Kal Kseib interviews acceptance and commitment therapy (ACT) pioneer Kelly G. Wilson, PhD.
What’s something people might not know about you that, if they knew, would surprise them?
I came to psychology late. I was 30 years old when I started college. I dropped out of school when I was 16. And between the ages of 16 and the age of 30, I was a drug addict and an alcoholic. Chronically unemployed and unemployable—a serial felon. Terribly, terribly depressed—suicidally depressed pretty much all the time, except for little glorious windows in time when I’d get just the right combination of drugs and I’d be able to feel like I could stay in my own skin for a minute. But mostly it was just hard and destructive to me and to a lot of other people. In 1985, at the age of 30, after many years of overdoses and car accidents and violence, illness, and just wanting to die, I was admitted into a locked psychiatric ward. I joke with people sometimes–although it’s true—that I got my start in psychology in a psychiatric hospital.
Quite a story. How did those experiences shape your next steps?
At the time, I carried a copy of Viktor Frankl’s Man’s Search for Meaning around like a compass. I looked at Frankl’s experience and thought “if Frankl could find meaning and purpose in a death camp, maybe Kelly could find meaning in Spokane, Washington. This is how I’m going to find my way in case I get lost.” So I went back to school. I was a high school dropout and I didn’t have any marketable skills that were not felonies. I discovered something that was quite an incredible surprise to me, which is that I love school! I had a job when I got sober—$4 an hour—and I went to this community college for two years, which is where you go if you’re a high school dropout. Then that summer I took a psychology class, and then it was rock and roll. I started taking classes at night, trying to work them around my schedule. I came from a family of working class people, that universe was not one I was aware of really.
You’re one of the co-founders of Acceptance and Commitment Therapy. How did that come about?
I wanted to help people find what Frankl found. A way to go forward. And I wasn’t sure how I was going to do that, but I thought “what if there was a science of how to arrange context and conditions that made it more likely that people would find meaning and purpose?” I immersed myself in the work of behavior analysis and started reading articles by these lunatic fringe behavior analysts, like Steve Hayes! In the fall of 1989, I started graduate training with Steve at the University of Nevada, and I spent 11 years there as his right hand man.
In the mid-1990s we got the first ACT grant funded and we were working with severe polysubstance abusers, mostly heroin addicts. I recognized early on how hard it was going to be for addicts to stop. What the meaning of stopping was, waking up to the day where you were fully conscious and aware of the wreckage that you had generated. And I thought we needed to put something in front of them that would make that worthwhile. So I wrote the original ACT values protocols that we started using in clinical trials. Playing rhythm guitar for Steve for all these years and having a chance to play lead once in a while has been one of the great honors of my life. It’s been a great thing.
When it comes to self-care, where’s a good place to start?
See, I‘m a behaviorist. We’re true believers in “shaping.” So you find some little tiny seed, kernel of potential connection, and you cultivate it. There’s interesting evidence out there about how even just small doses of such things can make a difference. In research looking at sedentary behavior, just a couple of minutes each hour of getting up and moving around is shown to disrupt some of those destructive metabolic processes. Reducing exposure to toxins including social toxins, moving your body, getting enough sleep, eating nutritious food, engaging in some small mindfulness practice—every bit of evidence seems to suggest that really small amounts matter. And if you look at behavioral activation, which is one of the tier one treatments for depression, it’s about “get them started.” The smallest thing—even if you just your feet move! Go down to the corner, go out for coffee, go out to a movie with a friend. That work was really built on the idea that these patterns of small activities give a chance for the stream of life to kind of pull you back in.
Rates of depression and anxiety are on the rise. What opportunity does an approach of self-care have in today’s world?
There are conditions in the modern world that are leading to some of these epidemics of psychological and physical ill health, which I think fall into the same cluster. If a client comes in and they’re depressed I say, “here’s the thing. I know on TV they tell you your depression is caused by some kind of broken brain or something like that but, in fact, the truth is we don’t know. We don’t know. But we do know some things that make a difference in the difficulties you’re having. So, for example, we can model depression in laboratory animals by restricting their physical activity. We can model depression in laboratory animals by social isolation. In the same way, we can improve symptoms of depression by getting people moving. We can improve depression by finding ways to connect with each other. These are things that I want to talk with you about, so we can make sure that we’re taking as good a care of you as possible. I’m not saying these things are causing you to be depressed, but we want to give you the best chance to heal.”
How would you work with someone who is struggling with overweight or obesity?
Change based on someone saying “you should eat xyz” is incredibly rare. So it’s how to cultivate change, and I actually think weight loss may not be the best end point. I’m madly interested in self-care, self-kindness, self-compassion. Now, if I get somebody in that conversation and they’re obese, they’ll almost always say “I want to lose weight. I’ve got to lose weight. I should lose weight.” And I will usually say, “how about we revisit weight loss in six months? But between now and then, what we’ll do is we concentrate on you becoming as fit and strong as possible.” I think fitness is a way better end point and, in fact, it’s not clear that the weight itself is causing all these illnesses.
It’s quite plausible that part of what’s going on with an individual is way too much sedentary time, and all the things that come along with obesity. For instance, there’s evidence to show that people with high levels of self-stigma about their obesity massively increase their risk of all-cause mortality and cardiac mortality. I don’t think it’s very confusing to try and figure out what’s going on there. “I hate myself because I’m obese.” What just happened to the likeliness that I’m going to go out and engage people? It’s likely it just went down. Whereas what is the likeliness that going out and engaging people is going to lead me to moving around in the world – non-sedentary activity? It’s probably a little higher.
So it seems like isolation and sedentariness would be areas you would target initially. How you connect and how you get fit.
Yeah, if the person is very isolated, then what are some ways we can start to break up that isolation. Just like if you’re the kind of person who spends many hours a day sitting which, in fact, a lot of psychologists do—you know, they make a living sitting—it’s a terrible risk factor. So I’m going to figure out how I can break up that pattern. And if you have a pattern of isolation, then I’m going to work with you and try to figure out some small ways that we can connect in meaningful ways—even just for little minutes here and there.
What specifically would you suggest for someone looking to move from 0 to 1?
Everyone has a certain number of people that they’re engaged with, day to day. Sometimes I think about all the people in the world who can go through their whole day without anyone taking time to see or acknowledge them. I wonder if, at the place you work, what could happen if you were to allow your awareness to travel out to the people you encounter – whether they be nurses, or doctors, or secretaries. I wonder if you could stop to ask after them in a way where you’re not just looking for “fine.” I might also ask a client, “are there people in your life who you love like crazy?” Maybe family or friends? I would even ask if they could picture them, and think of a particular time when they felt that sense of love from that person strongly, maybe when they were little. Just when I said that I’ll bet you thought of some particular people in your own life. So, what if after we were done with this interview, you were to pick up your phone and call that person and say, “hey, I was just in this interview and this guy asked me this question, ‘are there people in your life who you love like crazy?’ and I thought of you.” What would that mean to that person if he or she got that call this afternoon? And what would it mean to you, to be someone who has made that call? It’s about noticing how small yet significant these social connections are.
To what extent do you feel like, in the world of social media, those connections that you’re describing have been lost?
You know, social media takes a bad hit on that. There are a fair number of people who are basically ready to say people are having a life on social media as an alternative to having an actual face to face life. And I’m sure there are some people who are doing that, but I wouldn’t be so quick to judge it in that way because it’s how you use it functionally that I’m interested in. When I ask the client about that, I’m going to ask questions that help me to get in closer. Let me see the particulars of how you’re interacting on social media. And if they’re doing something like Facebook-stalking an ex, then I’m going to ask about it. If they’re doing heavy impression management, you know, only posting photos of themselves with a big smile on their face, then I’m going to enquire about how that works, because it’s possible they feel false and sad.
So in that sense perhaps social media and face to face connections are neutral. It’s more to do with the interaction itself. In the same way, for example, you could be in a face to face situation and not really connecting either.
Yes, certainly. It’s easier with social media. It’s easier to do things like negative social comparison with social media, because it’s 24/7 365 days a year. You just pick up your phone and there it is. So there are more opportunities to engage in toxic social exchanges.
A lot of this makes intuitive sense, but it can often be a struggle to maintain. What would you say to the people who find themselves “falling off the wagon” when it comes to inactivity or avoiding social connections?
It’s practice. I always emphasize the practice element of this. You take something like a mindfulness meditation, a breathing meditation, as a great metaphor that has a lot of scalability. So, in a sitting meditation we bring your awareness to your breath. What will inevitably happen within a breath or two is that your awareness will wander, and then your job is to notice that your mind has wandered and to come back. How many times? Well, however many times you go away, plus one. It’s the same thing in activity, sleep, meaningful engagement, and valued patterns of action.
In fact, you could think about the whole ACT model in the same way. So in ACT we set a valued direction. I ask, “what are the things that are really important in your life?” And I get that you’re not here by coincidence on your own time, that you care about your profession and the work that you’re doing, being a good steward of that work and carrying it on. So, if you say “this is the direction I want to have my life take, to cultivate my work and my participation in it,” then what will happen, after two or three breaths, is that you’ll find yourself, your life, wandering off in directions that don’t have anything to do with that.
And then you have a chance to notice that and to come back—to bring yourself back into alignment. Maybe it’s to make a call, do a piece of work, or reach for that next thing. How many times? Well, however many times you wander, plus one. Now, sometimes we’re working with people who haven’t thought of that direction except while punishing themselves for failure, and for a long time. So that can be very painful and hard work to even begin that conversation about what matters most to you.
But ultimately, it’s still the same process?
What advice might you give to aspiring psychologists?
One piece of advice I would give is, “do what matters.” Gordon Paul, one of the godfathers of modern behavior therapy, once said to me “no matter what research area you pick, eventually it will be a giant pain in the ass. Pick one so that when that day comes, it’s worth it.” It’s the same advice I give others.
Doing what matters. What if someone isn’t clear on what matters to them? Where do people go from there?
What I did was follow my heart. There were things that were so compelling to me, and I looked for people who were deeply involved in the things that moved me and that seemed most compelling to me. And what that kept doing was putting me around other people who were interested in other things that I hadn’t even known about, that I couldn’t have thought of. If you spend time with the brightest people who are talking about things that are super compelling to you, then what happens is you meet other people who are interested in those things, and it drafts you along. I couldn’t have said “oh, I want to do ACT,” because there was no ACT. But what I did want to do is something that had to do with purpose and meaning and that had to do with the acceptance of pain in the service of that. And so I was just really following that sense of “there’s something important in here and if I stay faithful to following important things, I’ll find myself somewhere important.”
What is the greatest lesson life has taught you recently?
That the things you love the most are also the things that are the sources of the most extraordinary pain possible. And there is no greater joy or pain life can deliver than that you get from your children. Sweet and sad, poured from the same vessel in equal measure.
What motivates you to inspire self-care in others?
I lost my eldest brother Randy in 1987 to suicide. Since then, I lost my brother David in 2011 to a cerebral hemorrhage, and my baby brother Michael in 2013, to a heart attack. In 1998 I was given a head and neck cancer diagnosis. My interest in self-care, kindness and wellbeing is not a casual interest, it has to do with me, it has to do with the people who I love, both the ones who I know, the ones I’ve lost, and the ones who I don’t know yet.
This interview first appeared as “You find some little tiny seed, kernel of potential connection, and you cultivate it” in The Psychologist magazine, the official publication of the British Psychological Society, as part of an interview series on the pioneers of acceptance and commitment therapy. Read the full companion interviews with Kirk Strosahl and Steven Hayes.
Join Kelly Wilson for a Powerful Training Experience: The Therapeutic Relationship in ACT
Reviews from a Therapeutic Relationship training in Los Angeles:
“What I got out of this workshop has had a profound impact on me personally and professionally. Kelly, thank you!”
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Looking for a comprehensive ACT experience? Kelly Wilson is also speaking for a full day at the premier ACT training event, ACT BootCamp, Nov. 9-12 in Nashua, NH.