ACTing my way through a pandemic

The Covid-19 pandemic coincided, almost seamlessly, with the beginning of my journey as an Assistant Psychologist (AP). I entered the NHS at a time where frontline workers' mental wellbeing and resilience were being compromised, my own included. Personal side helpings of imposter syndrome, working from home (WFH) and pre-existing health anxiety were added in for good measure. Not only was I dealing with all of the 'usual' worries of a new job, I also found myself having to cope with dramatically uncharted territory for the delivery of psychological services within the NHS as a whole.

I, like many, entered this profession to practice psychology and provide evidence-based, patient care to the best of my ability. This drive is ultimately guided by my professional values and internal moral code, both of which have been compromised by the current pandemic https://thepsychologist.bps.org.uk/when-two-worlds-collide-values-and-morality . The ways in which lockdown, and the inevitable shift to WFH, affected me – I now know – are closely linked to this idea of my values being stripped and the thought of 'being cheated' of my first AP post. 

What I have come to understand however, through the processes of Acceptance and Commitment Therapy (ACT), is that this is not the case. Ultimately, my initial perception of these changes was being dominated by negative thought processes; relative to health anxiety, imposter syndrome, WFH, among many others. I held an assumption that because I wasn't practicing in the typical context, laid out in the pre-covid job description, that my values were being 'violated' and I wasn't 'doing what matters'. I felt stagnant despite having no evidence that this was the case – my thoughts presented this to me as an unalienable 'truth'.  

I went from Covid feeling far removed from my immediate world to being fully immersed in this pandemic, supporting a team working not only in acute settings but also in frontline, staff wellbeing provisions. I was (like many others in the field) embedded in a totally new service – different to what I or anyone else had ever anticipated. In all of the urgency I didn't stop to think about how my role had changed in nanoseconds, how the expectations I had for this job had been transformed or how I would ultimately come to deal with these alterations. I didn't think about my clinical work being 'stopped', my research duties being 'suspended' or my learning coming to a 'halt'. But that did finally arrive; conspicuous and blatant, and it was these realisations that ignited the ACT journey I find myself navigating. 

So, what is ACT? 

ACT is a psychotherapy that is rooted in traditional behavioural principles. ACT is primarily concerned with goal-orientated action that is guided by our deepest core values. Ultimately, it is encouraging us to engage in fundamental question of; 'what do you want out of life?' and it uses mindfulness-based principles to address this. As such, there are six core processes of ACT all of which nurture 'psychological flexibility' which, put simply, is: 'the ability to be present, open up, and do what matters' (according to Russ Harris, ACT Made Simple, 2009, p.12).  

On Being Present

Four weeks into my new role I found myself WFH. The comfort of my office and my colleagues being next door, was gone. I was (what felt like) 'on my own' and 'clueless' (hello, imposter syndrome). My mind was tenanted by feelings of: Doubt; about how I would do my job and gain adequate experience, guilt; related to a loss of motivation and trouble transitioning to WFH and confusion; around how this would work longer-term and ultimately how I would come to cope with it. This was compounded by my own emotional vulnerabilities – as someone with health anxiety, an accelerating health crisis meant that things were becoming difficult. 'Being present' became a critical undertaking if I were to, not only; fully embed myself in this role but also take control of my anxiety. 

Going through the motions of a pandemic are hard, and they're also pretty urgent… it doesn't seem to offer much time to be 'present'. I began lockdown with the unproductive idea that things were being 'taken away' from me; from my freedoms to socialise to my learning. The world was terrifying, as was the thought of starting this new role, what felt like, on my own. I now see that these patterns of thinking were focused around literally everything but the present. They were instead based on some truly catastrophic projections that I had somehow come to believe as truth (e.g. that I would become ill, I would lose my job or I would be redeployed to work on the front line – despite having absolutely no training to do so). The fusion of 'me' with my thoughts meant that focusing on the present was impossible – not that I realised this at the time. Rather, I thought that I was a fraud and that WFH would inevitably expose this. I thought that I'd become terribly ill or that I would be responsible for spreading the virus.

These worries were tiring, so I worked to get to a point where I was able to acknowledge that, yes, things were bad but definitely not as bad as I thought them to be. I was healthy, employed, had secure living, family, supportive colleagues… what I didn't have, was perspective or an understanding that just because I think something doesn't mean it's true. 

I was soon acknowledging, through some mindfulness, that lockdown wasn't all 'take' after all. Being at home left me no option but to slow down – if I allowed it to!! This wasn't easy and a lot of the time I was met with wandering thoughts or would end up tangling myself up in negative ruminations. But the more I read about ACT, the more I was persuaded by its philosophy. I knew there was truth in this, I knew that this could work… but I had to understand that it wouldn't be easy. This was the first instance in really understanding what it meant to be truly 'present' – the idea that I had to create space for failure and uncomfortable feelings. 

Through this difficult journey, ACT offered me a way to cope in the belief that, whilst things may drastically change around me, that I am still 'me', this is what's known as accessing the 'observing self'. Russ Harris describes this concept convincingly: 'your body changes, your thoughts change, your feelings change, your roles change, but the "you" that's able to notice or observe all those things never changes' (2009, p.11). 

I was able to explore these sometimes overwhelming adjustments from a position of mindful observation. This is not to say that all of my anxieties disappeared or that it was 'easy', but it did allow me a lens through which to view them that was less daunting and self-critical. My weekly supervision has also contributed to this growth, as it has (and continues to) offer a space for compassionate exploration of what has been going on. These conversations have helped me at times disentangle my thoughts from 'me' (owing to the development of the 'observing self').

Thus, through being present, I was able to reset my perspective and acknowledge the situation as far bigger than me. I now feel better equipped to contextualise my experience and offer myself some self-directed compassion. Creating space for these sometimes distressing feelings isn't something I have ever done before. I felt hard-wired to push these feelings out, but – as I was learning – when we allow our thoughts some room, their ability to overwhelm or scare us is reduced. With this understanding, I felt like I was on my way to regaining some control. 

The Power of Opening Up

'Acceptance' has always seemed like a difficult feat, especially when it comes to anxieties. But, on reflection, I have noticed that this difficulty is due to distorted beliefs around what 'acceptance' really is. For me, I seem to have aligned acceptance with being at total 'peace' with my thoughts. Acceptance however, I have learned, is about opening yourself up to create space for uncomfortable sensations to come and go. As such, I acknowledged my heightened health anxiety and created room for it, which let me recognise why it was feeling more prominent – as opposed to trying to push it out and thus offer no room to explore it. I became more aware of how the sensations were appearing and reappearing and actually understanding that they were reasonable responses to very distressing times. 

Our thoughts are dominant forces to be reckoned with, something I didn't owe much credit to. I've realised that, I have assumed unhelpful thoughts to be true and their demand to be listened to: 'warranted' because of the sheer noise of them. They're loud, domineering and definitely convincing… so they must be true? But they're not. Really, they are 'nothing more or less than words or pictures' (Harris, 2009, p.9).

With a bit of openness and curiosity (awarded from my mindfulness practice), I was able to see my thoughts differently. When I say 'differently' I mean that I would allow them into the space, let them have their say and move on. The real challenge came from not colluding with them. I would continue to do some great work for my job whilst a thought popped by to tell me I was 'useless at being an AP'. So, I didn't push the thought out, I didn't repress it, but most importantly, I didn't believe it! 

Doing What Matters

All of these conversations I was having with myself were fundamentally leading me to question my direction in life. In order to reconcile these difficult circumstances, thoughts/feelings and my overall goals, I had to ask myself: 'what do I want my life to be?'. Balancing my imposter syndrome with this new role made it hard to see that I was doing what I loved, it stopped me from being truly grateful for where I was and the work I had the opportunity to do. I was using my research skills of qualitative analysis and audit as well as carrying out meaningful clinical work (where possible). These were hugely meaningful responsibilities which eventually highlighted that I was exactly where I needed to be. I was contributing to something bigger, something valuable, things that were going to help other people. At my core, I strive to do things that are purposeful and this is exactly what I was doing here… this is what I had worked towards. 

Whilst I wasn't carrying out duties I thought were typical of an AP, I soon realised that although the context was different, the skills were the same and in fact I was doing this in a more challenging and complex setting. My learning hadn't 'halted' at all. Instead I was faced with an opportunity to learn and experience things that I wouldn't have typically got the chance to. It wasn't until I was able to detach myself from my negative thoughts that I could really see; not only that all of the work I was undertaking was undeniably important, but that I was fully aligned to my core values.

Overall, it is important to remember that things are going to continue to change and transitions back to normality are likely going to be as difficult as transitions were at the beginning. So with this in mind, I'd like to end with some advice from Russ Harris himself that I think is useful to keep in mind as we complete the last leg of this journey: 

'By all means, have your beliefs – but hold them lightly. Keep in mind that all beliefs are stories, whether or not they're "true"' (Harris, 2007, p.6). 

- Find Samantha Ross on Twitter; email [email protected]

References

Harris, R. (2007). The Happiness Trap: Stop Struggling, Start Living. Shambhala Publications Inc.

Harris, R. (2009). ACT Made Simple. Oakland, CA: New Harbringer Publications Inc.