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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.
- The Catch-All Nature of Acceptance and Commitment Therapy - Big ... ›
- Feeling Bad About Feeling Bad? Embrace Negative Emotions ... ›
- Psychological perspectives: why are you the way you are? - Big Think ›
Northwell Health is using insights from website traffic to forecast COVID-19 hospitalizations two weeks in the future.
- The machine-learning algorithm works by analyzing the online behavior of visitors to the Northwell Health website and comparing that data to future COVID-19 hospitalizations.
- The tool, which uses anonymized data, has so far predicted hospitalizations with an accuracy rate of 80 percent.
- Machine-learning tools are helping health-care professionals worldwide better constrain and treat COVID-19.
The value of forecasting<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTA0Njk2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMzM2NDQzOH0.rid9regiDaKczCCKBsu7wrHkNQ64Vz_XcOEZIzAhzgM/img.jpg?width=980" id="2bb93" class="rm-shortcode" data-rm-shortcode-id="31345afbdf2bd408fd3e9f31520c445a" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />
Northwell emergency departments use the dashboard to monitor in real time.
Credit: Northwell Health<p>One unique benefit of forecasting COVID-19 hospitalizations is that it allows health systems to better prepare, manage and allocate resources. For example, if the tool forecasted a surge in COVID-19 hospitalizations in two weeks, Northwell Health could begin:</p><ul><li>Making space for an influx of patients</li><li>Moving personal protective equipment to where it's most needed</li><li>Strategically allocating staff during the predicted surge</li><li>Increasing the number of tests offered to asymptomatic patients</li></ul><p>The health-care field is increasingly using machine learning. It's already helping doctors develop <a href="https://care.diabetesjournals.org/content/early/2020/06/09/dc19-1870" target="_blank">personalized care plans for diabetes patients</a>, improving cancer screening techniques, and enabling mental health professionals to better predict which patients are at <a href="https://healthitanalytics.com/news/ehr-data-fuels-accurate-predictive-analytics-for-suicide-risk" target="_blank" rel="noopener noreferrer">elevated risk of suicide</a>, to name a few applications.</p><p>Health systems around the world have already begun exploring how <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315944/" target="_blank" rel="noopener noreferrer">machine learning can help battle the pandemic</a>, including better COVID-19 screening, diagnosis, contact tracing, and drug and vaccine development.</p><p>Cruzen said these kinds of tools represent a shift in how health systems can tackle a wide variety of problems.</p><p>"Health care has always used the past to predict the future, but not in this mathematical way," Cruzen said. "I think [Northwell Health's new predictive tool] really is a great first example of how we should be attacking a lot of things as we go forward."</p>
Making machine-learning tools openly accessible<p>Northwell Health has made its predictive tool <a href="https://github.com/northwell-health/covid-web-data-predictor" target="_blank">available for free</a> to any health system that wishes to utilize it.</p><p>"COVID is everybody's problem, and I think developing tools that can be used to help others is sort of why people go into health care," Dr. Cruzen said. "It was really consistent with our mission."</p><p>Open collaboration is something the world's governments and health systems should be striving for during the pandemic, said Michael Dowling, Northwell Health's president and CEO.</p><p>"Whenever you develop anything and somebody else gets it, they improve it and they continue to make it better," Dowling said. "As a country, we lack data. I believe very, very strongly that we should have been and should be now working with other countries, including China, including the European Union, including England and others to figure out how to develop a health surveillance system so you can anticipate way in advance when these things are going to occur."</p><p>In all, Northwell Health has treated more than 112,000 COVID patients. During the pandemic, Dowling said he's seen an outpouring of goodwill, collaboration, and sacrifice from the community and the tens of thousands of staff who work across Northwell.</p><p>"COVID has changed our perspective on everything—and not just those of us in health care, because it has disrupted everybody's life," Dowling said. "It has demonstrated the value of community, how we help one another."</p>
It's hard to stop looking back and forth between these faces and the busts they came from.
- A quarantine project gone wild produces the possibly realistic faces of ancient Roman rulers.
- A designer worked with a machine learning app to produce the images.
- It's impossible to know if they're accurate, but they sure look plausible.
How the Roman emperors got faced<a href="https://payload.cargocollective.com/1/6/201108/14127595/2K-ENGLISH-24x36-Educational_v8_WATERMARKED_2000.jpg" ><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ2NDk2MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyOTUzMzIxMX0.OwHMrgKu4pzu0eCsmOUjybdkTcSlJpL_uWDCF2djRfc/img.jpg?width=980" id="775ca" class="rm-shortcode" data-rm-shortcode-id="436000b6976931b8320313478c624c82" data-rm-shortcode-name="rebelmouse-image" alt="lineup of emperor faces" data-width="1440" data-height="963" /></a>
Credit: Daniel Voshart<p>Voshart's imaginings began with an AI/neural-net program called <a href="https://www.artbreeder.com" target="_blank">Artbreeder</a>. The freemium online app intelligently generates new images from existing ones and can combine multiple images into…well, who knows. It's addictive — people have so far used it to generate nearly 72.7 million images, says the site — and it's easy to see how Voshart fell down the rabbit hole.</p><p>The Roman emperor project began with Voshart feeding Artbreeder images of 800 busts. Obviously, not all busts have weathered the centuries equally. Voshart told <a href="https://www.livescience.com/ai-roman-emperor-portraits.html" target="_blank" rel="noopener noreferrer">Live Science</a>, "There is a rule of thumb in computer programming called 'garbage in garbage out,' and it applies to Artbreeder. A well-lit, well-sculpted bust with little damage and standard face features is going to be quite easy to get a result." Fortunately, there were multiple busts for some of the emperors, and different angles of busts captured in different photographs.</p><p>For the renderings Artbreeder produced, each face required some 15-16 hours of additional input from Voshart, who was left to deduce/guess such details as hair and skin coloring, though in many cases, an individual's features suggested likely pigmentations. Voshart was also aided by written descriptions of some of the rulers.</p><p>There's no way to know for sure how frequently Voshart's guesses hit their marks. It is obviously the case, though, that his interpretations look incredibly plausible when you compare one of his emperors to the sculpture(s) from which it was derived.</p><p>For an in-depth description of Voshart's process, check out his posts on <a href="https://medium.com/@voshart/photoreal-roman-emperor-project-236be7f06c8f" target="_blank">Medium</a> or on his <a href="https://voshart.com/ROMAN-EMPEROR-PROJECT" target="_blank" rel="noopener noreferrer">website</a>.</p><p>It's fascinating to feel like you're face-to-face with these ancient and sometimes notorious figures. Here are two examples, along with some of what we think we know about the men behind the faces.</p>
Caligula<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ2NDk4Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY3MzQ1NTE5NX0.LiTmhPQlygl9Fa9lxay8PFPCSqShv4ELxbBRFkOW_qM/img.jpg?width=980" id="7bae0" class="rm-shortcode" data-rm-shortcode-id="ce795c554490fe0a36a8714b86f55b16" data-rm-shortcode-name="rebelmouse-image" data-width="992" data-height="558" />
One of numerous sculptures of Caligula, left
Nero<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ2NTAwMC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1NTQ2ODU0NX0.AgYuQZzRQCanqehSI5UeakpxU8fwLagMc_POH7xB3-M/img.jpg?width=980" id="a8825" class="rm-shortcode" data-rm-shortcode-id="9e0593d79c591c97af4bd70f3423885e" data-rm-shortcode-name="rebelmouse-image" data-width="992" data-height="558" />
One of numerous sculptures of Nero, left
A new study proposes mysterious axions may be found in X-rays coming from a cluster of neutron stars.
Are Axions Dark Matter?<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="5e35ce24a5b17102bfce5ae6aecc7c14"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/e7yXqF32Yvw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
New research suggests you can't fake your emotional state to improve your work life — you have to feel it.
What is deep acting?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTQ1NDk2OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTY5MzA0Nn0._s7aP25Es1CInq51pbzGrUj3GtOIRWBHZxCBFnbyXY8/img.jpg?width=1245&coordinates=333%2C-1%2C333%2C-1&height=700" id="ddf09" class="rm-shortcode" data-rm-shortcode-id="9dc42c4d6a8e372ad7b72907b46ecd3f" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
Arlie Russell Hochschild (pictured) laid out the concept of emotional labor in her 1983 book, "The Managed Heart."
Credit: Wikimedia Commons<p>Deep and surface acting are the principal components of emotional labor, a buzz phrase you have likely seen flitting about the Twittersphere. Today, "<a href="https://www.bbc.co.uk/bbcthree/article/5ea9f140-f722-4214-bb57-8b84f9418a7e" target="_blank">emotional labor</a>" has been adopted by groups as diverse as family counselors, academic feminists, and corporate CEOs, and each has redefined it with a patented spin. But while the phrase has splintered into a smorgasbord of pop-psychological arguments, its initial usage was more specific.</p><p>First coined by sociologist Arlie Russell Hochschild in her 1983 book, "<a href="https://www.ucpress.edu/book/9780520272941/the-managed-heart" target="_blank">The Managed Heart</a>," emotional labor describes the work we do to regulate our emotions on the job. Hochschild's go-to example is the flight attendant, who is tasked with being "nicer than natural" to enhance the customer experience. While at work, flight attendants are expected to smile and be exceedingly helpful even if they are wrestling with personal issues, the passengers are rude, and that one kid just upchucked down the center aisle. Hochschild's counterpart to the flight attendant is the bill collector, who must instead be "nastier than natural."</p><p>Such personas may serve an organization's mission or commercial interests, but if they cause emotional dissonance, they can potentially lead to high emotional costs for the employee—bringing us back to deep and surface acting.</p><p>Deep acting is the process by which people modify their emotions to match their expected role. Deep actors still encounter the negative emotions, but they devise ways to <a href="http://www.selfinjury.bctr.cornell.edu/perch/resources/what-is-emotion-regulationsinfo-brief.pdf" target="_blank">regulate those emotions</a> and return to the desired state. Flight attendants may modify their internal state by talking through harsh emotions (say, with a coworker), focusing on life's benefits (next stop Paris!), physically expressing their desired emotion (smiling and deep breaths), or recontextualizing an inauspicious situation (not the kid's fault he got sick).</p><p>Conversely, surface acting occurs when employees display ersatz emotions to match those expected by their role. These actors are the waiters who smile despite being crushed by the stress of a dinner rush. They are the CEOs who wear a confident swagger despite feelings of inauthenticity. And they are the bouncers who must maintain a steely edge despite humming show tunes in their heart of hearts.</p><p>As we'll see in the research, surface acting can degrade our mental well-being. This deterioration can be especially true of people who must contend with negative emotions or situations inside while displaying an elated mood outside. Hochschild argues such emotional labor can lead to exhaustion and self-estrangement—that is, surface actors erect a bulwark against anger, fear, and stress, but that disconnect estranges them from the emotions that allow them to connect with others and live fulfilling lives.</p>
Don't fake it till you make it<p>Most studies on emotional labor have focused on customer service for the obvious reason that such jobs prescribe emotional states—service with a smile or, if you're in the bouncing business, a scowl. But <a href="https://eller.arizona.edu/people/allison-s-gabriel" target="_blank">Allison Gabriel</a>, associate professor of management and organizations at the University of Arizona's Eller College of Management, wanted to explore how employees used emotional labor strategies in their intra-office interactions and which strategies proved most beneficial.</p><p>"What we wanted to know is whether people choose to engage in emotion regulation when interacting with their co-workers, why they choose to regulate their emotions if there is no formal rule requiring them to do so, and what benefits, if any, they get out of this effort," Gabriel said in <a href="https://www.sciencedaily.com/releases/2020/01/200117162703.htm" target="_blank">a press release</a>.</p><p>Across three studies, she and her colleagues surveyed more than 2,500 full-time employees on their emotional regulation with coworkers. The survey asked participants to agree or disagree with statements such as "I try to experience the emotions that I show to my coworkers" or "I fake a good mood when interacting with my coworkers." Other statements gauged the outcomes of such strategies—for example, "I feel emotionally drained at work." Participants were drawn from industries as varied as education, engineering, and financial services.</p><p>The results, <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fapl0000473" target="_blank" rel="noopener noreferrer">published in the Journal of Applied Psychology</a>, revealed four different emotional strategies. "Deep actors" engaged in high levels of deep acting; "low actors" leaned more heavily on surface acting. Meanwhile, "non-actors" engaged in negligible amounts of emotional labor, while "regulators" switched between both. The survey also revealed two drivers for such strategies: prosocial and impression management motives. The former aimed to cultivate positive relationships, the latter to present a positive front.</p><p>The researchers found deep actors were driven by prosocial motives and enjoyed advantages from their strategy of choice. These actors reported lower levels of fatigue, fewer feelings of inauthenticity, improved coworker trust, and advanced progress toward career goals. </p><p>As Gabriel told <a href="https://www.psypost.org/2021/01/new-psychology-research-suggests-deep-acting-can-reduce-fatigue-and-improve-your-work-life-59081" target="_blank" rel="noopener noreferrer">PsyPost in an interview</a>: "So, it's a win-win-win in terms of feeling good, performing well, and having positive coworker interactions."</p><p>Non-actors did not report the emotional exhaustion of their low-actor peers, but they also didn't enjoy the social gains of the deep actors. Finally, the regulators showed that the flip-flopping between surface and deep acting drained emotional reserves and strained office relationships.</p><p>"I think the 'fake it until you make it' idea suggests a survival tactic at work," Gabriel noted. "Maybe plastering on a smile to simply get out of an interaction is easier in the short run, but long term, it will undermine efforts to improve your health and the relationships you have at work. </p><p>"It all boils down to, 'Let's be nice to each other.' Not only will people feel better, but people's performance and social relationships can also improve."</p>
You'll be glad ya' decided to smile<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="88a0a6a8d1c1abfcf7b1aca8e71247c6"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/QOSgpq9EGSw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>But as with any research that relies on self-reported data, there are confounders here to untangle. Even during anonymous studies, participants may select socially acceptable answers over honest ones. They may further interpret their goal progress and coworker interactions more favorably than is accurate. And certain work conditions may not produce the same effects, such as toxic work environments or those that require employees to project negative emotions.</p><p>There also remains the question of the causal mechanism. If surface acting—or switching between surface and deep acting—is more mentally taxing than genuinely feeling an emotion, then what physiological process causes this fatigue? <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2019.00151/full" target="_blank">One study published in the <em>Frontiers in Human Neuroscience</em></a><em> </em>measured hemoglobin density in participants' brains using an fNIRS while they expressed emotions facially. The researchers found no significant difference in energy consumed in the prefrontal cortex by those asked to deep act or surface act (though, this study too is limited by a lack of real-life task).<br></p><p>With that said, Gabriel's studies reinforce much of the current research on emotional labor. <a href="https://journals.sagepub.com/doi/abs/10.1177/2041386611417746" target="_blank">A 2011 meta-analysis</a> found that "discordant emotional labor states" (read: surface acting) were associated with harmful effects on well-being and performance. The analysis found no such consequences for deep acting. <a href="https://doi.apa.org/doiLanding?doi=10.1037%2Fa0022876" target="_blank" rel="noopener noreferrer">Another meta-analysis</a> found an association between surface acting and impaired well-being, job attitudes, and performance outcomes. Conversely, deep acting was associated with improved emotional performance.</p><p>So, although there's still much to learn on the emotional labor front, it seems Van Dyke's advice to a Leigh was half correct. We should put on a happy face, but it will <a href="https://bigthink.com/design-for-good/everything-you-should-know-about-happiness-in-one-infographic" target="_self">only help if we can feel it</a>.</p>
Archaeologists discover a cave painting of a wild pig that is now the world's oldest dated work of representational art.