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It’s better to focus on where you are going than how you are feeling
A therapist explains acceptance and commitment therapy (ACT).
The notion that emotional pain and suffering reflect a deviation from a default happy baseline has been referred to as the 'assumption of healthy normality'.
But it's a mistaken assumption. Estimates of the lifetime prevalence of psychiatric disorders indicate that around one in two adults will meet the criteria for a mental-health condition at some point in their lives. Given that psychological pain is so ubiquitous, we should focus less on what might make us happy, and more on achieving a sense of meaning, regardless of how we're feeling. Psychotherapy should help people manage effective functioning while they are distressed, above and beyond aiming to reduce symptoms such as difficult thoughts, emotions and sensations. Acceptance and commitment therapy (ACT) takes this approach, using mindfulness, acceptance and other behavioural strategies to promote more flexible and value-driven behaviours. The goals in ACT are not necessarily to change or reduce one's problematic thoughts or emotions, but to foster meaningful and effective behaviours regardless of mood, motivation or thinking. In other words, the primary goal is to promote what therapists call 'valued living'.
Think of valued living as going about your daily life in the service of values that you find important, whereby engaging in these actions creates a sense of meaning and purpose. From an ACT perspective, symptoms of psychiatric disorders, and psychological suffering more broadly, are problematic when they are linked to rigid behaviours that pull us away from valued living. We might not have any control over the pain we experience – in fact, our emotional pain is profoundly human – but one area where we can exert some control is what we do in response to that suffering. Many common responses to difficult thoughts and emotions – such as avoidance, substance abuse, withdrawal and aggression – can alleviate distress in the short term, but also lead to long-term damage in our relationships, our jobs, our freedom and our personal growth – the very areas that provide that sense of meaning and purpose. By letting go of an agenda guided by minimising pain, and recalibrating toward a more value-driven agenda, our choices can be based on who we want to be, rather than how we want to feel.
In their 2013 study, the psychologists Todd Kashdan and Patrick McKnight of George Mason University in Virginia examined the day-to-day relationships between valued living and wellbeing in a sample of individuals with social anxiety disorder. This is a common but debilitating condition that's marked by intense fear of social situations that might involve being negatively judged by others. People with social anxiety disorder often want and value positive relationships but considerable distress makes them avoid social interactions, so this is an excellent group in which to examine values and meaning.
In the study, participants began by identifying their central aim or purpose in life (eg, 'trying to be a good role model to others'). Then, each day over the next two weeks, they rated their daily efforts and progress toward this goal, and provided daily ratings of their self-esteem, meaning in life, and experience of positive and negative emotions. On days when they reported investing greater effort toward their main life goal, they also tended to enjoy greater wellbeing: they said their life had more meaning, and they scored higher on self-esteem and the experience of positive emotions. Importantly, support was not found for the reverse path – greater wellbeing did not predict greater effort or progress toward strivings. This study highlights that sometimes we need to make the value-guided choice, regardless of how we feel.
If only it were so easy, though. For this reason, in ACT-based treatments, there is substantial focus on skills and techniques that can assist one in cultivating a more aware, willing and tolerant stance toward difficult feelings and other internal experiences. This stands in explicit contrast to a 'do X and your distress will alleviate' approach. The ACT techniques are not in the service of changing emotional states – they are in the service of facilitating valued action.
The effectiveness of ACT across different diagnoses and problem areas shows that committing to the benefits of valued living transcends traditional diagnostic categories. In addition to anxiety disorders, in studies of post-traumatic stress disorder, depression and resilience, chronic pain, suicidal ideation and many more, engaging in behaviours consistent with personally held values has been linked to a range of positive outcomes.
Which brings me back to my work as a therapist. While the breadth of exercises and techniques employed in ACT is beyond the scope of this article, there is one exercise I'd like to share that has helped some of my clients see the inextricable link between valued living and painful experiences. In this activity (of which there are different variations), the therapist first asks the client to write on an index card some of the internal experiences they are struggling with most – difficult thoughts and judgments, emotions, memories.
I ask them, what do you notice when you read that index card? I feel awful, I don't want this. What do you want to do with the card? I want to throw it in the trash. Then the client flips the card over, and I ask them to write out some of the things that are most important, most meaningful to them – being a parent, caring and supporting others, learning, growing, etc. What do you notice when you read this side? Warmth, it feels right, this is who I want to be. Where is the pain, where is the other stuff? Still here, on the other side of the card. What happens if you push that pain away, escape or avoid it? I push the meaningful stuff away too. In your heart of hearts, what does your experience tell you right now? If I'm going to do the things that are important to me, be the person that I want to be, I also have to make room for the painful stuff.
In my experience, this is both an emotionally difficult exercise and also one that helps a person grasp that it's impossible to disentangle pain and valued living. Sometimes it is hard to engage with those struggles in session, but we regularly return to the rationale of the approach – that maybe a different stance toward pain is necessary. And that is the crux of the work in ACT – opening up to the demons, judgments and suffering that lie underneath, all for the purpose of moving toward that which is meaningful.
The valued path is not necessarily the happy path. Social connectedness sometimes brings us in contact with memories of abuse and trauma. Being a parent stirs up doubts, uncertainty and feelings of anxiety, fear, anger and shame. Advocating for social justice requires repeated exposure to the inequities in our societies and the feelings of helplessness that can come from fighting for an equality that might not exist until after you're gone. But a growing body of psychological research suggests that the valued path is the more workable one, whereas the happy path can be more of an illusion.
For readers who would like to find out more, I recommend the book Get Out of Your Mind and Into Your Life (2005) co-authored by the founder of ACT, Steven Hayes, and also Things Might Go Terribly, Horribly Wrong (2010) co-authored by another ACT pioneer, Kelly Wilson. And here is the international directory of ACT therapists, maintained by the Association for Contextual Behavioral Science.
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The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
What’s Eminem doing in Missouri? Kanye West in Georgia? And Wiz Khalifa in, of all places, North Dakota?
This is a mysterious map. Obviously about music, or more precisely musicians. But what’s Eminem doing in Missouri? Kanye West in Georgia? And Wiz Khalifa in, of all places, North Dakota? None of these musicians are from those states! Everyone knows that! Is this map that stupid, or just looking for a fight? Let’s pause a moment and consider our attention spans, shrinking faster than polar ice caps.
Researchers make the case for "deep evidential regression."
- MIT researchers claim that deep learning neural networks need better uncertainty analysis to reduce errors.
- "Deep evidential regression" reduces uncertainty after only one pass on a network, greatly reducing time and memory.
- This could help mitigate problems in medical diagnoses, autonomous driving, and much more.
Credit: scharsfinn86 / Adobe Stock<p>On the road, 1 percent could be the difference between stopping at an intersection or rushing through just as another car runs a stop sign. Amini and colleagues wanted to produce a model that could better detect patterns in giant data sets. They named their solution "deep evidential regression."</p><p>Sorting through billions of parameters is no easy task. Amini's model utilizes uncertainly analysis—learning how much error exists within a model and supplying missing data. This approach in deep learning isn't novel, though it often takes a lot of time and memory. Deep evidential regression estimates uncertainty after only one run of the neural network. According to the team, they can assess uncertainty in both input data <em>and</em> the final decision, after which they can either address the neural network or recognize noise in the input data.</p><p>In real-world terms, this is the difference between trusting an initial medical diagnosis or seeking a second opinion. By arming AI with a built-in detection system for uncertainty, a new level of honesty with data is reached—in this model, with pixels. During a test run, the neural network was given novel images; it was able to detect changes imperceptible to the human eye. Ramini believes this technology can also be used to pinpoint <a href="https://www.theguardian.com/technology/2020/jan/13/what-are-deepfakes-and-how-can-you-spot-them" target="_blank">deepfakes</a>, a serious problem we must begin to grapple with.</p><p>Any field that uses machine learning will have to factor in uncertainty awareness, be it medicine, cars, or otherwise. As Amini says, </p><p style="margin-left: 20px;">"Any user of the method, whether it's a doctor or a person in the passenger seat of a vehicle, needs to be aware of any risk or uncertainty associated with that decision."</p><p>We might not have to worry about alien robots turning on us (yet), but we should be concerned with that new feature we just downloaded into our electric car. There will be many other issues to face with the emergence of AI in our world—and workforce. The safer we can make the transition, the better. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His new book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
Can passenger airships make a triumphantly 'green' comeback?
Large airships were too sensitive to wind gusts and too sluggish to win against aeroplanes. But today, they have a chance to make a spectacular return.
Vegans and vegetarians often have nutrient deficiencies and lower BMI, which can increase the risk of fractures.