If you’re reading this site, it might be because you already know what ACT is about, in which case feel free to either skip this page or give me constructive feedback on how to summarise more clearly. In case you don’t though, I thought an introduction might be in order.
Acceptance and Commitment Therapy (ACT) is a third wave Cognitive Behavioural Therapy (CBT) often utilised by Clinical Psychologists and other mental health professionals in a 1:1 therapy or group setting. It’s also often used by mental health professionals for self-care and maintaining well-being. It’s based on sound theory and research by many groups of people but for example Steven Hayes, and the evidence base of which problems it can be helpful to treat in what age groups is expanding all the time. For example, there is research evidence of ACT being helpful for adults and young people with depression and anxiety, for people recovering from eating disorders, for people recovering from addiction and for people living with chronic pain or other chronic conditions, and for people grieving. There’s also evidence of mindfulness improving mental health outcomes for pregnant women, and an app developed specifically for this is “mind the bump”. As such, while there is validity to using this approach to cope with miscarriage, baby loss, trying for another baby and managing pregnancy anxiety that may come when and if you do go down that path, it isn’t mainstream yet and I feel it should be. I also believe in being the change you want to see in the world, so feel some personal responsibility to do something about that given I’m a Clinical Psychologist with lived experience of the pain and struggle of miscarriage and loss.
In ACT, therapists take the stance of two mountains – that is, both therapist and client each have their own mountain to climb, and this can be openly acknowledged. We all have stuff. We have difficult experiences, we can all cry, get frustrated and engage in unhelpful behaviour patterns. Being a mental health professional doesn’t give immunity to the emotional and physical challenges of pregnancy and loss but it does offer a road map and my aim of this site is to share information both about ACT and how it can be a roadmap through dark days and also to illustrate with some of my own life examples from my own pregnancies and losses. That approach is consistent with that taken by the ACT field leaders who have inspired me in my work, who also illustrate their books about ACT and training events with their own life examples. Perhaps not least because otherwise therapeutic concepts can be a bit abstract and context is helpful to integrate them into our own learning – and ACT is a contextual cognitive behavioural approach. In 1:1 or group therapy, I would never share my own stuff unless intended to be directly to the benefit of the person I was working with. My blog is perhaps a bit different in that because this is a public site, I have shared what I would normally comfortably share in a group with people I didn’t know that well yet, but had some connection with if the topic of miscarriage arose. That means its possible someone reading this could feel a degree of overshare at times, in which case please feel free to look away. However, I wanted to share enough examples that someone looking for help to understand an ACT idea connected to a topic I’m trying to cover might find it of use. I’m open to feedback on that, or indeed anything else here.
There are some key concepts from ACT which I’ll give separate pages to and also refer to repeatedly in my blog. For example – Values, mindfulness, defusion, opening up to experience, dropping the struggle, self as context and committed action. The key to making ACT work for you is psychological flexibility- getting lots of practice in with these skills so you can get slick at shifting between them when you need to in a way that improves your quality of life and satisfaction.
If you are still reading this far, you might be particularly interested in how ACT might apply for grief, so here are some introductory thoughts inspired by Russ Harris’s writing –
- Accept your feelings. This might include being open to shock, anger, despair, hopelessness, emptiness or loneliness. Whatever you feel, make some room in your life to let yourself have it. While you do that, make time to rest and cut back on demands on you if you can.
2. Accept that there will be times of feeling overwhelmed, especially in the early days. It might help to think of this as standing in giant tidal waves which might knock you over, but you will still be there when the wave passes. You may want to remind yourself of the saying “This too shall pass”.
3. Learn some mindful noticing skills to anchor you when the waves hit – for example, practice noticing what you can see, hear, feel, taste and touch when you are calm – when you are overwhelmed, it becomes easier to call the noticing skills to mind with practice.
4. Values – What really matters to you and how can you get more of that into your life?
5. A powerful question to ponder – Suppose you could choose – 1. You never have to have these painful feelings ever again – but it means you never get to love or care about anyone or anything again either. 2. You get to love and care about all sorts of people and things – but when you lose what you care about, you will feel intense pain. Which option would you choose? While acknowledging your loss and allowing your feelings about it, keep an awareness of what you still have in your life that you value, particularly considering relationships.
6. Develop self compassion – this takes real courage but is such a powerful tool when we’re grieving.
7. Watch out for unhelpful stories or life rules you’ve told yourself for a long time or society may even have told you which are now unhelpful. For example “My life is worth nothing if I can’t have children” or “I’ll never heal from this” or “it’s all my fault”.
8. Find vitality within your pain. Your grief about your miscarriage tells you two very important things: a) you’re living, and b) you have a lot of love to give. Tune into that and connect with your values to keep going with life, doing the things that matter to you. And take your feelings of loss and memories of your pregnancy with you, carrying them as gently and carefully as if they were a living child in your arms.
9. Consider how you can grow as a person from this experience. What is there to learn about forgiveness, compassion, letting go, acceptance? How might your own experience benefit others that you care about? It’s amazing how many more women have miscarriages than there are women who openly discuss their experiences. There are great opportunities to support and empower one another here.
10. Consider a grief ritual to mark the loss of a pregnancy, regardless of how soon it ended. You are marking the loss of hopes and dreams, even if it ended early. For example, light candles, write a poem or journal, bake a cake, make a memory box or scrapbook.
The link below is to an interview with Steve Hayes, the key founder of the ACT approach – he talks through the model in a way I find very engaging –
For information on Russ Harris’s books and resources (highly recommended!) – take a look at the Further Help page.