evidence is pretty good if it's just used as a window to come in and teach these skills, you get long-term benefits and no side effects.

So don't let yourself be sold just because a commercial interest wants to sell you things. The government should help, because the average citizen cannot go out and do scientific literature reviews. And focus on processes that have few side effects and good long-term results. Right now you will find them in the psychosocial area, in the therapy area, in empirically supported treatments like ACT or cognitive behavioral therapy, behavioral therapy. And go there first instead of going to the pill bottle like it's the end of your journey, like it's going to solve the problem. Very often it will only help, and even to a lesser degree, and more will be needed.

Question: What is your advice for someone experiencing a panic attack? Steven Hayes: Well, the advice I would give you if you were my patient would be a little different because we would have a little more time. But if I can boil it down to the essence of what we do in a course of therapy, the person with panic (I can say this from the inside out, since we are looking at a person with panic disorder in recovery) has taken a stance regarding to the inner world in which your own anxiety is your enemy. And they think that if they could get the anxiety to decrease, go away, not happen as much or not happen as intensely, or at least not happen here or there, in that situation, then things would be better.

In fact, all that is not the solution to the problem; that's the problem. Maintaining anxiety as your own enemy, and that it has to subside, subside, disappear and not occur here is a kind of self-invalidating and inward-focused process that would entangle you even more with these processes. Instead, what we're going to need to learn to do is allow our story to bring thoughts, feelings and memories into the present, and sort of hold them consciously and with self-compassion, and then focus on what we do and contribute. accompany them on that journey. So, feelings are just your story caused by the present moment.

If that is your enemy, then your story is your enemy. If sensations are your enemy, your body is your enemy. And if memory is your enemy, you better have a way to control your mind so that you never remember painful things from the past. Well, there is nothing like that that is healthy. And most of the things that people do that are called psychopathology are unhealthy things that people do when they're trying to fulfill that agenda. If you avoid people, avoid being pressured, avoid going to places that may cause anxiety; if you are taking drugs and alcohol;

These are all methods of trying to set up that unhealthy agenda. So I would say: could we, instead,consider this anxiety as something that can be important, even significant? And it says something about your story, and could we learn to hold it in a more compassionate way, to bring the scared part of you closer and treat it with some dignity and stay focused, instead of doing that? Go away, focus on what kind of life you want to live, connected to what kind of meaning and purpose. That will be a faster, more compassionate, safer journey forward than this kind of "out with anxiety, in with relaxation", "out with self-doubt, in with confidence" kind of... "Let's get out of that kind of way." harsh, uncompassionate place we find ourselves in with things like panic disorder.

Question: Why don't some psychologists believe in the effectiveness of ACT? Steven Hayes: It's an argument about theory and processes, but the processes, and those that we've been talking about inform what we think of ourselves and what we should encourage in our children and what we should try to incorporate into the culture. And I think we've really gone through a time where we thought we could thinking how to get out of this, and thinking clearly and that would solve the problem, and detecting logical errors and that would solve the problem. We thought of suffering as a problem of dysfunctional cognitions.

I think we are reaching a time where it has to do with how you relate to your own inner world and to those around you in the outer world. And I think these are the things that we need to put in our schools, in our education, in our psychotherapy and in our culture, finding a way to not be so harsh and judgmental, so objectifying and dehumanizing, constantly focused inward and trying to achieve. these thoughts and feelings difficult to disappear; or focused without objectifying and dehumanizing others. So the center of the controversy is: is it more powerful to take an acceptance and mindfulness-based approach compared to a cognitive and emotional change approach when we face these problems?

I think the evidence is more in our favor, especially the evidence of the process. And I think if you look at where the culture is going, there's a reason why Eckhart Tolle is on Oprah. There's a reason The Purpose Driven Life is a bestseller, aside from appealing to evangelicals and the Christianity it contains. There is also a longing for meaning, for values, for mindfulness and acceptance, because we have created a modern world in which our children are exposed to 10, 20, 30 times more words than our great-grandparents. . And we are exposed in a day or two to more horror on our Internet web pages than our great-grandparents were exposed to in decades of life.

And we have not created modern minds for that modern world. Science and technology have just caught up with us. And I think people crave it. I think you see it in what's popular. And why do people want to learn about meditation and why do they go to mindfulness retreats? And why do they talk about a life with purpose? It is because they know that more is needed in the modern world. And that is the core of the controversy. I think it's pretty clear how things are moving in empirically supported treatments that we're going to speak to the culture with a different voice.

It won't be the relaxed voice of the '60s, but it will have some echoes of some of the deeper clinical, spiritual and religious traditions that contained wisdom. If we're not going to get there through religious means and things like that, which have been greatly weakened in the West, we're going to have to find a way to put it into the culture in a different way, because we need something right now that's not another cable advertisement or other Internet website that shows us the cellulite on the actress's butt. I mean, because of the amount of judgment and harshness that there is in our culture, we need something that is prophylactic for that, and I think that's what's within these new methods.

Question: What keeps you up at night? Steven Hayes: What keeps me up at night in a positive way is the possibility that we can contribute to the development of human culture in a way that, years from now, people who will never know our names can live more empowered lives. . And if you ask what your great-great-grandfather's name is, you probably won't even know if you get three or four grand. So it's not that we are immortal; We are going to die very, very soon. It is not that what we produce will last; it will not. But the changes we can make in culture can be there for people we will never meet, who will never know us, and that's what keeps me up at night.

That's what excites me about science, that we can learn ways to be with each other. And the behavioral sciences have not been a sufficient part of cultural development. The physical sciences have; behavioral sciences do not. And I'd like to see if we can incorporate some things into human culture that humanize and soften and empower people. What keeps me up at night in a negative way is that if we do not solve these problems of the human heart and the human head, of human psychology, there is no technological solution so great that it can prevent the world that is coming. , and a world of suitcase bombs or the ability to contaminate the planet in a way that cannot be recovered, of global warming and so on.

We have created through science and technology a different world that has terrifying aspects, and psychology and behavioral sciences have to be part of this, because if we take something like the so-called war on terrorism, if we go out another 20 years and it's not just about planes crashing into buildings, but a suitcase bomb in the middle of New York, there aren't enough soldiers or enough bullets to kill enough people to keep us safe. I think we're going to have to find a way to humanize the culture itself. And it's not just them; We are. When we fly planes over countries, dropping bombs on the wicked, I think we are doing something very similar to what is done when infidels get their comeuppance with planes crashing into buildings.

So we have reached the point where if we are not psychologically healthy as a human society, we will not have a planet to live on. And that's what keeps me up at night, when I see so little attention to the behavioral aspect of these problems and the idea that only politics, or only physical science, is going to solve this. Or simply the military; is not true. We have to figure this out, and we have to figure it out in our own heads and in our own hearts, one at a time. And I think psychotherapy actually tells us a little bit about what we might need to do to soften the culture and make it more possible for us to live together as human beings on this planet.