Acceptance and Commitment Therapy (ACT) and Facebook

When I first began this blog, I posted a page on Acceptance and Commitment Therapy (ACT), which you can find here. I drew from the article Using Acceptance and Commitment Therapy to Treat Infertility Stress by Brennan D. Peterson & Georg H. Eifert. Some of the major points of the article are summarized on my blog page, but I’m going to whittle it down even more for you in this post, so you can take in the major points more quickly. And then I’ll write a bit about Face.book and how it relates to ACT:

ACT:

  • Mindfulness-based therapies have demonstrated efficacy in reducing stress and depression in patients diagnosed with physical disorders such as cancer and arthritis (Foley et al., 2010; Zautra et al., 2008). ….Because patients diagnosed with infertility report similar levels of depression and anxiety when compared to patients diagnosed with cancer, the usefulness of testing mindfulness-based therapies with infertile patients would also be valuable (Domar, 2002).
  • Acceptance and Commitment Therapy (ACT) is an experiential acceptance-based behavior therapy that targets psychological inflexibility, experiential avoidance, and efforts to reduce and/or manage unwanted aversive experiences (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). These authors define experiential avoidance as a tendency to engage in behaviors to alter the frequency, duration, or form of unwanted internal experiences (i.e., thoughts, feelings, physiological events, memories) and to avoid the situations that trigger such thoughts and feelings.
  • Indeed, the use of avoidance coping is strongly correlated with increased amounts of infertility stress, marital dissatisfaction, and depression (Peterson, Newton, Rosen, & Skaggs, 2006a; Peterson, Newton, Rosen, & Skaggs, 2006b). Family events and social activities associated with young children now become painful situations to be avoided at all costs, and these avoidance efforts contribute to feelings of social isolation (Domar, 1997). Additionally, prolonged periods of infertility stress can strain a couple’s interpersonal relationship (Berg & Wilson, 1991).
  • These avoidance strategies take up a great deal of time and energy and ultimately result in couples feeling helpless and not in control of their lives (Daniluk, 2001). According to ACT, avoidance strategies are related to and fueled by cognitive fusion (Hayes, Strosahl, & Wilson, 1999), which can be described as “buying into” one’s thoughts and feelings about infertility.
  • Thus, activities that once provided the couple with intimacy and security now become the catalyst for increased stress and anxiety (Peterson, Newton, & Feingold, 2007). Overall, a couple’s sense of vitality is greatly reduced and ultimately replaced by a narrow set of behaviors that couples find isolating.
  • ACT uses acceptance strategies and cognitive defusion techniques (e.g., metaphors, mindfulness exercises) to teach clients to respond more flexibly and less literally to infertility-related thoughts and create a healthy distance between themselves and their internal experiences. Instead of trying to dispute or otherwise change thoughts such as “It’s unfair that we can’t have a baby” or “We must have done something wrong for this to happen to us,” clients learn to acknowledge these thoughts as mere thoughts that can simply be observed that don’t need to be acted upon.
  • ACT’s ultimate goal of helping men and women live lives consistent with their values and goals. Infertile couples experience a significant inconsistency between what is important to them and their actual life situation because living out their key value of becoming and being a parent has been thwarted. This creates a great challenge for these couples.
  • The therapist gave Brooke and Aaron a Chinese finger trap, asked them to put one finger in each end of the trap, and then attempt to remove their fingers. The more they struggled to get their fingers out, the tighter and more restrictive the finger trap became. To get out of the trap, they had to push their fingers in. This counterintuitive movement provided a basis for approaching infertility stress in a different manner than in the past. By resisting infertility stress and pulling away from it, they had eliminated much of the flexibility and space in their lives and thereby increased their distress. Thus, in order for new solutions to emerge, both Brooke and Aaron had to experience the effects of “moving into” the stress of infertility, rather than avoiding or pulling away from it.
  • The “watching thoughts on leaves” exercise (see Eifert & Forsyth, 2005) was an intervention aimed at helping Brooke and Aaron defuse from their thoughts by becoming mindful of them as they watched their thoughts drift by like leaves floating down a stream. Rather than getting fused with the content of these thoughts, the couple learned to view the thoughts as products of their minds and themselves as mere observers of the thoughts.
  • Couples reported that their lives became so dominated by the infertility experience that they stopped making choices consistent with their life values and goals. One woman reflected, “How much longer did I want to live my life excluding everything I value about it . . . at the expense of my marriage and my relationship with my family, my schooling, my career, friends?” (Daniluk, p. 128.) Another woman reflected, “Before you realize it, you’ve put your life on hold for five or six years . . . I could have had a fuller life during that time” (Daniluk, p. 128).

It was with ACT in mind that I started visiting Face.book again.

Because DH and I live far away from most of our friends and family (because DH found a job here), Face.book is, for better or worse, one of the main ways we stay involved in the lives of many people who are important to us. Our Face.book announcement of our court-house marriage, for example, was a huge deal, and one of the few ways we shared that moment with people. Face.book annoys me and bores me sometimes, but it also does make me feel connected to people I love, for sure. So when I drop it, I feel it. This past time I dropped it, I thought it would be forever. But I hopped back in again recently, with the hopes that I can put to the test my claims that I am getting over my triggers (little babies, pregnant women, images of happy family life).

I even took on the “100 happy days” challenge posted by Fertility Doll and have managed to halfway keep up with it on Facebook, pulling in comments and “likes” from a lot of people who probably wondered why I seemed to fall off the face of the earth since late October, when the pregnancy went south. The challenge is helping me appreciate the richness of my life and helping me reconnect with my FB community in a fun way.

More than once, I’ve had thoughts like: “If I had kids, I would have posted photos of them by now, and not this stupid photo of the falafel burgers I made from scratch.” More than once, DH and I have joked that we are going to start taking photos of random people on the street, posting them, and claiming the people are part of our fascinating social life. But the truth of our lives right now is that things are rather quiet and simple, and filled with beautiful things every day—just not with children. And the tenets of ACT challenge me to not “buy into” any negative thoughts that pop up about our childlessness. It’s okay to have the thoughts, but then just notice them, acknowledge them, and let them go.

I love the Chinese finger-trap metaphor discussed in the ACT article—the more you try to pull you fingers out, the harder the trap grips. So by going back on Face.book, I am, instead of trying to pull out and avoid what might hurt me there, trying to go back in, rejoin community and enjoy the things about that community I used to enjoy.

There have been a few particularly difficult moments. Like the morning I was feeling the quietness of my home in an oppressive way and I saw a post from a friend about how she’d just spent the past three hours jumping on the bed with her kids. She posted a photo of them, rosy-cheeked and cracking up. My refrigerator hummed.

But for the most part, rejoining has been a healthy thing, I think. DH and I have even talked about sharing this next cycle on FB. We’ve never done anything remotely close and realize that this could be a risky thing to do. We would have to spend more time considering the possible consequences. But if we posted to a select list of people we really trust, the outpouring of support could be incredible, and could make us feel less alone, no matter what happens with the cycle and possible pregnancy.

I’d love to hear your Face.book stories—both the good outcomes and the bad that you’ve experienced as a result of participating in that world, or sharing your IF journey there.

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18 Comments

  1. Ah yes. Love me some ACT. The Chinese finger-trap metaphor is very good. I like the green skittle one, too. If I tell you not to think about a green skittle and then say okay GO! STOP THINKING OF A GREEN SKITTLE RIGHT NOW! what are we going to do, right? It seems so obvious, and yet it’s not.

    Reply
  2. Clare

     /  February 12, 2014

    One thing that struck me once we finally conceived and got to the point of announcing… I had spent a lot of energy hiding our infertility. I was open with a few close friends and fam, but I was embarrassed for the public at large to know. Well little did I know, everyone already knew what we were going through and what I kept hearing over and over once I conceived was how concerned everyone had been bc I had changed so much. They thought about me and worried about me. It would have been so good had I known that, all the times I felt so isolated, all these people wanted to give me support but it was me keeping them at arms length and wearing myself out trying to keep a secret for no reason. (Sorry I always write a novel in your comments)

    Reply
    • Novels are welcome here. (:
      Wow—thank you for this. It makes me wonder who out there is wishing I was sharing with them, who out there is yearning to give me support but feels like I won’t be receptive to it, or feels like it would be awkward for me. A wake-up call. It does take a lot of energy, doesn’t it? To stay “in the closet.” I think I need to include more people this time, let them in and feel their support.

      Reply
  3. I found this very interesting. I’ve never heard of ACT before this. Everything you’ve written makes a lot of sense to me, and I appreciate the synopsis.

    Some of it definitely sounds easier said than done. But, I know there’s no easy solution to the grief of infertility, or else we’d all be already doing it, right?

    I have a love-hate relationship with Facebook. I also am not working and find it is something that fills the quiet, lonelier moments in my life. I’ve found it necessary to block certain people from my feed for my own mental heath. Not all of the people I’ve blocked are because of infertility, some of them just write stupid, ignorant things that really make me cringe, but for whatever reason I’m not ready to delete them as a friend, like good old Aunt Helen.

    Maybe for your next treatment you could try a group message? It might be a safer place to share some of your next cycles. It could be a little more private, yet, you could benefit from the support of the people who mean the most to you. Those who aren’t as supportive might be able to see what others have written to you and get a hint about what might be helpful.

    What’s been driving me crazier lately about Facebook is the amount of overt bragging and the humble-bragging. I find there’s a fine line between sharing and bragging.

    Wishing you well as you navigate your experiment. :)

    Reply
    • I have to mirror pretty much everything Julia has said (and add that I relied on facespace a lot more when I lived far away from everyone I know–so I felt ‘connected’). Her suggestion to share with a more intimate group is a great idea! I ‘hide’ people who irritate me, even some of my closest friends, and just check in on them occasionally. And I despise ‘overt’ or ‘humble’ bragging, like “The twins learned how to escape from their Restoration Hardware crib!” *Cringe* XOXO

      Reply
    • A group message is a fantastic idea! So you mean in a private message, just send a private message to a select list of people, right? There are also private group pages, but that’s probably less private somehow…? I know what you mean by easier said than done—that’s my first reaction to the “drifting leaves” metaphor in the article. I resist it and inner voice says: Yeah right! I’ll just send those thought on leaves down a river, no problem! But the truth is, I sometimes do use that metaphor with good effect—nothing takes the discomfort away totally but these little tricks can assuage it at the very least, when am at my best. Thank you for sharing all of your impressions and ideas. And for expressing pretty much exactly how I feel about that community—the sense of filling an absence when I am lonely, loving it sometimes, hating it at others.

      Reply
    • A group message is a fantastic idea! So you mean in a private message, just send a private message to a select list of people, right? There are also private group pages, but that’s probably less private somehow…? I know what you mean by easier said than done—that’s my first reaction to the “drifting leaves” metaphor in the article. I resist it and inner voice says: Yeah right! I’ll just send those thought on leaves down a river, no problem! But the truth is, I sometimes do use that metaphor with good effect—nothing takes the discomfort away totally but these little tricks can assuage it at the very least, when am at my best. Thank you for sharing all of your impressions and ideas. And for expressing pretty much exactly how I feel about that community—the sense of filling an absence when I am lonely, loving it sometimes, hating it at others.

      Reply
  4. I think I need to go read that whole article. Like, right now. Thank you for sharing.

    Reply
  5. circlesbecomeme

     /  February 12, 2014

    Thanks for all the references!

    And on your considering sharing the cycle in Facebook, this last cycle I picked a dozen important people in my life and shared the hope (and sadly the subsequent sadness) with them via email and whatsapp. The support really made me wish I had done that for my first cycle. Plus I really saw how much it meant to them to share in the excitement and hope, particularly my mom. And as a side benefit, they have started reaching out and sharing things they hold close to their heart. I feel deeper connections now. FB is a place i only go when I am up for it, and I for one don’t have the willpower to avoid skimming my feed whenever I open it. Direct communication, but not phone, worked well for me. Good luck!

    Reply
    • Thank you for sharing this. What a great outcome. That’s what I want—deepened connections. I want to put myself back in the fold, so to speak—and there are probably those out there who want me back. It is so hard to stay in touch when there is so much that I feel like I can’t say. Can’t plan trips because of cycle. Can’t get a drink because of cycle. Can’t talk about work because I quit my job due to trauma. But what if I just told a select group what is really going on? They must feel the distance and want it to go away as much as I do.

      Reply
  6. p.s. I think part of the problem is that I am embarrassed about how long this is taking and I’m worried that people are going to judge me and think I need to get out of ART—and the laborious explanations I’d have to go through about our guarantee program, the fact that we are back at square one and don’t know what is going on, etc. I wonder how I can share while keeping it vague enough that I don’t have to belabor all of that. The other tricky thing is the group of people who DO know what we’ve been going through, and whom I did reach out to in the beginning, but who I am now afraid to talk to about what’s going because I’m afraid that they will do the math, see that I’ve been in this world for 3 years, and not approve of are continuation of treatments. I’m afraid that every one of them will be thinking: MOVE ON TO ADOPTION NOW. And they won’t understand why that is not possible for us right now. But so what? So what if some people do think that, right? The positive could far outweigh the negative.

    Reply
  7. Thanks for sharing this. I have never really heard of ACT before and the whole time I was reading it I was amazed at how I can/should apply it to my and my life. When I lost my first pregnancy in July I immediately said screw this, and deactivated my Facebook. I was angry at all the pregnant people and all their happy littles ones, and I stayed that way through my second loss in late September. It was well after I had my personal blog up and running and I worked through a lot of ‘feelings’ to reboot my facebook. Day 1 welcomed me with 3+ pregnancy announcements, 5+ baby bumps… It was challenging at first but tried to embrace it. I don’t talk about our next steps regarding treatment, even in my blog I stay pretty private. Like you, I just don’t know how much to share, who I would share it with, and would they really even care… HA! I’ve found my IF really only matters to my and DH. My family isn’t too supportive, and his family seems to think we can cure our IF naturally (HAHAHAH). Good luck girl! You are brave, keep us posted on how it goes and what kind of feedback you get! XOXOX

    Reply
    • I’m so sorry to hear your fam is not that supportive, and as for his family—I understand you all too well, UGH. DH’s mom is one who says (or at least used to say): “Oh, just relax.” DH is sad that if we connect with people through a private Facebook message his parents will not be included—but the hard truth is, they cannot handle being included. They worry inordinately and judge every move. We have to communicate with them about things after the fact. They do not know about this last loss at all—we just knew it was best for all of us if they weren’t part of that.

      Anyway, I’m excited about the “experiment” and I will certainly keep you posted! Xo

      Reply
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