CHAPTER 3 - And the truth shall set you free

Einstein is credited with saying, “Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”  It’s a great quote; notwithstanding the minor discrepancies that: (1) not everyone’s a genius, and (2) Einstein didn’t actually say it [94]. 

Inaccuracies aside, the point the quote is making is still mostly true.  Unrealistic expectations about someone or something make for failure and disappointment for all concerned.

When Jesus said, “And you shall know the truth, and the truth shall set you free”, he was undoubtedly speaking words of profound spiritual guidance, but the phrase also holds in the most general sense.  When you understand what’s really going on, you are free.  Imagine you’re stuck in a maze.  With no directions, or with wrong directions, you face hours of fruitless wandering and frustration.  You are trapped.  When you understand the right directions, you are free to navigate out of the maze and you are liberated.

The same metaphor applies to thoughts and behaviours.  We all have behaviours that we don’t like, and that we want to change.  Sometimes we can change them ourselves, but we inevitably find ourselves stuck in a pattern of other thought or actions that are not what we want.  But as hard as we try, we remain trapped, unable to move through the maze, frustratingly trying over and over again to find our way out and remaining exactly where we were when we started.

If you happened to be trapped in a maze, the most useful thing to have would be a map, or at least someone with a map that could help navigate.  The wrong directions, or no direction, both guarantee more failure.  The right directions give hope, and eventually, freedom.  This is what this chapter, and indeed, the whole book, is all about – the right directions, hope and freedom.

In the last chapter I used autism as an example of how the Cognitive-Action Pathways Model works in a real life.  But the model doesn’t just apply to autism, but for all of our behaviours, in all aspects of our lives.  In this chapter, I want to explain how the Cognitive-Action Pathways Model can be applied to other part of our lives, both in disease states, but also in the course of our daily lives.

By understanding the relationships of our actions to our thoughts and the rest of our biology, we see the right steps, get the right directions, and finally free ourselves from the maze.  At the same time, we can remove the failure and the weight of guilt and disappointment that unrealistic expectations causes us.

Remember: The right directions, hope and freedom.  They are our goals.

Genes, environment and pre-determination

The popular media sometimes gives the impression that our fate rests with our genes.  It hasn’t always been this way.  In the early 20th century, eugenics was a powerful philosophy.  Eugenics is the science of improving a population by controlled breeding to increase the occurrence of desirable heritable characteristics.  It was based on the idea that genes were solely responsible for physical traits.  The pendulum swung away from the determinism of genes in the 1940’s as psychiatrists moved to the behaviorism model promoted by B.F. Skinner.  The pendulum of public opinion swung back towards the absolute determinism of genes in the late 20th century as better techniques saw the discovery of gene mutations as the cause of disease.

In reality, both genes AND the environment make us who we are.  It’s wrong to think that our genes control us completely, just as it’s wrong to say our genes have no effect at all.

In modern research, biologists have studied the question of the influence of nature (genes) versus nurture (the environment) with GxE studies, shorthand for Gene x Environment.  Using the best available data involving large numbers of people with the particular trait and without it, common gene variations are analysed and the average effect of those genes is compared to the influence of the environment.  The result is expressed as a percentage split.  For example, eighty-eight percent of the chance that a person will develop insulin dependent diabetes is related to their genes, while the remaining twelve percent is determined by their environment [95].  On a population level, the power of genes and the environment can be averaged, and shown by GxE studies.  But the genetic risk for an individual finds its own unique level because of different mutations, polymorphisms and variants each have different levels of expression.

Therefore, genes have a significant impact on our biology but they do not have the final say in everything.  Genes are like a set of corrals, limiting the area in which we have the power to choose.  To take the most obvious example, my genes determine my gender and my athletic ability.  I can partially overcome one genetic limitation but never overcome the other.  That is, if I worked supremely hard, I could run a five-minute mile, but no matter how hard I tried, I could never change my male genes, become pregnant or give birth (I’m not too unhappy about that).  One set of genes is impossible to overcome, the other I could choose to overcome, but it would take a lot of extra work, which still limits my ultimate decisions.

This is important for two reasons.  Whatever your family history or genetic lineage is, it doesn’t completely negate personal choice.  You may have a higher risk of depression because of your lineage, but you can choose to engage in appropriate therapy to help negate that risk.  At the same time, don’t blame yourself if you try to prevent an unwanted trait and it occurs anyway.  You can’t control everything.

For example, you may have a genetic risk of depression of 66%.  With the right tools, you may halve your risk, which is good going by any standards.  But that still leaves you with a 33% chance of suffering depression, and if you end up being the one out of three, there’s no shame in it. 

There was a study of people who had pre-diabetes published in the Lancet in 2001, who through lifestyle modification (ie: radically changing their environment), managed to achieve an average 58% reduction in their risk of developing diabetes.  Still, after 4 years, 11% of them developed diabetes anyway [96].  This is a good example of how choices can sometimes change your ultimate destiny. 

So I’ll say it again, because this is important.  Genes don’t completely negate your power to choose, but they set limits over what choices you can make, and they have a say in the final outcome of your choices.

Thought in its proper place

Placing your thoughts at the top of the chain as the most influential step in the process is like placing the Earth in the centre of the Solar System.  It seems intuitively correct.  Aristotle declared that the Earth is stationary and must be the centre of the universe, since the Earth doesn’t seem to move, rather, everything else moves around us.  In the same way, Descartes mused, “I think, therefore I am”, noting how our thoughts are so integral to our being that they must be the centre of it.

Aristotle’s view disabled scientific reasoning and discovery for centuries until Copernicus proposed the view that the Earth wasn’t central, but was actually the third planet circling the central sun.

In the same way, by getting thought in its proper place, everything else in the process aligns and enables us to move forward purposefully.  We see that thought is itself dependent on a number of steps beyond our conscious influence.

This puts the “helpful” advice that we get from other people into perspective.  Like Alan Watkins said in his TEDx presentation, “So if you feel anxious, for example, it’s no good me saying to you, ‘Don’t worry.’  You’ll have experienced that doesn’t work.” [47] How often do your friends tell you, “Don’t worry”, or you say the same to them?  It’s fairly redundant, because no matter how much they say it, it doesn’t stop you from worrying.

Deification of thought only produces frustration, guilt and feelings of failure.  My son loves the show,  “Mythbusters”.  There was a recent episode [97] in which they were testing some “Battle of the Sexes” myths, specifically that men don’t ask for directions when they get lost.  They took ten men and ten women, put them in the middle of suburbia without a map, and gave them a misleading set of directions.  The result was, of course, that all twenty volunteers got lost.

The reactions of the volunteers provided some interesting insights.  They all drove around trying to retrace their steps, trying to figure out where they went wrong, trying not to look stupid on an internationally broadcast TV show.  The more they drove around, the more lost they became.  They all got frustrated.  You could see their anxiety rising as each time they tried to go back to their starting point in the endless maze of uniformly bland streets and houses, they would find themselves driving around in circles.  The men did this for an average of four whole minutes; the women did it for over five minutes.  Two of the volunteers drove completely lost for a full fifteen minutes before the hosts pulled them off the course to put them out of their misery.

It didn’t matter how hard they tried, either to follow the (incorrect) instructions better, or try and rely on their own skills.  They didn’t find their way to their desired location until they asked the “neighbours” (people planted around the streets by the producers) to give them directions.

Thoughts are much the same.  It doesn’t matter how hard you try, or how good you are.  If you try and fix your thought pattern, you’ll wind up confused, frustrated and entirely stuck.  It’s no good telling yourself or someone else to “just try harder”, or “I just need to change my thoughts from toxic to non-toxic” or “I just need to become a better person” or anything else for that matter.

Admittedly the surge of hope that accompanies pop-psychology self-help mantras does make you feel better for a while, a bit like the first four days of a diet.  But they inevitably lead to a crash because they’re trying to fix the “symptom” of dysfunctional thinking with more thinking.  These repeated failures reinforce feelings of guilt and shame, the despair of failure.  These feelings then lead to guilt about having guilt, or anxiety over having anxiety.

Having thought in its proper place makes it easy to understand why pop psychology and self-help mantras don’t work.  It also allows you to make changes that do work, realigning the upstream processes where you can, so that the important outcomes like awareness and actions are aligned with your values.

Does the CAP model have room for choices?

As I said before, our genes have a corralling effect, limiting some choices, but allowing enough space in others that to overcome them by efficient effort and determination.

In order for us to have choices, there needs to be feedback points where the active decisions we make have an impact on the earlier steps in the process, before they reach our thoughts and actions.  There are three places in the model in which our choices actively influence the steps which then feedback into the model and influence our thoughts and actions for better or worse.

1. Action activation

The relationship between feelings, thoughts and actions has been described for many decades now, and underpins the success of Cognitive Behaviour Therapy, or CBT for short.

CBT is actually less of a single, specific therapy, and more of a family of similar therapies that arise from the core relationship of feelings, thoughts and behaviour.  CBT has proven benefits in a wide variety of psychological disorders, physical problems and unwanted habits, including anxiety disorders and phobias, depression, low self-esteem, uncontrollable anger, substance abuse, problem gambling, eating disorders, insomnia, marriage or relationship problems and chronic pain management [98].

Cognitive Behaviour Therapy has two main components, Cognitive Therapy, and Behaviour Therapy.  Cognitive therapy stems from the seminal work by Beck and his colleagues, first published in 1979 and revised in 1985.  It proposes that “symptoms and dysfunctional behaviors are often cognitively mediated and, hence, improvement can be produced by modifying dysfunctional thinking and beliefs.” [52] Beck proposed a number of ways to challenge these dysfunctional modes of thinking, such as become aware of the dysfunctional thoughts, testing how true they are, finding external evidence to determine if they are true or false, examining their consequences, and generating alternative explanations [51].

Behaviour therapy is another very broad group of therapies, and can be considered as any suggested change in behaviour to improve health and wellness.  Technically, anyone who shares a problem and is given an action to follow, could be considered to have been treated with behavioural therapy.  The origin in modern psychology could probably be found in the work of Skinner in the 1940’s, and his model of radical behaviorism [99].  Behaviour therapy remains loosely based on Skinners model, but has broadened to include therapy involving operant learning as well as therapies focused on value-based action in spite of one’s thought process [100].

When the two approaches combine into CBT, the data is incredibly supportive.  But what does recent evidence say about the effectiveness of each step in the process in achieving the desired outcome?  Which is the most effective: cognitive therapies, behavioural therapies, or are they as equally as each other?

There is some evidence in favor of cognitive approaches generally, and specifically for Social Anxiety Disorders [51].  However a number of meta-analyses have concluded that adding cognitive therapy to behaviour therapy offers no incremental benefit over behavioural therapy alone [101].  This was confirmed by a large randomised controlled trial comparing behavioural therapy and cognitive therapy side by side with medication for depression [102].

In other words, therapies aimed at fixing thinking works equally as well as therapies aimed only at promoting therapeutic action.  However, when thinking therapies are added to behaviour therapies, they add no extra benefit over and above the behaviour therapies alone [101].  This suggests that it is behaviour change that is the driver of the therapeutic effects of traditional CBT.  If thinking therapies were the driving force of the C/BT partnership, the addition of cognitive therapy to behaviour therapy should have an incremental effect.

That cognitive therapy works equally well as behavioural therapy may be related to their fundamental similarities. Dobson et al explains, “Behavioural Activation is implemented in a manner that is intended to both teach coping skills and to reduce future risk. The same is true for Cognitive Therapy, which adds an emphasis on cognitive change, but otherwise takes a similar skills-training approach.” [102] In other words, cognitive therapy is just behavioural therapy with bling.

This is further evidence to justify the recurrent theme of this section - just trying to think better does not make your life better.  In most cases, changing your thinking is the result of, not the cause of, adaptive action activation.

New forms of CBT, such as Acceptance and Commitment Therapy, confirm the predominance of behavioural activation over cognitive restructuring, by showing therapeutic improvements in many different conditions through value-directed action in spite of dysfunctional thought processes.  ACT refers to “defusion”, which is “the process of relating to thoughts as just thoughts so as to reduce their automatic impact” [100].

The take home message for the Cognitive-Action Pathways model is that Action Activation is nothing more than learning a better way or finding a new solution to an old problem.  In practical terms, improvement comes with better coaching, a principle that applies as much to the sporting field as it does to life in general.  Like the volunteers on Mythbusters, when they stopped and asked someone else for the right directions, their frustration and confusion stopped and they found their way out of their maze.  If you want to find your way out of your own maze of frustration and confusion, find someone who can provide the right solutions, and ask for their help.

2. Operant learning loop

Whatever actions we choose, we automatically acquire feedback through our sensory input (our senses).  Whatever the action is, all of the senses are involved in receiving data so that the action can be encoded, correlated and stored, our brains building a base of knowledge for future use.

For example, if I choose to eat an apple, I would look at the apple, smell the apple, feel the apple with my fingers, assess the movement of my hand to the apple and back to my mouth, feel the apple with my lips and mouth, and taste the apple with my tongue once I bit into it.  I would also hear the crunch of the apple with my ears, and the response or reaction of people of things around me as I eat the apple.  All of this data is received by the sense organs and passed up the processing chain.  My brain perceives this data, as well as what it does to my physiology, in turn changing my emotional state, and the awareness of this emotional state in the form of feelings and thoughts.  This awareness is both compared to previous memories and written into a memory of its own, as well as all of the information processed to this point culminating in the process of performing my next action.

If the apple is firm to touch, crunchy, cool, sweet and juicy, my brain will perceive all of these things, and the chances are that they would act positively on my internal physiology, combining into a pleasant emotional state which is perceived as a good feeling.  This will be entered into my memory bank.  Next time I come across a firm round fruit, the memories of the apple experience will be recalled and used for me to judge my next action, which will probably be to eat the next apple.  The sensations perceived when I eat the next apple will be compared to the sensations stored in memory from the last time, and new memories will be formed based on the combination of both experiences.  If the same process occurs many more times, my brain will have a strong memory bank of good experiences from eating apples.

On the other hand, if one of the sensations perceived is not good - the skin is soft, the flesh is dry, the taste is putrid or sour or I see a worm in it - then the chances are I will have an displeasing emotional experience and I will become aware of unpleasant feelings.  This will be added to my memory bank.  If everything about the experience was unpleasant, future exposure to apples will result in retrieval of these unpleasant memories and my subsequent actions will be entirely different than when I experienced the emotional state rendered by the fresh apple.

In modern psychology, this feedback loop is known as Operant Learning, first formally described by Skinner in the 1950’s, but it has always been an integral part of the basic human experience.

This operant learning loop acts in two ways within the context of our personal choices.  Firstly, we learn the positive consequences of desired actions, which can have the effect of correcting our maladaptive thought process.  When we act according to our new set of instructions and the unhelpful predictions of our maladaptive thinking don’t materialise as we expected, new memories are stored, influencing future schemas while encouraging more of the same actions.  Secondly, the flip-side is also true, in that we can learn the unwanted outcomes of unhelpful actions, and not perform them in the future.

3. Meditation mediation loop

Certain actions can also feedback to our physiology with minimal involvement of our sensory receptors.

The action involves reducing sensory inputs by focusing on a simple, rhythmical source and then regulating the act of breathing.  By regulating the rate and depth of breathing, the balance of the autonomic nervous system is tilted more towards the “rest and digest” parasympathetic system and away from the “fight or flight” sympathetic system.  This slows the pace of the heart and makes it more even in its rhythm.  It improves oxygenation of the blood stream.  It reduces the activation of the adrenal gland while increasing blood flow to the gut, improving the absorption of nutrients.

This is basic meditation, something that has been show by numerous studies to have a myriad of positive effects, both physical and psychological [103].  While meditation is often considered an Eastern/Buddhist practice, meditation is not exclusively an Eastern tradition.  Indeed, the Bible discusses meditation several times, most often in the Psalms by King David who often wrote of meditation upon God’s words (Psalm 63:6 and 119:148, for example).

But in terms of psychology, this form of meditation is nothing more than just quiet, controlled breathing to help reign in the internal physiological systems.  For example, in anxiety states or phobias, huge amounts of adrenaline surges in response to unconscious automatic protective mechanisms that are inbuilt in all of us, but which in some people are a little bit touchy.  The sympathetic nervous system is pushed into overdrive, overwhelming the counterbalance of the parasympathetic system.  The emotional state formed from the sum of the hyper-drive leads to anxious feelings and thoughts.  If the action is to use relaxation techniques like meditation, the balance of the sympathetic and parasympathetic nervous systems can be restored, improving the feelings of anxiety as the underlying physiology is brought under control.  This technique is proven to be useful, not only in anxiety disorders, but also in depression and states of psychological stress [104].

Bringing it all together

When it all boils down to basics, this model is about understanding and empowerment.

Understanding:  because we all need to recognise what it is about ourselves that we can’t change, what we can change, and what we need to change.  We all have parts of us that we can’t change, or that we could change if we wanted to, but that would not have a great impact on the quality of our lives.  Understanding the parts of our lives that are amenable and critical is the key to life change.

Empowerment: because when you recognise what it is about your life that you can’t change, you stop wasting precious strength and time fighting it.  Instead, all of the effort that would have been needlessly spent on the unchangeable can be effectively spent on improving what needs to be, and can be, changed.

In chapter 2, I used autism as an example of how small changes in a persons genes can flow through to effect nearly everything about how they experience life.  A person with high functioning autism (Aspergers Syndrome, to use the old classification) could spend their whole life trying to change themselves to be “more normal”.  But rather than fighting to change their perception or their personality or their underlying physiology, a more effective strategy is to understand they will always have some oversensitivity to certain sensory stimuli.  They may have a tendency to be more anxious.  They may be more inclined to miss some social cues.  How they think is going to be more literal, more analytical, and more concrete than other people.  By pulling out of the needless, endless struggle with things that can’t be changed, they can move forward onto things that can be changed.  They can be coached in social skills, giving them more confidence.  More knowledge and confidence naturally eases anxiety, but when they do feel more anxious, they can accept that it’s there, but use the skills of basic meditation to reduce it.  As a result of focusing on effective action, they have improved their quality of life without changing who they are.

The model applies to other problems too, and not just “mental illness”, but to anything.  Do you, or have you suffered from depression?  You’re in good company.  Many others have, and still battle with it, including some of the most brilliant thinkers and leaders of modern times like Winston Churchill, Abraham Lincoln, performers like Kylie and Danii Minogue, and funny men like Jim Carrey and Zach Braff.  It can be difficult to see anything other than despair, but trying not to think negatively doesn’t help, and often increases the struggle.  Rather, taking that first action step slows, then reverses the downward momentum, even if it is simply going for a walk or sharing your despair with a health professional.

Frustrated by a bad habit?  Frustration is common because they seem so hard to break.  But is your habit really “bad”?  So what if you chew your nails or scratch yourself?  Those things don’t define your self worth.  If they aren’t harming you in any way, why try and fight them?

Perhaps you smoke?  Smoking isn’t good for you, to be sure, but it doesn’t make you a bad person or unworthy of love or joy.  Genetics may increase your risk of starting, and reduce your chances of stopping, so understand that because the quitting process is hard doesn’t mean that you’re weak.  Quite the opposite - acting on the choices that you do have and overcoming, even if it is slower or more difficult, actually shows that you are stronger.  They key is to seek advice and take a step.  Value-directed action is powerful and results in change even if your thoughts might not.

The most poetic of summaries

The Cognitive-Action Pathways model, modern neurobiology and modern psychology help us approach our state of health in a scientific way.  But decades before the foundational work they’re based on, a prayer was published that so neatly summarises the process of acceptance, change, values and mindfulness that it may as well be the prototype model for life enhancement.  Shortly after it became published, it was officially adopted by Alcoholics Anonymous, and has assisted millions of people around the world as part of numerous mutual aid fellowships.

Although it was not officially titled when it was first published, it has become known as the Serenity Prayer.

God, give me grace to accept with serenity
the things that cannot be changed,
Courage to change the things
which should be changed,
and the Wisdom to distinguish
the one from the other.
Living one day at a time,
Enjoying one moment at a time,
Accepting hardship as a pathway to peace,
Taking, as Jesus did,
This sinful world as it is,
Not as I would have it,
Trusting that You will make all things right,
If I surrender to Your will,
So that I may be reasonably happy in this life,
And supremely happy with You forever in the next.
Amen.

Final remarks

Every two-bit life coach and pop-psychologist has some quasi-realistic seven step process.  Most of them are useless.  Some manage to marginally out-perform the placebo effect, but usually they’re the ones that through sheer luck, provide some behavioural therapy somewhere along the line.

Ultimately, thought is nothing more than the projection of a small part of the much larger information cycle within the brain, a single section of music within the grand symphony.  Incorrectly assuming thought to be the conductor diverts attention away from the bigger picture, and targets the wrong part with the wrong solutions.  Putting thought back in its proper place ensures that meaningful action can take place.

When it all boils down, I wrote this section (and the entire book for that matter) to help people.  I know what it’s like to be struggling in the maze.  I don’t want others to experience it if they don’t have to.

Like the Mythbusters example of the volunteers attempt to negotiate their suburban labyrinth, being given the wrong instructions eventually results in frustration and confusion.  In this section, I have outlined what I believe is the correct solution.  In the following sections, I will discuss how the theories and teachings proposed by Dr Caroline Leaf differ.