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Dr. Michael Twohig joins Tony to talk about his early involvement in the then “new kid on the psychology block,” acceptance and commitment therapy (ACT). Dr. Twohig shares his initial hesitation in embracing ACT and what eventually led him to pursue his Ph.D. in clinical psychology by working with Dr. Stephen Hayes, the founder of ACT. He discusses the differences in using ACT to treat OCD vs. the traditional CBT-based model, and they talk about using metaphor in ACT. Tony shares his experience of how learning ACT changed his therapy practice and his general outlook on life. They discuss the differences between using diffusion in ACT to make room for thoughts and feelings vs. responding to the body’s cues concerning treating trauma.
They talk about Dr. Twohig’s new online course on ACT and OCD https://praxiscet.com/virtualcouch and the challenges of marketing an online course. Finally, Tony challenges Dr. Twohig to a “try not to laugh” challenge.
Dr. Michael Twohig is a licensed psychologist, a professor at Utah State University, and one of the world’s most published scholars of Acceptance and Commitment Therapy (ACT). Dr. Twohig’s research focuses on using ACT across various clinical presentations emphasizing OCD and related disorders. He has published five books and more than 200 scholarly works and is the former President of the Association of Contextual Behavioral Science, the organization most associated with Acceptance and Commitment Therapy https://contextualscience.org/
You can find out more about Dr. Twohig via his Utah State University page https://cehs.usu.edu/scce/clinicians/twohig-michael or his private practice website https://junipermh.com/team/michael-twohig/
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Transcript
Mike Twohig pt 1
Tony: Okay, I will start with the former, I mean, you were so kind to say, call me Mike, but, Dr. Michael Twohig, welcome to the Virtual Couch.
Mike: Yeah, thank you so much for inviting me.
Tony: Yeah. I have you on this pantheon of my big gets, so I don't know if you ever get that vibe or, I mean, I don't know.
How do you feel about that knowing that you are one of these world renowned active researchers?
Mike: I don't feel that way in the slightest. So it's, yeah, let me think. Do I ever bump into that? I don't know. I feel like sometimes grad students applying here give me that feeling because they're all excited.
But no, really in my real life I don't really bump into that. And then one of the things about being a faculty member is your life really is kind of between your office and your lab. So that's all you really bump into. So whenever someone's like, oh, I like your work. That is kind of cool because you know, you don't really get to bump into that very often.
Tony: Okay, well, I sing your praises often, and so I'm going to try to be very calm and very collected throughout this interview. So what I'm really curious about, and this one is going to be personal, I just want to know, and then hopefully listeners will enjoy it as well.
I learned CBT out of grad school and I did CBT for a few years and then when I learned act, it really was like the sky's parted and the heavens shown down. And then it's changed my life, my practice, and then most of my podcast is all talking about act.
And then I'm curious, what has your experience been with it? I mean, you studied under Steven Hayes and so I would love to just hear your story about that.
Mike: Yeah, thanks for asking that question because it’s, you know, I feel like I was really lucky, because I didn't plan this, it just, right. Like sometimes things just happen.
So I'll tell you the story. I hope the listeners aren't bored because it's kind of fun. I'm working at the University of Wisconsin Milwaukee with a guy named Doug Woods, who's the best. And we're treating people with Trichotillomania and I remember saying to Doug, you know, I was getting a master's in behavior analysis and I said, Doug, we're doing a good job teaching people how to stop pulling their hair, but they have all this emotion and urges and like there's all this internal stuff and behavior therapy's not like we don't really have a strategy for it.
And he said, you should learn act. And it was interesting because this is like 1999. And I really liked Steve Hayes at the time because he wrote a lot of good behavior analysis theory on language and cognition and how private events work. So I knew of him as kind of like a researcher of behavior analysis. So the two of us in 1999 flew out to Reno and did an ACT workshop and back then they were like 24 hour workshops. Right. It was just ridiculously long and not many people. So we went and I remember being at it and not really enjoying it per se, because it was a little too much.
Because I was a behavior analyst and this [ACT] is like watching your emotions and sitting there and seeing your thoughts floating by. It was out of the world that I lived in. But when I was finished with the workshop, an interesting thing I took away is you can have whatever thoughts or feelings you have, and that's just fine.
And that was what 24 hours taught me. We came back and we integrated act and behavior therapy for the treatment of Trichotillomania. And it clicked really well. And I remember at one point, it clicked well for the clients, I remember at one point Doug Wood says, Mike, you don't know what a good idea this is.
And he's right because I was like 23 at the time. Right? Like, I didn't know that this was a pretty wise career move. So the next step would be, I applied to grad schools and I'm not that great a student. But when I applied to work with Steve, I had done an ACT project in 2001, not many people had done an ACT project. So that's how I got into grad school. And those years from 2002 to 2006 at UNR were super fun years because Steve had just stopped being department head so he had more time. And that's when ACT was in Time Magazine.
Yeah. And also if you look at like, when the study started coming out, that's when everything was happening. And it was super fun. I just felt like the whole time in the lab was really inspired. You know, we thought we were changing the world.
I never felt like I was at work ever. And then that was my world, behavior therapy and act and I guess it's always stayed that way. Yeah, it's kind of a weird thing because the only therapy I knew how to do was act. So most people I bump into learn traditional CBT then act.
So I had to learn how to do traditional cbt.
Tony: Okay. Which is funny because, I don't want to talk much at all in this episode, but I really would love, can I lay out what I say about my aha moment of CBT versus act? And I honestly, Mike, I want, I kind of want you to poke holes in it because now I realize I have confabulated this narrative where now I think I've got everything figured out, which obviously means I don't.
So I was a CBT therapist. I was an intern working for my church non-profit. And I had a guy that came in and he was, he had lost like half of his weight and he had social anxiety and I was trying to do the CBT skills of, okay, he walks into a room and everybody turns and looks at him and, and then he feels shame and he leaves and so in the old CBT world those are, that's automatic negative thoughts. That's stinking thinking. And so what are other reasons why they might be looking at you? They might think you look great. They might just turn when a door opens and you know, he would leave and say, yeah, right.
And then he would come back and then he would say, it did not work. You know, and again, start doing the, all right, what's wrong with me? This sounds like a good tool. And then we would come up with other things or other reasons. And I literally then went to an ACT workshop and for me, oh, and I say this often, he's the only version of him that's ever walked the face of the earth with his nature, nurture, birth order, dna, abandonment, rejection, all that.
And so that's how he feels. So I love what you're saying. Right. So then, of course he's going to think everybody's looking at him because he walked around as a 400 pound 12 year old where everybody did look at him. So if he didn't think that it would kind of be crazy, you know? So I started off by, okay, acceptance, that's how you feel.
And then we got into the values, and he had a value of connection and social connection. And so then whether they're looking at him or not, doesn't matter. It's not a productive thought, and he can bring that along with him. And so it was like a game changer. But then I realize now all of a sudden I go black and white, and now I think CBT is horrible and it's almost doing damage.
And because, you know, it says you're starting with your negative thoughts now just change them, you know, just to be happy. And then when I feel like, here's the part I make up, so this is where I want you to poke holes, please. So then the third part is and then if I say to somebody, Hey, how's that working for you, champ?
Then they say, okay, well I already started with broken thoughts and automatic negative thoughts. I can't just change them magically, but that must be my problem. So then I feel like they say, no, it's doing pretty good. And then they leave and just feel like I need to figure this out. And then they leave therapy and then I feel like then they look for the next self-help book or whatever.
And so I felt like ACT was so, I think I've almost demonized CBT, but then I know what act is, what do we call it the next, CBT? So please tell me I'm wrong. So can you explain that and then, and either validate the heck out of me or tell me I'm wrong.
Mike: I think you're on a great track because, you said, here's the part that I'd like you to, double check. The, how is that working for you. And that question, like when you said it, the light bulb, you know, that went off for me is what does that mean to him? When you say, how is that working for you and what do you mean?
When you say, how is that working for you. Because yeah, clients will usually go, how is that working? Am I feeling better? I'm doing air quotes. And an act therapist would say, how is that working for you? Meaning like, how is this working in your life? Are you going in the directions you want to go?
Tony: Yeah. And that's what I feel like was so good. I like your question because if I was saying, how was that working for you? And meanwhile I'm handed a population, and this is funny because I didn't even remember that it was you that I read an article about that helped me here too.
But I was working with people that were struggling with turning to pornography as an unhealthy coping mechanism. And the training I was getting at that time was a lot of, you know, seeing him, do some pushups, behavioral, and then I felt like, ooh, that one's not quite working. And then I think I read something that you did there about, was it mindfulness?
Yeah. And that was, that was also a game changer. And so then it was getting people to start to just take action on things that matter. And right now we're going to not worry about the unhealthy coping mechanism. You know, nothing's wrong with you, you're human. And the more they started doing things of value, then the more they started to feel better and the less they turned to unhealthy coping mechanisms.
And so then, yeah. So I think my, well, how's that working for you? I think, right. I then had, I think the part with trying to identify people's values was a real challenge, you know?
Mike: Yeah. I think the shift right there, you can say to a client or the two of you, you know, I don't know if this is a listener.
Actually, I told you, two of my friends said something about being mentioned on your podcast, and one is not a therapist and one is a therapist. So, okay. I'll say it for both people or both styles of people that we can work on altering how we feel, or we can work on altering how we live and we're whole human beings and whether you alter either one, it's going to affect all sorts of stuff. So if you change the way you live, you'll change the way you feel. If you could change the way you feel, you'll probably change the way you live. But from the kind of an act or behavior therapy model, we're going to lean on changing the way you live to affect, you know, without the goal of affecting how you feel but it will. So like this client, when he said it's not working. My question would be, well which one are we going to focus on? Are we going to focus on what you feel internally or how you're living? And I say this to clients a lot, that a lot of the things I really care about and a lot of things I work hard on don't feel good. You know, like parenting a team doesn't feel fun. But it's meaningful, it's important, but it's not like, ooh, you know, that was great. Or even the same thing like writing a paper, it's not the same as snowboarding, so like the feeling and the importance of it.
So yeah, it's orienting the client and you to what's meaningful.
Tony: Well, and what I like about that so much, Mike, is sometimes I think in my head that if a client almost “breaks act” where I think, oh, that was well played. Where if maybe they don't hold a value of, I don’t know, if they almost hold a value of, I know there isn't necessarily in the values list codependency, but I'll get people to say no, my core value is helping everybody else and putting myself second and, and I want to say, but no, that, that one's not cool. But then you know it’s what it feels like to be them. And so I like what you're saying to yeah, that change in behavior, or living by one's, yeah, because I feel like, I don't want to sound arrogant, but I feel like, okay, that is where that person's at right now.
But if I go back to that, how's it working for you? Then sometimes I feel like, oh, okay, they're trying to just adapt or cope with this thing that they don't enjoy.
Mike: Yeah, and I'll often, like that question, I'll be more precise. I'll say, how's that working to change these thoughts about your self image?
Or I'll say, how's that working to be part of the group?
Tony: Hey. Okay. So speaking of that too, and I know that this is going to feel like five minutes to me of talking with you. I really like the work you've done with ACT and ocd.
I had read Brain Lock I think when I was doing OCD work initially, and I feel now like maybe because I love act so much that I've almost had my own emotion and maturity, black and white, that oh that was bad, and this is good. But how does ACT and OCD stand out from traditional cognitive behavioral therapy?
Mike: So, and this fits with the conversation we were just having. Kind of the easiest way I've found to describe this is like, no matter your theoretical orientation for treating an anxiety disorder or OCD, I like to break it down to what is the outcome you're looking for. Like, how do you and your client agree things are better? What's the process of change? What is it you're trying to instill in the person that would help them be able to do these things? And then what are the techniques you use to instill that process of change? So in ACT, I think the main outcome that we're shooting for is that a person can live sort of a successful and meaningful life.
And I think for those who know ocd, what's missing from that, is any statement about what's happening internally. So I don't need the power or the frequency or the words in the obsession to be different. I just need the person to be able to effectively live when they show up. And then the process of change is psychological flexibility, which is being able to see thoughts as thoughts, emotions as emotions, sensations as sensations.
Allow them to be there and still move in the directions you want in life. Right. So again, nothing needs to change. We just need to not be overpowered by it. And then the techniques we use, what I tell my practicum students is, you know, we teach people how to be psychologically flexible until they kind of get it. And then we start practicing. And those can look like exposure exercises, but as you can imagine, the style is different. We're not watching intensity of internal experience. We're not watching habituation. It's more like, let's practice having what you have, and then we have our own style for doing exposure exercises.
Tony: And can you talk a little bit more about that too? Because I feel like the exposure for the sake of exposure to reduce anxiety and I, boy, I'm wanting to be so emotionally vulnerable here today as I realize, and maybe it's just I have created a narrative in my head of I've had clients that haven't had good experiences with just, okay, let's sit on a dirty floor because you don't like germs, you know?
Right. So can you explain the difference there in act?
Mike: Okay, there's a couple things. Why don't we start with, when I think about doing an exposure, I would like the exposure to have some tied values. And either that's, that's obvious. For someone with social phobia, we might go talk to people or send a message to someone we haven't, or practice giving a phone call to someone they like, like you can make it values based.
Sometimes it's harder, but then even in that moment, we're going to help the client see how it could be value based. So if we're dealing with a germ phobia or ocd, we might go manipulate a garbage can or go to a bathroom, and then, let's practice having this stuff so that when the real game shows up, you're good at it.
And I'll use a sports analogy of we're just practicing being good at having what you have. And I'll remind the person a lot like when's the situation when this might happen, when you're going to go on a date or go out to dinner or something, and these things are going to show up. I think what stands out to those who maybe do exposure work is I have never had a moment where I would go above and beyond or do those sort of extreme exposures, because I kind of struggle to figure out where those tie to values.
Our outcomes are just fine, but I don't have to lick a gas pump or, you know, like rub my food on the toilet. And I did that work, you know, because I worked in an OCD clinic at the University of British Columbia.
And it can work if the person can engage, it works very well, but they have to be able to engage. Right. So, yeah, I always said, and I'm not knocking that work's great work, right? If you have 10 people, two will do nothing, five will get better. And the other three, kind of putter along, it's like those five who can't do this, they can't get behind the exposure work.
Tony: Okay. You know, I give a story that I think, again, maybe I swing to the extremes, but I've often said, okay, if somebody just lets a spider crawl over you to reduce anxiety, that's ridiculous, it might cause you to disassociate. But if your grandpa leaves you a $2 million spider farm then maybe that might be, you know, a value of financial security for your children, then maybe I'm willing to sit with the spiders. I mean, so is it kind of, we need to find some value if we can?
Mike: I think a value gives meaning to the work. Going back to raising kids, I remember sitting and doing homework with my daughter just many years ago, and she's essentially crying and trying to get away from the table and like everything about it's terrible.
And then I'm being sweet and nice and as helpful as I can be because I can find a value in this that is meaningful to me to help this kid be a decent student so she can do the steps she needs to do and go on and do whatever she wants to do with her career. Like I could find a reason, but if I didn't like this kid or didn't care, some kid screaming at me, it would be hard to find motivation to stay there and be nice.
Tony: Yeah. That makes so much sense. And man, I just, I want to go on a tangent, but I'll get back to the ACT piece, but when you mention one of the things that also I feel like dramatically game changer for me were the concepts of, socially compliant goal and then experiential avoidance. And maybe can you, as an expert in this field kind of speak to how those show up?
Mike: Yeah. Rules, like when you said a socially compliant goal, rules are really interesting things. And this is a good point for a professional and non-professional that an interesting thing about humans is we decide the way the world works and then we follow that. And the truth is it's never fully accurate. Like it's always, it could be close to the way the world works or it could be totally far. But yeah, that's an interesting thing about human beings is that we'll make this rule about what we're supposed to do and then we'll just keep following it.
And lots of research has said it's really hard to help people do things differently. Like it's hard to create variability and behavior. If someone has a problem or like they have a way of living that's not really functional. Some of that is they've determined how it all works and they've been doing the exact same thing for 20, 30 years.
And part of the therapist's job is to create flexibility in different behavior patterns. And that is tricky. Now the experience of avoidance stuff is just that humans spend a lot of their time working to feel a certain way and I think that's in contrast with doing the things that are important to us.
So one of the lines I say is I think healthy, happy people are probably spending 80% of their day doing things that are important to them. I didn't say fun, I said important. And then people who are maybe less healthy are probably spending 80% of their day working hard to feel good.
And those are like the clients I see. If I say like, what was meaningful to you today? They don't have much. Their whole day was about dodging the anxiety and getting away from stuff that they're afraid of.
Tony: Yeah. I can launch into a whole thing there where I feel like with the amount of things that we can use for experiential avoidance. Phones, games, unlimited access to downloads of things. I do feel like that's so difficult for people that aren't aware of what is important to them and why I feel like that values work can even be more difficult and yet even more important. And I even, you know, I do a lot of couples therapy, Mike, and I find that I will not do the individual, I won't do the values exercise with the couple in there because boy, you watch even the way that, let's say a guy wants to express that he doesn't necessarily have a core value of honesty. Maybe more of compassion because he grew up in a home where there was brutal honesty and that was harmful. But then if his wife hears that that's not a value. So I feel like just that example, I feel like the dynamic of even trying to get to one's core values or what matters to them can be tricky because I think people are still worried that, I don’t know if you hear this often, but I know I shouldn't care. You know, or I know I'm supposed to care about, I don't know. Do you hear that in the work you do?
Mike: When I heard you talking about this, one of the things I was thinking about is with my clients, I worry less about having the right values just more like is your behavior about values? And then people get into like, well, I have so many things and I can't balance them all.
And to me that's more of that fusion and rule following that I'm supposed to do this right. And no, we're always wrong. You're always not living your values perfectly, but if you're at least living your values, that's pretty solid. And if you're too heavy in one area and too weak in another area, then you can work at it.
But I'll never, I'll never balance this out totally. It'll always be a little heavy on work. Yeah. It's just how it’s going to be.
Tony: Yeah. And I like what you're saying because I do find that if I'm kind of bringing somebody from a, they don't know what they don't know to now, they know but don't know how to, in essence. And I love that you bring that, cause I feel like, okay, we have to figure out your values. But then I find that then often, oh, I still need to work on my values, becomes a story their brain is fusing to. I went to a training with a lady about act and she said that at that point she tells a client, just walk outside and begin. I see an animal, I don't like animals. Okay. Well note that. I tried to talk to a stranger, which was fun. Maybe there's, you know, there's something there and I just love that concept.
Mike: Yeah. I think that's the rule stuff. If I'm going to do this, I need to do this right. Well, you'll never, you can't live right. It is going to be full of errors and mistakes and it's just like how it is being a person on the planet. I was giving a workshop and it's one of the moments it kind of stuck with me. This was a workshop just like a couple months ago, and I'm up there doing a role play and all my students are there and all these professionals are there and the role play is just like going really poorly and not really poorly, but you know, in the poorly category.
And it was in a weird way it was kind of nice. Because it was, that's how workshops will be, you'll be saying really fun, smart things at one point, and then you'll just be stinking and that's life. And I think in a way, it was like a good model for the group. Like yeah, well therapy will sometimes you'll like totally go into a dead end and you just have to walk back and go the other way.
Tony: Oh I love that. Okay. Over back to the OCD treatment plan, which I love, you've got a course and I want to promote that, in the notes as well. But, you do a lot of metaphors and I have to, again, it's so nice. I feel like you're now my therapist for this. I don't know why I felt this insecurity around dealing with all the metaphors in ACT at first because there's a part of me that felt like this person's paying me large amounts of money for me to tell stories. And now all of a sudden, once I embrace act metaphors, oh my gosh, they're so powerful. And so what has that been like for you? Do you like metaphors? How do you feel they fit in?
Mike: So what I think is okay, the idea of metaphors goes right back to our rule stuff. Like in act we like to teach experientially versus rules, because then people will originally follow what we said.
So we like to tell a story about it or use a personal example or use a client's life example and sometimes a metaphorical thing describes it better. Like just before I said, you know, I went the wrong way down the alley, and I had to realize, okay, wrong spot. And I had to back out that, that metaphors rich, because we've all felt that, you go down a trail and you're like, uh, this isn't right.
And then you have to like, literally, so there's knowledge that comes with our real life experience. So, I could say, your mind is picking on you like someone picked on you in grade school. It just has more meaning because people got picked on in grade school and they know what that was like and they can link the two.
And I think it's richer than me sort of lecturing on, you know, on what cognition is like. So I think that's the two parts. It's kind of rich and it's not so rule based, but you ask what it's like for me, I think at the beginning I had to use some from the book.
But then now it's just sort of my style and I've sort of also learned, I learned how to make metaphors that match the client's interests, but I've also learned how to use self-disclosure at that safe level. I've already talked about using my kids as examples and no one hears, oh my gosh, what a bad parent. You know? It's a metaphor that I think most people with kids can appreciate. And if you don't have kids, I think you can imagine.
Tony: Yeah, no, and it's funny, I don't think I've been doing this as long as you have, I'm at 17, 18 years. But I feel like even that concept of self-disclosure has been more embraced over the years that when I first started, that seemed like that was taboo, but I feel like it's more of that human experience. And I feel like act makes more room for that, I feel like, than my CBT days.
Mike: Well, yeah, it'd be weird to be like, oh my gosh, you have these negative thoughts about yourself. So strange.
Tony: Right, right. Hey, do you have a particular favorite of the metaphors though? I am curious, of course that's me wanting to say, because I do Mike.
Mike: What's funny, my students forever make fun of me that I lean towards sports ones. But that doesn't mean it's right. It's just like I can, I can find so many rich examples and actually we wrote a book and one of the editors was like, how about we take out just a handful of sports ones and we like mix in some other ideas. But with a client, I try to gauge what they're into. And then go that way.
Tony: I'm laughing because have you ever had those fail? I mean, because I don't know, in the past I felt like I would talk and maybe give one about gardening and halfway through I realize I have no idea what garden, you know, but maybe you plant something and I don't know. You know what I'm saying?
Mike: I do. I think there's a little skill in just assuming that things work under a natural order and this'll work. I like to have the client help me along. Your favorite, you said you had a favorite though.
Tony: You're very good, Mike. Because I was going to say, I love the one about you've fallen in a hole and you have a shovel. I love that one so much because I feel like I work with people that are determined to then, no, right. The shovel is an amazing tool by itself, and I am a hard worker. And so I love being able to say, and have clients say to me, and then I went and grabbed my shovel and I dug a little bit more. And then my favorite ever is the, and then somebody hands you the ladder and you try to deal with it. And so that one alone to me was the metaphor that then allowed me to embrace metaphors.
Tony: So do you maybe want to talk about your course a little bit. I mean, have you done courses? Have you done a lot of courses? Is that something you enjoy doing? Or what was that like?
Mike: Well, yeah, kind of a broader answer. . It's an interesting thing being a professor, because I really enjoy training my students how to do therapy and that includes act, but you know, professors, we're almost taught to not market.
So that's been like a weird thing because I feel like after all these years, I actually do know act pretty well and I kind of know how to teach people how to do it, but I have this like weird emotional reaction that happens when it's like, well, you know, come to my workshop or buy my book. And I've been able to let that go more and more in the sense that this work does good and people, like even if they're very good at therapy, we can get stagnant or stale and coming at things from another perspective can be really useful. ACT is getting big and people want to know, act is big, and people want to know how to do it. I'm really privileged to work at a university where they give me the time to sit and develop things. Like write a paper or writing a book. You know, like if you're a clinician, how do you find the time to write a book? And it's, it's really great that a university's like, that's why, that's what we want you to do. So something like this course, it took me a little bit to, it's an act for anxiety disorders and OCD.
It took me a little bit to sort of wrap my head around like, no, it's okay to create something that is going to get sold. And I think I had to find the value there, which is, I do think this works important and I've spent a lot of time understanding how to do this. And then I start feeling good about getting it out there. And it's a really high, high quality course. And that's another just, it's another great thing. I think it's worth what people have to put into it.
Tony: And why I'm so grateful for the way you just shared that, Mike, I have a lot of therapists that do listen and I feel like I have a fair amount of life coaches, and I feel like there's a battle between the therapist and life coach, and I talk about this from time to time.
The guy that helped me create my magnetic marriage course, which man, I'm right there with you. I feel like I have this stuff I want to share and I know it can help, right? But then I feel anxiety around promoting it. I feel like I'm being prideful and boastful. And so I will often set the frame up by saying I'm standing in my healthy ego, which nobody else knows what I mean by that, but it makes me feel better because you know, a healthy ego based on real experience and work and that sort of thing, but here's what I think is interesting and I want, I would love your opinion, so I bought courses by other research, Sue Johnson, and I bought Steven Hayes's course, and I've got your course. And then as I was creating a course, I was struggling with the guy that's helped me. He's a very successful life coach named Preston Pugmire, and he kept talking about selling the destination. And do you know this concept? Okay. It's this, I fought him for about a year on this and so, you know, he would say that, okay, if you look at a Delta Airlines commercial, they show the family in Hawaii, so they're selling the destination. This is what you want. But they offer a plane. And basically what he said is what I was saying, well, I've got these, what I call my four pillars of a connected conversation based off of emotionally focused therapy, and here's the nuts and bolts, and here's the emotional bid. And so I'm saying, hey, forget the destination. Let me show you how cool my plane is because I've got these really cool nuts and bolts. Right. And that's what I felt like and then I realized, and I love this, like the courses I've taken from somebody like Sue Johnson and I feel like, oh, as a clinician I'm buying the nuts and bolts.
I want to see how the rivets go into the seats and that sort of thing. And so I found that if I'm trying to get a client to get excited about a course like that, they sit through maybe one section of it and it's like, eh. Yeah. Right? And so it's like, I found, it's a weird balance to try to sell the destination and have this person that I trust help me create it say, nobody cares about your plane. And that's where I'm saying, okay, I need to stand out in my healthy ego as a clinician and say, I think it does matter, but I will try to work some of the destination in the coolest plane that you can get there, you know. So I love your honesty around that because I feel like a lot of the therapists I work with, the first course I ever put out was probably just showing how to make up a bolt, you know, that sort of thing.
Mike: Well that's a really nice point because it's real values consistent because it's like, I don't love writing every paper but while I'm writing them, I usually connect to like, well, this is really cool. I want people to read this. I want this to be out there. And same, I'm not trying to sell the course here, per se, but it's a neat sort of values analogy, that there's a lot, like, take trichotillomania and ocd, that the course is a non trick, but let's say you know, OCD and panic, if you knew how to treat those well, you will always be busy, you will always have a flow of people, which means there's that many people out there who are looking for therapists and my life, and I'm not knocking any therapists around me, my life is seeing people after they've seen other people. Because, and nothing against the person who worked with them before, sometimes clients need to be in a new spot, but hard panic cases, hard OCD cases, you probably do have to do the best of breed intervention, otherwise you're not going to get the movement. So yeah, that's a nice way of thinking about it. I'm not promising if you learn how to do act for anxiety disorders, you're going to win every time. But I do think this is where the data is today. Like this is well thought out, well researched, it's as good a bed as you can think of right now.
Tony: See, and I love that because I feel like that is healthy ego and healthy ego comes from our actual lived experience. And I had a whole career in the computer industry where I didn't realize, and I didn't enjoy it. It was not value based. I lived for the weekend, but then by the weekend I was so bummed from the week that I kind of didn't care. And I would say, well, next weekend or next, you know, that whole thing. And so I do, I appreciate what you're saying because I feel like from a healthy ego, it's more of like what we feel like inside and I am offering this, so I love that you just shared that because I think that'll resonate with so many people that are listening. And maybe, because I have to bring my insecurities and anxiety and fear of invalidation along with me, maybe, you know, while I put those things out there. So, no, I love that. So would you rather work with OCD than any, any other thing, or is it just something that you have found yourself really good at?
Mike: Okay. Interesting question. I started out working with Trichotillomania.
Tony: Which by the way, you've mentioned that I know some of my clients aren't going to know, but, so talk about that.
Mike: Yeah. So, it's a disorder where people pull their hair out and, if you're like, why? I'd say it's really self soothing. We call it egosyntonic. That's a very enjoyable behavior for people. And almost all my clients would say, you know, I would happily pull my hair and then if the next day I came back and all the hair had grown back, I would never be coming in because I enjoy doing it. Okay, but obviously they end up with bald patches and or huge hair loss, it can get pretty extreme and then one of the things that happens is as you pull a lot, the area you pull from starts kind of getting infected and stuff. So then it's almost like you need to pull, because it's like a little infected. So you pull out the hairs that are infected and it feels better.
So you get yourself caught in this trap. Wow. So where this ties into OCD is that was like one of the areas I started and then when I got to UNR to work with Steve, it was like, well, what's, what's the next step? It would be OCD. Like trick and OCD are what we call OCD and related disorders. So then I did my first studies on ACT for OCD, and what's slightly different is clients with OCD come in and they say, I hate this. My life is terrible. Please, please help me stop. And people with trick are like, uh, I know I should stop, but I don't really want to. So there's something about OCD clients that they really want it gone. And that's kind of enjoyable to have clients who are just on the same page as you from day one. I will, and I don't mean this to like pick on the clients, it is a little funny story, but I did an OCD trial followed by a marijuana dependence trial. And I have to, I have to tell you the difference in sort of clients like being on time and not canceling appointments. You know, it's another thing. My clients with ocd, it's kind of easy work. They're on time, they are ready to work and certainly there's hard times, so it's just, the other thing, if I can just kinda keep blabbing, the idea of sticky thoughts is really fun to me.
So when someone has a really horrible thought and they just feel trapped, I find it really fun disentangling it and helping them find a way to not get pushed around by that thought. And I have a sort of a unique style to myself where that stuff doesn't bother me. So, you know, clients can describe all sorts of stuff, and I like am a hundred percent, that's just a thought. You know what? Whatever this thing is. And, that's been really fun. And learning that skill has generalized to other areas because like really sticky thoughts show up in other disorders.
Tony: So what's an example, by the way, of a sticky thought? Tell the listeners.
Mike: Oh. You know, I'll admit I even got caught in it, like, oh, do I wanna share one. So you're from Utah, so do you have some knowledge of the local religion?
Tony: Oh, absolutely, yes.
Mike: Okay. So, one of the most predominant things in the local religion to Utah is like the importance of family and taking care of your family. So OCD is always going to attack what you care about most. So parents having thoughts about harming their kids is, I don't know, half of what I see. And, they come in and they're like, this is the worst. Like you can't get any worse than picturing seriously harming your own children. I can just hear that and be like, that's an obsession. Let me work with you on what we should do with that. And they're like, but I'm a horrible person. Deep down, I'm a horrible human being who needs to get off this planet? And I'm like, no, you have an obsession. We got it. We'll figure this out. Like, it's okay. And, when I hear someone say their obsession, like just nothing. Like I don't have an emotional reaction because I know it's an obsession.
Tony: Don't you feel like one of the, I love that, because I do talk about, one of my first episodes five, six years ago was on intrusive thought syndrome and at that time, right, I said, we all have them, just because you have them doesn't mean anything, doesn’t mean you're going to do them. And then, thought suppression doesn't work.
And at that time, I actually was speaking to a lot of relief society organizations and I don't know why I found it hilarious, but when I would open it up, I would say, I would kind of share that just for fun and say, how many of you thought about your driving? And man, I could just mm, right over into a tree and you would see the people like yeah, but I've never told anybody. And, I would tell a story about sharing this with my family, and we had a little yorkie at the time, and I was sharing this with one of my daughters. She's like, you ever think about just that you could snap her leg? And I'm like, I have thought that.
And then all of a sudden she's like, okay. And then we go all in on it. And my wife wasn't aware. And so then one night at the dinner table, we're talking about using a watermelon, melon baller. And one of my kids saying, you ever thought about like, that could just be an eyeball, you know, and I could see that, you know?
And my wife, I think she was not up to speed on the conversations, but, so I really like what you're sharing because I feel like being able to express it and having somebody just say, oh yeah. Or I have, or tell me more. There's some pretty cool research, right, that shows that, oh, the scary thing in my head and that person didn't react. Maybe it isn't scary, do you find that's the case?
Mike: Well, I'll just give, this is a really interesting one. When I worked at the University of British Columbia, they were finishing an intrusive thoughts trial. So they were just treating it like sometimes what people call where you have the obsession and then the compulsion is something you do in your head. You say a prayer, you try to squish the thought, you picture something else. And, it was interesting because the control condition actually got a lot better. I don't know what they did with a controlled condition, but it wasn't supposed to be that useful.
And how we hypothesized it at the end was no one had ever said to these people like, this is just an obsession. This isn’t you. And like half of them walked in and they were just assuming this was a police sting. Like people who wanted to murder or kill or you know, whatever the horrible obsession was and they just assumed they'd walk in and the cops would be there and we were like, no, this is an OCD clinic. You have OCD, welcome to our world. And for a ton of people just hearing like there's a category of people who have really rough thoughts and the truth is the reason they have such rough thoughts is when they first had the initial ones, they tried so hard not to have them that it went out of control. Whereas if you would've been like, that's weird, then it probably wouldn't have grown into anything. But if you tried really hard to get rid of it, yeah, then it just kept growing.
Tony: Well, what I like about that too is one of the things that I, in your treatment program or for OCD, is you and I wrote down a note on this that I like. Can you maybe talk about 95% of life when you don't want it, you can get rid of it. And then that other five, that's, that's good stuff. So I don’t know, can you kinda explain that?
Mike: Yes. Like in our life, this is you know, second session of therapy. In our life, if we don't like something, we can change it. If you need a haircut, you can get a haircut. If your room's dirty, you can clean it, your clothes look grubby, you can purchase new ones. So then, you know, as you grow up in life, you have thoughts or feelings you don't like, why wouldn't you try to get rid of them? Like everything else in life, if you don't like it, you could get rid of it.
And a lot of times our families are going to say, yeah, that's how it works. But, like right now, if I said, you know, don't think of a pineapple or a pineapple painted blue that someone wrote “you stink” on it.
Tony: Done, done and done.
Mike: Right. It doesn't work that way. But if I said, you know, don't touch your keyboard, everyone can do that. That's the difference between behaviors we do with our hands and our feet and attempting to control internal stuff, internal stuff doesn't work that way. And frankly, it might work the opposite way. And then one of the jokes I say in therapy a lot is, this is the reason I have a job. Like, if it worked, you wouldn't need me. But it actually goes backwards, so that's probably why you need me.
Tony: Well and I find that a lot of things that I feel like in the world of mental health are counterintuitive, which is, I guess I would say that often too, that thank goodness, or I would be out of work but then I know that's humor and sometimes we have to use humor and people, if it's heavy for them, that might sound right. And then, and I feel like that's maybe part of their avoidance is, well I can't, this guy's being silly, or I can't, I can't look at it a different way or somebody, he doesn't understand what it's like. And I don't know, I feel like what do you do with those kinds of situations.
Mike: Yeah, you don't understand what it's like. I mean, I don't get that as much. I know people get it with other disorders, and I will say from an ACT perspective, if I keep talking about that I have disturbing thoughts, I have frustrated thoughts, I feel overwhelmed. I don't feel good enough like that’s just part of being a human being.
I feel like it's probably nice for a client to see that, you know, my therapist who seems to have it together also doesn't feel smart enough and feels overwhelmed and feels annoyed. And like if he has it, then it may not be so weird that I have it. And I'll definitely stress in my work, it's way more what you do with it than what you have.
Tony: I like that. Yeah. Well, it's funny, the insecurities even, we had a technical glitch there, and we went silent for a while and oh, I was all in my head about, man, this is my one chance and I thought we were vibing and now Mike's never going to come back in and you know, and that whole thing.
And it's funny the way we do that and then I just had to notice that was the thought. You know, that was something. So really quick as well I like that part about trying to control, so we don't do that. I do have one, I have a hypothetical, not even a hypothetical, so I would love your take just as I view you like this world renowned act researcher and knows act so well. And I tell you one thing that my latest kind of aha is I've got somebody, so if I have somebody that is, let's say they're in a job and they don't like their job and I've done, I've had enough of the experiences where I can then maybe have somebody that they feel like they really can't do anything about it, we can work their values into their current job, and then, you know, they might insert a value of humor or a value of connection, or they might go learn other values of curiosity. And I've had some success with that. But then I've also had, you know, I do a lot of work with trauma and I don't if you're familiar with the book The Body Keeps the Score and it's amazing. And so over time, because our emotions are traveling faster than our logical brain.
And you know, that visceral reaction as our brain says, is it safe? And if it's safe, then what do I do with it? And so when people have felt unsafe, that emotional reaction can intensify and they're all up in their amygdala and that sort of thing. So then I'll have people that will be in situations where, in a work situation where, okay, but my blood pressure is rising and I'm starting to have different ailments and then, and in the trauma world we say, okay, that's your body trying to tell you something and we need to listen to it, and maybe that's not the right opportunity for you. And I've been doing so much of the act work where, oh, that's just, you know, these are stories your body, your brain's telling you. And so invite them to come along with you and insert your values.
And so I don't know if you have any thoughts, and I know I'm just springing this on you right now, but it's interesting because act works so well, and now I've had a couple of people that are like, man, I'm still trying to be present. I'm noticing, I'm meditating, I'm working, you know, but I am still, I am still having this visceral gut reaction. And, and so I feel like there's an interesting, I'm not sure which one to rely on, you know?
Mike: Mm. Well, you tell me if I heard your question right. That if it's like the person's trying to be there for something but it's hard because their internal stuff is so loud.
Tony: Yeah, well said.
Mike: And what I'd probably say to that client is, you know, we may have spent 20, 30 years conditioning this to be at this volume. And now that we are not giving it the attention it needs, it's going to scream pretty loud. And I'd say, what do we want? Do we want it quiet or do we want to be in life? Because I'm going to be honest, it's not going to get quiet until you stop caring it's there.
So if you're always trying to check how loud it is, it's like it knows to put out some noise. So it's like you really just have to shift the game and then, and then we'll see what will happen. Yeah. And it's interesting, the description you gave, maybe we're about the same age. I'm starting to get more and more clients who are like, where do I want my life to go? My career isn't quite what I'm hoping it would be.
Tony: And then I love that because and then when I'm putting out there on my podcast that yeah, I switched after 10 years and now I love everything I do and it's value based and passionate.
And then I'll feel like people will then say, well, yeah, but that was easy. You know? No, it was incredibly uncomfortable. But, I find that then those yeah buts, that's why I call them, the yeah buts from act where, okay, I'm going to take action on this value and then sit back and I'll listen to all the yeah buts. Because it's scary and I think that just people hearing that that's part of the human experience is pretty cool. Hey Mike, I am just grateful for your time. I really am. Thank you. I am going to be very honest and say that I have done something exactly one other time with an interview a few days ago. And I love humor and I feel like that is something that maybe you can identify with as well. Okay. So this is either going to be something I will delete and never use again. I would love to see if you cannot laugh and I'm going to read a couple of my funniest two line jokes ever.
Mike: Okay. Oh, I'm gonna be terrible at it. We'll try.
Tony: Okay. Let me find one, let me get one here. I've got a couple of them that I think are just hilarious to me and let's alright, so, Dr. Michael Twohig, world renowned ACT researcher, try not to laugh. Just say no to drugs. Well, if I'm talking to my drugs, I probably already said yes.
Oh, that's good. Okay, next. I thought I could get you on that one. Don't laugh yet because this one, I’m Scrolling through them, here it comes. I feel bad for the homeless guy, but I really feel bad for the homeless guy's dog because he must be thinking, man, this is the longest walk ever.
Mike: Okay, you try. I have like two banked jokes.
Tony: Okay. Well this is my second experience and the first person texted me yesterday and said, oh, I want to do it to you now. So, alright, now, this is the first ever experience.
Mike: So there's two fish in a tank. One says, I'll drive you man the guns.
Tony: I don’t even know what that means.
Mike: In a tank.
Tony: Oh, that's even better. I just thought it was complete nonsense. Okay. All right. Okay.
Mike: How does it go? What did the fish say that swam into the concrete wall?
Tony: What?
Mike: Damn.
Tony: Okay. Okay. Maybe I need to rethink this. I thought I'd be able to do that. Okay. Well done. Those are good enough. So, alright, Mike, thank you so much for coming on and I hope that I can have you on again in the not too distant future. Sneak preview. I meant to even bring this up earlier, I work on some with scrupulosity, which I think is kind of a whole other realm and I would love your thoughts on that. Maybe as just a sneak preview.
Mike: Well yeah and being two Utah based guys, we just skipped right over the pornography stuff.
Tony: Yes.
Mike: Such an interesting,, yeah, I was like, oh, I want to tell you stories about that. Okay.
Tony: So maybe next time? Okay. Yeah, yeah, we'll do that. So, alright. What a pleasure. I really appreciate the time. This is everything I had hoped it would be and more, so I can't wait to talk to you again. Okay. Right. Thanks Mike.
