Can you choose not to suffer?
A little while ago, I took my son to see Manchester City play Manchester United in the FA Women’s Super League. Naturally, this experience led me to reflect on the principles of Acceptance and Commitment Therapy (ACT) and its application in managing chronic pain (I mean, isn’t that the first thing you thought of?!). Let me explain.
Man City women’s team usually play in the smaller Joie Stadium. But because this was a local derby, with large crowds expected, they were playing in the 53k-capacity Etihad Stadium, home to the mens team (my son’s idols). He was beyond excited.
Me?
Less excited 🤣.
My ex-husband had booked the tickets and I wasn’t really fussed about going. But I went along with it, leaving all the arrangements to him. Two weeks before the match, he got some overseas client work he couldn’t refuse, meaning he would miss it.
So now, the trip was down to me. No big deal, right? I used to manage multi-million-dollar projects in some of the most difficult contexts on earth. I’ve created several successful businesses. I spend my days supporting others to deal with their biggest challenges. Sorting a trip from Sheffield to Manchester was a minor task.
But I couldn’t do it. I procrastinated for the majority of those two weeks. And as the days went by, I got more and more frustrated. Mostly I was frustrated that I was having to organise this trip at all, seeing as I didn’t really want to go. My inner child was digging her heels in - “I don’t WANNA!”
And then there was the issue of…The Bag.
My ex-husband would have driven us over, but for health reasons, I couldn’t do that. So we would be taking the train. The Etihad Stadium has strictly-enforced rules about bags. Only one, A4-size bag could be brought to the stadium, and no food or water could be taken in.
This made me unreasonably cross.
How was I supposed to keep an 8-year-old fed, watered and occupied on a 2-hour journey there and back if I couldn’t take a bag, or food, or water? (If you’re thinking right now that I was being ridiculous…well, you’d be right 🤣) And not being able to take our reusable water bottles was terrible for the planet! How dare they create this situation! It all got worse when I made a half-hearted attempt to book the train - there were engineering works planned, so we’d have to go on a rail replacement service (aka a bus).
At this point, my fury reached DEFCON 2 (to be fair, anyone who’s had to go on a rail replacement service in the UK will understand 🤣).
And in my fury, I was completely unable to act. The days ticked by, and I hadn’t bought tickets. I hadn’t planned the day. My mind was mentally snagged on The Bag …I CAN’T DO THIS without my normal day sack. What if they confiscate it? Could I leave it in a locker in the station? But the expense! This is so stupid and unfair and I never wanted to go in the first place!…The task hung over me like a dark cloud, interrupting my thoughts at inopportune times, making me cross and childlike.
Eventually, of course, time ran out. I remember the exact moment when my mind flipped. I saw my small, cross body bag hanging on a peg and I decided I would use that.
As if the sun had come out from behind a cloud, everything became easy. The choice of bag dictated what we could take - money, keys, phone, a card game, some paper and pens. We’d take only enough food for the outward journey, and use disposable water bottles (still cross about that one 🤣). We’d buy some food in Manchester for the way back. I knuckled down and bought the train tickets and made our plan. I was still a bit cross about the whole thing, but it had become easy.
Why? What had changed? That same, small bag and been on the same peg for the past two weeks. Why did it take me til this moment to see I could use it?
Acceptance.
I had accepted that I had to do something I didn’t want to do. And once I had accepted it, I could move forward.
Turns out it was never about the bag (well, duh). I was still cross. But I was in action.
Let me be clear. Acceptance doesn’t mean you have to be happy about your situation. It doesn’t mean that your situation is ok. It doesn’t mean that you have to forgive someone, or that their bad behaviour is ok, or has to be excused. It doesn’t mean that you have to give up hope, or passively accept what’s happening.
Acceptance means being fully present in your reality. And in accepting your reality, you can move forward.
And acceptance isn’t just for the small things…
Acceptance and chronic pain management
Last year, I ran a workshop for a group of Dental Speciality Trainees. Did you know there are 13 different dental specialities in the UK? Me neither. I digress. The workshop (one of my favourites) was called ‘Mind Control for Beginners’ and was all about managing that pesky voice in your head.
At the mid-workshop break, one of the participants came to talk to me about Acceptance and Commitment Therapy (ACT). They said that it was being used to great effect to help their patients live with chronic pain.
How fascinating! I had to find out more.
Right now, a staggering one in five of us is experiencing chronic pain, defined as pain which persists for longer than three months. It’s not only a physical thing - it can disrupt pretty much every aspect of your life. Your ability to work, socialise, take part in activities. Your relationships, your mental health. It can cause anxiety, frustration and isolation, particularly when the pain is invisible and people close to you don’t understand your experience.
If you’re suffering from chronic pain, of course you want it to stop. You experience the pain as something bad, something that’s getting in the way of you living your life. As it continues, it’s common to fall into ‘pain catastrophising’, in which your (completely understandable) negative response towards your actual or anticipated pain becomes more and more exaggerated.
So, what if the pain is with you for a long time? What if it never goes away? Does this mean you’ll never live a full and healthy life? It certainly seems that way to a lot of sufferers.
ACT (which has its roots in Cognitive Behavioural Therapy) aims to literally change your mind about this. The idea behind ACT is that, while pain undeniably hurts, it’s your ‘struggle’ with your pain that causes your suffering. So it follows that if you can minimise your ‘struggle’, you can minimise your suffering.
It does this using acceptance, mindfulness, commitment and behaviour change strategies. It can help patients to accept their experiences, choose their behaviours mindfully (as opposed to falling back on conditioned responses) and take committed action, increasing agency in their life.
Patients are supported to change their expectations from ‘being pain free’, to ‘living a rich and full life with the pain’. By accepting and learning to live with the pain, they can limit the impact it has on their lives.
A little more important than choosing a bag to take into a football stadium…
Ok, this sounds powerful. How can this help me?
Our minds get snagged on things all the time - just two weeks after the football match I went through the whole process again. Someone casually backed out on a commitment which caused me a HUGE amount of work and put back a project by a month. I was furious and frustrated…and completely paralysed. I didn’t do anything about the situation for a week, stuck in some sort of fantasy that it would all magically sort itself out. I’d had a strong expectation of how this was going to turn out, an expectation that was now in ruins - and I couldn’t accept it. My inaction put the project back by a further month, and every time I thought about it, I got myself into an angry, red-faced tizz.
When I finally realised what was happening, I paused…took a breath (well, maybe more than one 🤣), and accepted.
I was still cross (there’s a theme here 🤣). But I was in action.
(And I decided to write this article!)
Negative experiences are inherent in living. We don’t choose to have the negative experience. But we can make a choice about how we react to it. We can choose to remain caught up in how bad the experience is. Or we can accept the experience, still be in it (in all its shit-ness), and move on.
* * *
I want to be clear at this point that I am absolutely not suggesting that if you’re suffering, it’s on you; you’ve somehow chosen to be that way; it’s all in your mind; that you simply need to think ‘happy thoughts’ and everything in your life will be sunshine and roses.
I’m not advocating for acceptance because I believe it’s your fault that you’re suffering - I’m advocating for acceptance because acceptance gives you agency in your life when you’ve been dealt a shitty hand.
I’m also not pretending acceptance is easy - I am, after all, the woman who spent two weeks not planning a trip because of a bag… But it is simple. So simple, in fact, that it can occur in a single moment…
* * *
Back in the 1930s, Protestant theologian Reinhold Niebuhr, wrote the Serenity Prayer. Here’s a secularised version:
May I have the serenity to accept what I cannot change, the courage to change what I can, and the wisdom to know the difference.
When we don’t accept reality, even the smallest of challenges can take a disproportionate amount of our attention, energy and time. We don’t move forward. Our actions or inactions make our situation and our suffering worse.
And when big challenges come for us (and come for us they will), our suffering can stop us from living our one, rich, joyful life.
A couple of years ago, I was walking out of the hospital the day after my right eye lens had dislocated and fallen into the front of my eye. I was in a lot of pain following emergency eye surgery, traumatised by the past 24 hours, blind in my right eye and had no idea if, or when, I would see out of it again.
It suddenly struck me that this whole experience could have been prevented - administrative mistakes had delayed preventative treatment. I felt a black, oily sensation creep across my body, as I started to contemplate the ‘what ifs’; the unfairness of it all; the ‘who is to blame’; the…
I paused.
I knew, with absolute clarity, that if I followed this train of thought, it would devour me from the inside.
I took a breath.
I chose to accept.
And I have lived free from the ‘what ifs’ ever since.
.
.
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Acceptance is the pivot between suffering and living.
All you have to do is choose…
A Practice for You
What is your mind snagged on right now?
What could you choose to accept?
What would be possible then?
Drop me a line at hello@changefoundry.org.uk and let me know what comes up for you.
