Acceptance and commitment therapy (ACT)

These exercises were written by Dr Sarah Gillanders, clinical neuropsychologist, and taken from our book Secondary Progressive Multiple Sclerosis. Try them out to get a sense of how an ACT approach can help you.

Feelings

What are some of the thoughts, feelings and beliefs you have about MS? What is it that is playing on your mind?

• Do you have thoughts of 'why me?', 'this is not fair', 'my body is failing', 'I am no longer the person I was', 'MS has robbed me of so much'?
• Do you feel scared, angry, lost, frustrated, alone, vulnerable, judged?
• Do you have beliefs such as 'the future is bleak', 'I couldn't cope if this got any worse'?

Exercise: write some of these concerns on paper

How do you respond?

When the thoughts, feelings and beliefs you wrote down pop up or are playing on your mind, do you:

• Shout, nip, make rude remarks; are you short tempered, tearful; or do you withdraw from others, miss appointments?
• Do you manage to tell someone how you feel, get some fresh air, listen to music, make a cup of tea, go out with a friend, go shopping etc?

Exercise: write down all the ways you respond when you feel upset

What are the consequences of your responses?

Looking at the list above, which ones are helpful and which are unhelpful? If you struggled to think of any helpful responses then take a moment to think about what might help you. How can you look after yourself when you are finding things difficult?

Exercise: make a list of helpful and unhelpful responses

What next... ?

Now that you have a clearer idea of the helpful and unhelpful ways you try to deal with the stress of living with multiple sclerosis, how can you do more of the helpful responses? What are some of the barriers that make it difficult?

• 'I can't talk to my husband/wife about this; they have enough on their plate'
• 'I would like to get more fresh air but I tire too quickly to go to the park'
• 'I struggle to make tea now that my arms are weak'

Exercise: what makes it difficult to respond in a helpful way to your distress?

What can we do about the barriers?

There are often challenges to doing what is good for us. The key is to try to stay focused on what we want to do, even when these barriers are in our way.

Taking the first barrier above, does your husband/wife have so much on their plate that they can't talk to you about your MS? If it's important to you to have a close and supportive relationship with your partner, and you value the support you can give one another, then perhaps it is worth trying to open up a little more, even if that is hard to do. You might start a conversation like that by saying that you're scared of overwhelming them as it feels overwhelming to you at times, but you value the support you can give each other and want to try talking a bit more. On the other hand, if you can't get that support from your spouse, are there friends or other family members who can be that source of support?

If the barriers relate to mobility problems, then is it possible to do things differently? Perhaps you used to go to the park, but if it is fresh air that you like then is it possible to sit in the garden or on the street in front of your house instead? It's not how it used to be but you still get some of the things you like. If it is making tea that is difficult then is it possible for someone to make one in a warm travel mug so even if there is a time when you are alone, there may still be a warm cup available.

Exercise: take a look at each of your barriers and think about how you can do more of what's helpful for you