Integration and Well Being

What is it about us that often make us our worst enemies? I suspect every therapist has heard patients ask questions like this. It may be possible to assume that there is this component in every clinical presentation, or at least the most common of them. Anxiety prevents people from approaching all kinds of potentially rewarding and satisfying experiences and depression may do the same. If the experiences are most likely going to be rewarding and satisfying and potentially life enhancing then it makes no sense to not take the risk. As therapists we see this happening in the majority of our sessions.

I submit this phenomenon may be related to one of the simplest formula ever discovered. Living organisms from insects to the highest order mammals seek to avoid discomfort and maximize experiences of pleasure. For insects it is quite simple. Avoid getting squashed or drowned or burned by running away and then go find the picnic basket. For humans however it can be incredibly complex and take on some extremely interesting forms as we seek ways to avoid even the uncomfortable feelings that arise in us. And often the forces directing self-defeating behaviors are partly if not entirely out of awareness.

But let’s make it clear from the outset. This phenomenon is common to all humans--patients and therapists alike.  If avoidance or discomfort drives a great deal of our troubling issues it is helpful to explore the common forms of avoidance in humans. It simply makes no more sense for a therapist to engage in avoidance and self-defeating things than it does for patients.

The most obvious may be in the phenomenon of addiction and humans can become addicted/attached to almost anything in service of avoidance and pleasure. Drugs and pornography are some of the most common but food, clothing, other material things, exercise, entertainment, video games, social media, physical pain are others. You can insert your favorite here. All of us do this. There is another however that often goes unnoticed because of its apparent positivity.

John Wellwood, Ph.D from the University of Chicago, in his classic text Toward a Psychology of Awakening, first described it even though the concept has been present in psychotherapy literature since Sigmund Freud with his constructs of defense mechanisms.

“Starting in the 1970’s I began to perceive a disturbing tendency among many spiritual communities. Although many spiritual practitioners were doing good work on themselves, I noticed a widespread tendency to use spiritual practice to bypass or avoid dealing with certain personal or ‘unfinished business’…So there is often the tendency to use spiritual practices to try and rise above our emotional and personal issues—all those messy, unresolved matters that weigh us down. I call this tendency to avoid or prematurely transcend basic human needs, feelings, and developmental tasks spiritual bypassing.” (p. 12)

Expanded for the broader public, i.e. to include those who do not necessarily consider themselves “spiritual”,  Steven Hayes calls this experiential avoidance (Acceptance and Commitment Therapy: An Experiential Approach to Behavioral Change, p. 58.)

“Experiential avoidance…occurs when a person is unwilling to remain in contact with particular private experiences (e.g. bodily sensations, emotions, thoughts memories, behavioral dispositions) and takes steps to alter the form or frequency of these events and the contexts that occasion them.”

How this looks in real time, for spiritual folks, depends on the framework of the spiritual practice used in service of both “enlightenment” and avoidance. Religious rituals, music, theology, services, retreats, revivals, prayer, meditation can all be used in service of either enlightenment or avoidance.

Obvious examples of spiritual bypassing gone amuck may be found in the person viewed as a spiritual authority, say a minister or priest, who despite appearances have a very “dark” side. The incidences of sexual molestation that have come to light over the past 20 or so years are tragic cases in point. The forces that drove those persons to engage in such acts in service of sexual desires perceived to be verboten were hidden behind vestments, robes, rituals, etc. As a result, what was not dealt with became destructive. And I suspect many of these offenders were sincerely trying to diminish or get rid of unwanted urges via spiritual practices for many years and because of avoidance never resolved the problems.  Problems with other kinds of abuses of power are examples as well and are too common among those in authority.

I meet many well meaning, sincere, devout religious persons of every stripe in my office who struggle with unwanted urges of various kinds and try to use their spiritual practices as a short cut to working through issues perceived to be too uncomfortable to even admit. Because their efforts to avoid have failed them they may present as anxious and depressed and/or attached to some addictive-type process.

For the non-spiritual person the avoidance simply does not take on a religious caste. Then the behaviors in service of avoidance take on a secular appearance. The consequences are however the same.

In the coping styles literature the research is becoming clearer regarding the role of experiential avoidance in the developing and maintenance of certain forms of psychopathology. The literature is mixed but some significant correlations have been found.

In a review of the literature “Experiential Avoidance as a Functional Dimensional Approach to Psychopathology: An Empirical Review”  in the Journal of Clinical Psychology, September 2007

Neharika Chawla University of Washington and Brian Ostafin North Dakota State University concluded:

“In sum, there is a growing literature suggesting that an unwillingness to be in contact with aversive private experience and taking action to alter that experience does indeed influence psychopathology. Although there are some inconsistencies between studies, the broad picture of the evidence suggests that EA (a) influences the likelihood of substance use relapse, (b) mediates the relation between traumatic events and general psychological distress, (c) predicts severity of symptoms in some specific disorders such as GAD and trichotillomania, and (d) mediates the relationship between maladaptive coping and self regulatory strategies, and psychological distress. Further, although little research has been conducted on EA as a mediator in psychotherapy, there is some evidence suggesting that focusing treatment on reducing EA can lead to improvements in an anxiety disordered sample. It may indeed be that “many forms of psychopathology are not merely bad problems, they are also bad solutions” (Hayes et al., 1996, p. 1162).”

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Here are a few specific research efforts and their results. Attempts to refuse or deny what is happening, trying to replace bad thoughts with good ones, talking oneself into feeling better, or distraction techniques (watching TV, calling a friend, etc) predicted negative outcomes for substance abuse (Ireland, McMahon, & Kouzekanni, 1994) for depression (DeGenova, Patton, Jurich, & MacDermid, 1994); and for those who have a strong trait or pattern of avoidance there is a tendency to increased depressive symptoms especially when thought suppression is a common coping strategy (Wegner & Zanakos, 1994).

It appears that experiential avoidance may strengthen what one is desperately trying to diminish or destroy (Clark, Ball, & Pape, 1991; Gold and Wegner, 1995, Wegner, Schneider, Carter, & White, 19910). And, if suppressed or repressed, the energy may be said to magnify and become the fuel of unwanted behaviors.   

So, if avoidance and the development of ineffective coping strategies such as addictions or other compulsive attachment behaviors, is a primary issue as the research and my clinical as well as personal experience more than suggests that it is, then approach behaviors (some form of "depth psychology" interventions) coupled with more effective coping behaviors is the remedy. 

The path is instead to “uncover” or permit the feared experience to come into consciousness, accept that it is indeed there and cannot be otherwise, understand what it means and what it has to offer, and integrate it. And, in case anyone should misunderstand what I mean, let me say what I do not mean.

To accept and integrate does not mean we indulge in every errant or destructive impulse. It means instead that we gain the understanding and develop the strategies which allow us not to, and that by doing so the impulses themselves can become defused.  If you want to moderate the temperature of a pot of water nearing the boiling point do NOT put a lid on it. Avoidance increases the energy. And it you want to get rid of unwanted thoughts avoidance of them paradoxically may make them the focus of attention. Try NOT to think of a polar bear. 

Only courageous, sustained approach behavior can relieve the pressure. The brain can then “work with it” and defuse it.

We simply cannot integrate what we will not “hold”.

Here is a simple practice drawn from my research and practice to experiment with:

1.    To begin we need to increase our awareness of the inner workings of our minds and bodies. We react and respond to varieties of stimuli throughout the day. So build on your innate ability to observe.

2.    Being mindful and practicing mindfulness is the cultivation of simple awareness of the present moment in all its richness without judgment. Observing as a scientist would rather than as an editor.

3.    When an unpleasant feeling, sensation, thought occurs direct your attention to it, breath with it or “around” it so it can be observed more closely.

4.    Welcome or embrace it as a part of your inner experience and possibilities.

5.    I might suggest not getting caught up in thoughts, or at least not too long, but instead focus attention on the feelings and sensations in the body.

6.    Observe how the feelings and sensations rise and fall, come and go by themselves though some may remain longer then others.

7.    Whatever arises, welcome it. Direct some kindness toward it. Befriend it rather than continue with it an an enemy. As it leaves, let it go.

8.     Of course, calm steady, comfortable breaths will probably be very helpful and when things get too heated or uncomfortable the breath is a wonderful place of retreat.

If you do this and have a therapist to help process things with you this practice will give a wealth of data to discuss. If you find that the practice or the experiences that arise are too painful or troubling I suggest you find a therapist who is experienced in helping people find their own way.  

As Master Thich Nhat Hahn wisely said, "A lotus flower does not grow on marble. It grows in the mud. No mud, no lotus."