There is a prayer, often linked with Alcoholic’s Anonymous (AA), called the serenity prayer, which reads: “…grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
There is a prayer, often linked with Alcoholic’s Anonymous (AA), called the serenity prayer, which reads: “…grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” The words are repeated regularly in meetings and the concept helps those in recovery live day to day with uncertainty, never knowing if today might be the day they relapse. This mentality is also one that cancer survivors and those with chronic illnesses have learned to manage as well. As time goes on in the pandemic, this strategy and others from acceptance and commitment therapy (ACT) seem to be skills we can all benefit from learning and honing.
That is because the uncertainty of it, including the length of time it will go on, only makes it more difficult to manage. What might have seemed like something that could be tolerated for one month, is much less tolerable for 6 months, or a year, or some uncertain amount of time in the future. It is the difference between gritting and bearing through a stressor, like getting a shot or going on an airplane, and living with that same stressor persistently. Dr. Keith Humphreys, Professor of Psychiatry at Stanford University notes that in studies of pain, pain is thought of as more unbearable if people don’t know when it will end. He explains, “We are seeing that dynamic in this epidemic: not knowing when relief will come makes everything worse. People thus have to accept two unpleasant things at once, namely that their lives are worse and that they don’t know when the storm will pass.” Not accepting our own limits, Dr. Humphreys notes, can lead to anxiety, depression, and shame.
But, just because people want predictable environments, does not mean the environment is actually predictable. In fact, it is quite the opposite. Dr. Steven Hayes, Nevada Foundation Professor of Psychology at the University of Nevada, Reno and author of a Liberated Mind, explains “we might have cancer right now and not know it, or we might have Covid-19 right now and not know it.” Still, there is a part of us that thinks if we worry enough, we can know all the answers or fix them. Dr. Hayes notes, “your mind has this idea that if I tantrum enough, some reality will care, but the virus doesn’t care if we say we just can’t stand it…we aren’t going to be rescued (like we were sometimes as kids), this is up to us to sort of sit with.”
Pain, like uncertainty, is also an inevitable part of the human experience. This is true not just during Covid-19, but always, like when someone is diagnosed with cancer unexpectedly, or experiences a complicated pregnancy. Dr. Hayes says that people like to think the world is “happy happy joy joy” but “if you live long enough, you start running into pain and illness and loss and tragedies of all sorts. It’s just part of it. That’s part of life.” Learning to accept that, as opposed to trying to change it, can make all the difference. Dr. Hayes adds that our mind also likes to tell us “our future will be better if we worry about it now,” but actually data says when that future becomes now, a person actually does more poorly if they worried about it too much.
As such, it is important that we change our strategies to cope (see: the World Health Organization illustrated guide for more ideas). One important skill to learn is psychological flexibility. Dr. Hayes defines this as “being able to be open to different kinds of thoughts and not have to grab on to truth with a capital T. And, to be open to a range of feelings without having to self soothe in ways that are avoidant and destructive in the long run”(like alcohol use, which is increasing during the pandemic). In a study during Covid-19, those with high stress had worsened psychological problems if they were more psychologically inflexible and pessimistic. Dr. Hayes explains that in all of the data he has studied, the single most important predictor of psychological outcomes was psychological flexibility processes. He says, “what these flexibility processes predict is who is going to crash and burn versus who has got to come on the other side of a challenge like this with post traumatic growth.”
The good news is that studies have shown repeatedly that people can learn to be psychologically flexible. Dr. Rhonda Merwin, Associate Professor and Licensed Psychologist in the Department of Psychiatry and Behavioral Science at Duke University, School of Medicine explains, “Our current situation is more a marathon than a sprint. We need to open up to what is (accept the current situation) and establish new structures and routines.” And now is a good a time to learn. Dr. Hayes adds, “You know, you’ve had a gut punch. Time for a gut check. How are you? How flexible are you? How resilient are you?”
3 Acceptance and Commitment Therapy (ACT) Skills to Use To Survive Covid-19:
1) Be in the present moment: When we are anxious or worried, our minds tend to wander to concern about the future. Right now, that is often “when is this going to end” or “what is happening in the fall” and is typically not the more adaptive future thinking of planning (or what Dr. Hayes calls “actions that are reasonable and helpful” like talking to your stock broker or getting toilet paper). When we are depressed, we tend to ruminate in the past, using unhelpful narratives of how things “should be.” Either way, as Dr. Merwin explains, “Our minds love to time travel.”
To cope, we need to work to be present or really let go of our worries and just be in the moment. To do this, Dr. Merwin suggests the following:
Try to notice when a thought has you “hooked” and instead of getting caught in it, work to let go and come to the present moment.
One strategy to help with this is noticing your 5 senses: what you can see, hear, feel, taste, and smell. Another is through breath, or gently allowing your own awareness/attention to find your breathing. You should be noticing all of the sensations of breathing in and out.
If you feel activated in your body, it can help to exhale longer, or to close your eyes for a few minutes. When you open them, reorient to your surroundings, meaning the moment you are in, not the future one.
Dr. Merwin says that if we focus on what we imagine or fear for our future, we borrow pain and “it brings additional suffering.” Being in the moment is more manageable and it also makes sure we don’t miss anything by being in our “heads.” Dr. Hayes adds that we have a “problem solving mind” and an “observe and appreciate mind” and through things like our smartphones with quick answers, we have fed the problem solving mind regularly. But, if we are aware and present, and see something beautiful, like a sunset, everyone knows just to appreciate it and say “wow,” and not instead, for example, to judge the color of it. The concept of “wow” can even be brought into pain, and Dr. Hayes explains that one can say, “Wow, this is hard. Wow this is weird. Wow, this has gone on forever. Wow, I don’t like this [and] I’m having the thought I don’t like this. Wow, I’m feeling helpless.” It is the stopping to notice and say “wow” that is part of the change.
2) Open up to feelings and uncertainty: This is where the serenity prayer comes in. Dr. Merwin says, “Resisting the rain doesn’t change the fact that it is raining, it only increases our suffering. Wishing it was over, wondering when it will end — that is [also] resisting, and it will feel harder.” Therefore, it is critically important to discriminate what is or is not in our control, and to learn to control what we can and let go of the rest- including the need for things to feel or be different.
Feelings are something we cannot, and should not, control. Dr. Merwin explains that we need to be open to the experience of them, which she says is not “wanting or liking, it means being willing.” This is particularly hard when there is uncertainty, as Dr. Hayes explains, “tolerance of uncertainty correlates with experiential avoidance and we have a hard time sitting with our emotions when we are unsure.” Covid-19, in particular, requires being open to the unknown even if it is scary, or can make us pause. Dr. Merwin notes that some of the most important things in life like a new career or relationship are uncertain. It is part of being human, but giving the space for it can be “life giving [and] can allow us to go and do things that we couldn’t if we needed to control or avoid this feeling.”
That is because stopping feelings or judging them has consequences and only increases our emotional pain. According to Dr. Hayes, a good way to be self-compassionate is to ask “If you met yourself as a kid, with thoughts like this, or worries like this, what would you do or say? And then, the thing would be well, could you do that with yourself right now?” He emphasizes that we are often kind to our past child self and respond to that question with something like “I really tried to listen to her or give her a hug” and rarely say something like “snap out of it” or “grow up baby.” Feelings should be allowed and given the space and, as Dr. Merwin says, we should “even welcome them like guests into your home.” By allowing feelings and uncertainty as part of our lived experience, we can also learn from them and what we might need. Sitting with uncertainty can also help shift the focus to the now, and allow for making plans, but realistic ones, with flexibility and contingencies.
3) Do what matters, Focus on your values: While we might not have control over everything, we can choose to behave consistently with our values in any situation and all circumstances. Especially in times of uncertainty, it can help to focus on the “next right thing” and not all of the right things. Dr. Hayes explains there are four ways to get to your values. One way is that you can think of the sweet moments in your life and unpack them to find the something of value in them. Another would be the opposite, looking at the emotionally hard moments and seeing what you yearn for or what value was violated in some way in them. Third, he says you can think about what you would do if you were writing your own story and wanted to empower others with it. Specifically, what theme would you use? Lastly, he says that he asks people to think of a hero, someone in their life that would rise to the challenge they are in right now and could give good advice or show them how to manage it. He says this can be anyone (a sibling, parent, friend, lover, therapist, coach), but is often the person you think of when you wonder “I wish they were here to give me some guidance.” He then tells people to imagine they are embodying that person and being filmed handling the coronavirus. He explains there is a reason a hero will be picked, because of what they stood for, because of their values, and that will help someone identify their own.
If those techniques do not work, Dr. Merwin says to ask ourselves the following questions:
Who or what is most important? How do you want to live the moments of our lives, even the hard ones?
How we can express our values given the current conditions? (some expressions are possible, others are not; i.e., we might not be able to visit our parents, but what else can we do to express gratitude and love).
Ultimately, knowing our own values can help us transform pain or personal discomfort, according to Dr. Merwin. For example, if we know we value protecting others, it is easier to choose to wear a mask or stay home. She explains, “It is important to remember why we (personally) are doing what we are doing.” Perhaps, in doing so, it also allows perspective taking, something that is very important overall in ACT principles. Dr. Merwin explains this as “we were ‘us’ before this and will be ‘us’ after this, although our thoughts/feelings may change with this experience.” This concept more broadly allows people to then try to think about what others might think or feel about something, or perspective take, in a more flexible way or situate the current experience in a much broader context, one of “humans that are living and working together.” Doing this, Dr. Merwin says, “gives us access to compassion and openness to others.”
Ultimately, learning to do any of these skills might help you better cope in the next few months, or longer. Obviously, like anything, these skills take time and you will have to get better with practice and repetition. But, as Dr. Hayes says, “Let’s all start where we can start. Today would be good.”