Q&A: John Blackledge, PhD, author of Cognitive Defusion in Practice

Editor's note: The following is a Q&A with John T. Blackledge, PhD, international ACT trainer, associate professor in the department of psychology at Morehead State University in Kentucky, and author of Cognitive Defusion in Practice: A Clinician’s Guide to Assessing, Observing, and Supporting Change in Your Client.

By your definition, what is defusion and what is the function of defusion in the therapeutic process?

There have been multiple definitions through the years, as the ACT community has changed and refined the way that we conceptualize defusion. Fairly recently, in the second edition of the main ACT book, Hayes, Strosahl, & Wilson (2012) defined fusion (the opposite of defusion) as involving “the pouring together of verbal/cognitive processes and direct experience such that the individual cannot discriminate between the two.” In such cases, we treat our thoughts as absolute truths, even when they may be very much at odds with our direct experiences—and those thoughts become very misleading substitutes for what’s “really” going on. 

Defusion, then, basically involves learning how to not take those misleading, problematic thoughts so seriously—to experience them simply as words, not binding realities. As illustrated in the book, this can be accomplished in a variety of different ways. In practice, all of these defusion methods involve experiencing our thoughts in markedly different ways (or from markedly different perspectives) than we normally do. For example, normally we are not even aware that we are thinking or “having” thoughts. You experience something, and you view what you think about that experience as a simple reflection of reality. From this perspective, there are no thoughts you are aware of—simply a direct experience that has been perhaps dramatically altered or embellished by the “unseen” thoughts you have wrapped around it. Something as basic as being prompted to notice, one by one, each thought you are having about that experience can help you begin to approach those thoughts more tentatively, to take them less seriously…to start noticing that there is rich, direct, tangible experience, and then these flighty, intangible, suspicious little words that don’t adequately capture that experience. That’s defusion—arranging conditions that allow you to view your thoughts from unconventional perspectives so that you can see them as they are and distinguish them from your more direct, in-the-moment experience of what’s going on. 

What are some of the most common difficulties clinicians face when using defusion in treatment?

Many defusion techniques seem “odd,” and thus therapists can feel uncomfortable using them at first. Part of this is by design. Certain conditions are in place when we are speaking and thinking “normally.” For example, we speak at a certain pace, using certain grammatical conventions; and typically we aren’t aware we are “thinking” at all. To defuse from our thoughts, then we need to do markedly different things—for example, speak too quickly or too slowly, seriously violate grammatical conventions, and notice that we are having thoughts in the first place. That’s likely to feel odd to therapist and client alike because we don’t normally do that. There’s a chapter in the book on how to introduce defusion in a way that seems more seamless, in a way that makes sense.  

What is the role of defusion in facilitating acceptance of distressing experience?

Words can make an already distressing experience even more distressing. Imagine the natural sadness you would feel if a romantic partner left you. It should feel sad—you’ve lost someone important to you, and all the potential positive interactions you could have had with that person in the future. Then imagine all the different thoughts your mind might add to that experience: What’s wrong with me? It’s not fair. I’ll never find someone like that again. If you “buy into” or believe those thoughts, you’re going to feel even worse. Defusing from such thoughts can make it less difficult to fully experience that sadness and act consistently with a relevant value. A good rule of thumb (one of a number of relevant rules of thumb discussed in the book): if a client isn’t willing or able to fully experience distress, more defusion may well be called for. 

How does defusion help us when it comes to fulfilling the aim of ACT—developing the ability to act consistently with our chosen values?

The answer to the last question is relevant here. If you are unwilling to experience what shows up in the course of acting consistently with a value, then using defusion can help bust up the verbal façade that is making that experience seemingly unbearable. Then, you are in a better position to accept the experience and move forward. 

Another of many ways discussed in the book that defusion can facilitate values-consistent action is by breaking up ineffective or counterproductive verbal rules we have about what we “must” or “must not” do to pursue our values. We can get rigid about how we try to embody a value, missing other opportunities and sticking with ways that may not be effective—or may even be problematic—in any given moment. Defusion can remind us that such verbal rules are simply tentative suggestions—that we don’t have to follow them. By the way, if that last sentence sounds like it could be ethically or morally dangerous, there’s a section on how to handle such issues in the book.    

Commitment can take on an “all-or-nothing” quality, especially when we’ve behaved in a way that’s clearly inconsistent with our values. How can defusion help?

When you’ve behaved in a manner that is clearly inconsistent with a value, you can have the thought that you’ve blown it—that you’ve derailed and can’t get back on track. Defusing from thoughts like this reminds you that the situation is more like learning to ride a bike. When you fall off and injure yourself (or even the bike), it hurts and you become aware of how hard it is. And the next moment (and the next, and so on), you have the choice to get back on again and metaphorically do something that’s values-consistent, regardless of what thoughts and feelings you are having.

Additionally, in extreme situations, people can think that living a value is impossible. A man who was an avid outdoorsman was in an accident that left him a paraplegic. He was despondent because he thought his days of climbing, biking, and hiking were over—that he could never live that “outdoorsman” value again. It became clear, though, that much of what he valued there involved being out in nature, connecting to it, enjoying the peace and quiet. Even though he couldn’t live that value just like he had before, he could still embody certain aspects of the value. Like all values, it wasn’t all-or-nothing, but rather a continuum of activities through which you bring your valued qualities of action to bear. 

References

Hayes, S.C, Strosahl, K.D., & Wilson, K.G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd edition). New York, NY: The Guilford Press.