Acceptance and Commitment Therapy for MuScle Disease (ACTMuS): Protocol for a two-arm randomised controlled trial of a brief guided self-help ACT prog

Have you read Hayes's stuff? I have big problems with the key notion that "human beings get depressed because they have language" [that's how the head of psychology explained it to me - reading Hayes' book and papers, that doesn't seem far off]. Does that mean that they get fatigued or experience pain because they have language too? It's nonsense!

 

This reminds me of a funny quote from The Hitchhiker's Guide to Galaxy:

 

To me, your quote is straight out the CBT rulebook.

Let me explain my thoughts here (they are my own, others may have a different perspective).

To me, CBT is founded on a very specific theoretical framework, whose core ideas are usually attributed to Beck. This framework places a person's thoughts on center stage. Thoughts precipitate the onset of depression and anxiety (lurking negative thoughts and attitudes can create a pressure cooker situation ready to blow as soon as something really challenging happens). These same thought patterns also maintain the psychological distress. These thoughts take the form of inner speech, so yes, the theory proposes that language is at the core of psychological distress.

According to this framework, the appropriate intervention for these disorders is to stop the client's stream of negative thoughts (rumination) because without them, the depression is not sustained. You can do this using techniques like cognitive reframing but you can also modify the person's habits and environment in ways that might also intervene to stop the negative thoughts. Like suggest they get out more, or avoid situations that get them ruminating. Or do a bit more exercise. CBT is inherently corrective. It can't NOT be. Severe psychological distress is a function of having the wrong types of thoughts. And those thoughts need to be corrected.

ACT is not founded on a specific theoretical framework. Its defining feature is that it rejects the theory and methods underlying mainstream "hard' CBT. Many therapists are deeply dissatisified with the stupid and limited ideas that underpin CBT. And the pejorative notion that people think themselves into these states (and no matter how pretty the words, I bet the clients can still smell the BS). ACT therapists don't want to tell their clients they're weak and thinking the wrong thoughts, and must stop doing this. They want to tell their clients - you're strong, you've done actually pretty damned well so far! Let's see if we can work together using your strengths, to find for you a new a better quality of life?

 

@Woolie

"
Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.

Based on Relational Frame Theory, ACT illuminates the ways that language entangles clients into futile attempts to wage war against their own inner lives. Through metaphor, paradox, and experiential exercises clients learn how to make healthy contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided. Clients gain the skills to recontextualize and accept these private events, develop greater clarity about personal values, and commit to needed behavior change.
"

From the horse's mouth - S Haynes - https://contextualscience.org/act
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I tend to think you're right that ACT is generally wiser but I think it overlaps quite a bit with CBT. I'd call it Buddhish CBT. I'm personally equally skeptical of their utility in the medical system.

 

And therein lies the problem. That's what I was doing before ACT therapist came in and told me everything I was doing was wrong (even though it was *exactly* what they wanted me to do - it just hadn't ever worked). And I guess that's the problem with the way that things like pacing gets undermined too. It's not what we're doing or thinking that's the problem. It matters not whether it is mental or physical. We are ill. Magically believing that we're not ill is not going to change that. Been there. Done that.

 

This is clearly not the case, would you agree?
My thoughts do not involve language at all in general.

 

So according to these theories, no-one with profound aphasia should get depressed? No inner language = no ability to think bad thoughts?
Which is of course, absolute rubbish.
The whole area of inner language is fascinating to me. I ask people with aphasia if their ‘thinking’ is different and they have great difficulty deciding. My experience is that it’s impossible to know where thinking and language overlap/how much they are entwined.
Sorry - I’ve gone off topic! For anyone who is still interested, there is a book called ‘Don’t sleep, there are snakes’ which goes into this issue. Great read!

 

Whoa, that's a huge question!

I think the short answer is probably "yes", your thoughts do involve language. But its complicated, and there's probably a massive network of representations that become activated during active "thought", including visual, linguistic, conceptual and spatial (I mean "thought" in the way its used in everyday conversation). In any case, the linguistic representations that are activated during thought are probably a little different than the ones activated in overt speech; a lot of the experience we have of "inner speech" is most likely a mental reconstruction.

 

Yes, of course, its totally silly. People with aphasia are in fact more prone to depression than those who've had strokes that did not affect their language - and by quite a bit too.

My sense is that people with aphasia are often unaware of the extent to which their stroke has affected their thinking. They will often say "I can think it, but I can't say it", but there are often documented changes to their thinking too, even when measured outside of a language task. It depends a lot on the type of stroke (the location of damage), of course.

Recently, there has been interest in the notion of "thinking for speaking", which is the idea that producing language requires a sort of powerful control over our cognitive activity. So in other words, to say "I just saw a green car", you need to do a whole lot of high level mental inhibitory control, to avoid saying words that may be in your mind at the time but are not appropriate for your message (for example, blue, or van), and also to make sure the words you do choose come out in the right order too. According to this idea, some types of expressive aphasia could be seen as a sort of failure of cognitive control that primarily affects the verbal domain. So in other words, its not a problem with language, its actually a problem with that sort of higher mental capacity.

So anyway, more than you ever wanted to hear I'm sure. But I guess the message is: cognition and language are not separate, they're kind of aspects of the same thing.

 

Yes, it is complicated. I am being a bit unfair @Woolie, because I have recently published something in Frontiers in Psychology on the structure of mental representations. (https://www.ucl.ac.uk/jonathan-edwards/publications/distinguishingrepresentations.pdf)
I think we can be fairly sure that individual neuron spikes have propositional meaning and language is simply a means of categorising these meanings for storage, re-access and communication purposes.

 

And we're back to correlation does not equal causation.

For example: i started to experience some very low, very bleak moods. It was extremely unpleasant and I had no idea why. I would be happily minding my own business and suddenly my mood would plummet like a stone down a very deep well. So I thought about it. I tried different strategies to reduce the frequency and severity.

Eventually, I thought I'll go see my GP. Sure enough, my TSH had shot up to 25 (ideally my optimum is about .5 or lower with a top end T4 reading). However, an additional hormonal problem was masking the usual hypothyroid symptoms.

So the rumination came after the bleak mood, not before. I believe that would be fairly natural because you try to think/talk your way out of it.

 

This is exactly why I believe so much of this stuff is inherently very dangerous.

The patient is already struggling with a health issue, be it "physical" or "mental" and the therapist barges in and undermines their self belief and their coping strategies. All done without necessarily having the first clue as to the root cause of the problem.

Even if the "treatment" seems to help some, no treatment, drug or talking, fits all. This one size fits all philosophy actually ends up being one size fits none. Worse than not helping many, it actually harms a significant number by undermining existing coping strategies.

 

Good for you, @Jonathan Edwards! You are not being at all unfair. The relationship between thought and language is in fact my area of expertise. More than happy to answer any questions you may have.

 

Yes, this is my suspicion too. Emotions are at the core of cognition and drive everything. Our thoughts, our feelings, our experience, our judgment, our decisions. Not the other way around.

 

Apparently "dogs don't get depressed, which is why it is all due to language, coz dogs don't have language" - according to the clin psychologist I saw.

 

I sometimes get depressive mood from eating certain (cheap, processed) foods. It causes the thoughts and feelings that are characteristic of depression.

 

https://www.youtube.com/watch?v=a_zMxHOPJcA

I'm not impressed by the clinical psychologist at all. It's worrying that a person with such poor levels of empathy and sympathy could even go into that job.