Defusing From Disordered Thoughts
Those familiar with Acceptance and Commitment Therapy, or ACT, may have heard of the concept of cognitive fusion.
Cognitive fusion refers to the tendency for individuals to accept their thoughts as absolute truths, or rules that must be followed.
In other words, the experience of automatically believing everything that our minds tell us as accurate information.
Cognitive fusion is not always a problematic occurrence. Sometimes, the thoughts that encourage us to make safe and productive choices can be helpful. For instance, the thought, “I need to wear my seatbeat, or I might get hurt” is beneficial, and leads to responsible decision-making.
Cognitive fusion becomes problematic when we allow our thoughts to dominate our behavior, rather than making choices congruent with our values or goals. For instance, the thought that “I can’t go to the barbeque because I know I will have a panic attack” can lead to avoidance of potentially meaningful experiences that contribute to a fulfilling life.
This thought also is not necessarily true, since we cannot predict the future.
Enter: cognitive defusion. Cognitive defusion is a process that allows us to make conscious choices about which thoughts we would like to listen to, versus which thoughts we would like to acknowledge— but ultimately decide to reject. Rather than ignoring thoughts, or trying to push them out of our minds, we simply examine all thoughts and choose which ones we would like to attend to.
Practicing cognitive defusion allows us to shift our relationship with our thoughts by taking a step back and examining them—thus creating a degree of separation between thoughts and reality.
ACT offers many techniques that are effective in facilitating cognitive defusion. My favorite cognitive defusion exercise is known as “Passengers on a Bus”.
Imagine yourself as a bus driver, with each of your thoughts representing a passenger riding on your bus. Now, imagine that each of these thoughts is giving you direction about which route to take toward your destination. Oftentimes, it may be easiest to listen to whichever passenger is giving the loudest direction, in the hopes that listening to the instruction will cause the noisy passenger to quiet down. Likewise, there will be many “loud” disordered thoughts commanding individuals struggling with eating disorders to use symptoms, engage in avoidance, or engage in other behaviors that directly interfere with recovery.
People living with eating disorders frequently describe particularly distressing disordered cognitions as their “loudest” thoughts. Since the “loudest” thoughts tend to be the most distressing, we become driven to attempt to quiet them through obeying whatever the disordered thoughts command.
The Passengers on a Bus metaphor allows us to practice challenging the tendency to automatically obey whichever thought is the loudest, and instead begin to acknowledge the thought as a thought, rather than an absolute truth.
The idea of cognitive defusion presents individuals with an empowering alternative to blindly following the direction of loud and disordered thoughts.
What if, rather than listening to the thoughts that are the loudest, we could notice all of the thoughts occurring in the moment, and choose which thought to listen to, based on our values and long-term goals?
In other words, what if we intentionally pay attention to the “passenger” on the bus who is encouraging a value-consistent choice, such as, “You should attend the barbeque even though you might get anxious. It’s been a while since you went to a social event, and it’d be great to see your friends! In the long run, you’ll be happy you went.” This thought may typically get overpowered by the louder passengers, and, if we don’t go out of our way to examine all of our thoughts, we could easily overlook this one.
However, listening to the thought that supports a value-consistent, goal-directed decision now becomes an option. Through listening to these goal-directed thoughts and practicing resisting the louder disordered cognitions, we can learn to take direction from the thoughts that will keep us on track toward our end destination, rather than those thoughts that will derail us.
Of course, this is all easier said than done. Thanks to negative reinforcement (the process by which the likelihood of behaviors occurring again in the future increases once a negative stimulus is removed), many clients with eating disorders have been conditioned to use symptoms, or other unhealthy behaviors, to decrease uncomfortable emotions.
My go-to example of negative reinforcement is the chiming noise that goes off in our cars to remind us to buckle our seatbelts. Most people find this noise unpleasant, and so we buckle our seatbelts in order to get the noise to stop. Next time we find ourselves in a car where that noise is disabled, or we sit in the back seat of a car, we may notice that we automatically buckle our seatbelts in the absence of the noise—because we have been conditioned to do so. So much of negative reinforcement occurs beneath our conscious awareness that is not uncommon for clients to refer to the use of eating disorder symptoms as “autopilot” responses to difficult emotions.
The reality is, in the moment, symptom use may be a very effective means of temporarily abating uncomfortable feelings. The problem is that long-term, we tend to feel badly about value-incongruent choices such as symptom use, isolation, dishonesty, and so forth.
Whereas, long-term, we tend to feel best about choices that are consistent with our goals. So—practicing cognitive defusion effectively means that we must be willing to tolerate the discomfort that arises as we begin to disobey the eating disorder thoughts.
For instance, let’s say the eating disorder thoughts are telling you: “You must exercise, otherwise you are lazy and unproductive.” If you are used to accepting this thought as an absolute truth, rather than recognizing it as an automatic thought that may or may not be accurate, it would be perfectly understandable if anxiety, guilt, sadness, or other uncomfortable emotions arise when you refuse to engage in the symptomatic behavior that the thought is encouraging.
That said, each time we refrain from following the demands of our thought processes, we empower ourselves to make a choice based in reason rather than one that is driven purely by emotions. Thus, we disempower our automatic thoughts, and empower ourselves to create the changes we long to see in our lives.
About The Author: Sarah Battista, MS, LCPC
Sara Battista resides in Washington, DC.
Sara is a Licensed Clinical Professional Counselor specializing in the treatment of eating disorders. She offers individual and family counseling to adult and adolescent clients of all genders at her practice in Bethesda, MD.
At Project HEAL, Sara is a member of the HEALers Circle, and is dedicated to making eating disorder treatment more accessible to those in financial need through providing outpatient care to a Project HEAL grant recipient.