61Get Out of Your Mind and Into Your Life

Steven C. Hayes with Spencer Smith, Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy, New Harbinger, 2005

Linked to 24 chapters: supports 20 · contradicts 4 · mechanism 10 · same claim 9 · pairing 4

Hayes opens with two words most self-help books would not risk: people suffer. Not that people have pain, which is obvious, but that they fight the pain they have, and the fight is the problem. He takes suffering to be the normal human condition rather than a malfunction, and traces it to the capacity that made the species successful. Human beings relate things to each other arbitrarily and in both directions at once, and that ability, which lets a child be warned about a stove without touching it, also means that a word on a page can produce shame and a beautiful sunset can produce grief. There is nowhere to go where pain cannot be summoned by something related to it. So people apply to their own insides the rule that works everywhere else — if you do not like it, get rid of it — and the rule backfires. Hayes calls the result experiential avoidance and treats it as among the most damaging processes psychology has identified. The alternative is not a better argument with the thought but a change in the relation to it: seeing a thought as a thought rather than looking at the world from inside it, feeling what is already being felt, and pointing life at something chosen rather than at the reduction of discomfort. This is a workbook, some sixty exercises with a page for the reader's answers after each, and the first trade book from Acceptance and Commitment Therapy, which Hayes had set out for clinicians six years earlier.

Human suffering

The opening chapter argues that psychological pain is universal, and that the evidence is a matter of record. Across a lifetime the chance of struggling with suicidal thoughts at a moderate to severe level for two weeks or more is about even. Nearly a third of adults meet criteria for a major psychiatric disorder at any moment, about half will at some point, and four in five of those will have more than one. Antidepressants were a ten-billion-dollar industry whose average effect on depression Hayes puts, following Irving Kirsch's 2002 reanalysis, at twenty per cent better than placebo and too small to matter clinically. Hayes says it is abnormal not to have significant psychological struggles, and that prosperity does not help.

He then draws the distinction that organises everything after it. A person with a panic disorder has the pain of the panic, and also the pain of the supermarket not entered, the friendship not made, the job not taken. The first he calls the pain of presence, the second the pain of absence, and the relation between them is that the harder you work to ward off the first, the more of the second you accumulate. Two exercises establish this on the reader's own material: an inventory of everything psychologically difficult, ranked by impact, and a sentence to complete — if this were not a problem for me, I would — whose answers turn out to be about a life rather than about relief.

The image Hayes uses for the predicament is quicksand. Lifting one foot and moving the other forward is what escape means, and it works about ninety-nine times in a hundred; in quicksand it kills, because raising one foot doubles the pressure on the other, and the correct move — lying flat to maximise contact with the thing you are trying to leave — is the one no struggling person will make. Hayes is careful about what he promises: the appearance of a problem may not change at all, and what his research claims to change is its role as a barrier.

Why language leads to suffering

The second chapter is the theoretical core, written with a co-author, John Blackledge, because it is where the laboratory work has to be made legible. Relational Frame Theory holds that human thought is a repertoire of learned relations applicable to anything at will — sameness, before and after, cause of, better than, and the perspective relations of I and you, here and there, now and then. Hayes demonstrates the arbitrariness in three questions. Write down two nouns; say how the first is like the second, how it is better, then how it is the parent of the second. An answer to the last always comes, and arrives feeling like a property of the objects rather than something the mind has just made.

The developmental evidence is a small experiment with an imaginary animal. A baby is taught that a picture is called a gub-gub and that the creature in it says wooo. That is two trained relations. Somewhere between fourteen and sixteen months a human infant reverses both without being taught, pointing to the picture when asked which one is the gub-gub and which one says wooo. Between twenty-two and twenty-seven months the child combines them, answering that the gub-gub says wooo and that the thing that says wooo is a gub-gub, though nothing has ever connected the word to the sound. Two trained relations have become six, and language-trained chimpanzees fail the tests a human toddler passes.

What makes this a theory of suffering rather than of cleverness is the next step. If the child is pricked with a diaper pin while someone says wooo, the child may cry at the picture and at the word, neither of which was ever paired with pain. Relational Frame Theory calls this a transformation of functions, and it is why a dog can avoid pain by avoiding the foot that kicked it while a person cannot. The dog needs the kick; the person needs only the thought of it. And because opposition is a relation like any other, happiness can call sadness to mind.

Three families of relation are enough for verbal problem solving, as a puzzle in the same chapter shows: get a slotted screw out of a board with only a toothbrush and a cigarette lighter, and watch the mind name objects and their attributes, run if-then relations, and evaluate outcomes. Those same three are sufficient to produce misery: naming lets a past trauma be described and wept over, if-then lets a person know that they will die, comparison lets them measure themselves against an ideal and lose. Hayes shows how early the machinery is complete with a wire story from 1993: a six-year-old girl in Florida stepped in front of a train after telling her siblings she wanted to be with her mother, who was terminally ill. Two-year-olds do not kill themselves. By six the tools are all there.

Then the obvious remedy is tested and fails. Citing Daniel Wegner on thought suppression, Hayes runs the experiment on the reader: picture a bright yellow Jeep, count how often it has come to mind lately, spend five minutes trying not to think of it, count again, spend five minutes thinking whatever comes, count again. The frequency rises — and in controlled studies it does not rise for people who are told about the Jeep but not asked to suppress it. The reason is mechanical: the rule do not think of x contains x. Feelings do the same thing, and suppressing a thought in the presence of an emotion eventually lets the emotion summon the thought.

Experiential avoidance is defined as trying to avoid one's own experiences — thoughts, feelings, memories, sensations, urges — when doing so causes long-term behavioural damage. The Coping Strategies Worksheet is the instrument: name a painful thought, name the strategy used against it, and rate that strategy from one to five for short-term relief and again for long-term effect. Hayes predicts high short-term scores against low long-term ones, and explains why the pattern is a trap rather than a mistake: immediate consequences shape behaviour far more strongly than distant ones. The rule that governs the world outside the skin meets a different rule inside it, which he states in eight words: "If you aren’t willing to have it, you will."

Having a thought versus buying a thought

Chapters three to six take the loop apart. Hayes gives five reasons why something so unworkable is hard to see — control works in the external world, children are told to control their feelings, the adults around them appear to manage it, advertising sells the absence of discomfort as happiness, and control does work briefly. He replaces blame with a coinage, response-ability: not whose fault the pain is, but whether any response is available. Then he locates the available response with a radio that has two dials. The visible one, Discomfort, looks adjustable and is not; it moves on its own, and life yanks it. The one at the back, later named Willingness, is the only one the person turns. Setting it low works like a ratchet — refuse to feel anxiety and anxiety becomes a thing to be anxious about — so the loop can only tighten.

The diagnosis underneath avoidance is cognitive fusion: allowing thought to dominate other sources of behavioural regulation by attending to the products of relating and never to the process. In plainer terms, treating thoughts as being what they say they are. Hayes borrows a demonstration from Ellen Langer to show that fusion transforms things and not only sentences. Saliva is a fine substance and you swallow it all day, yet the idea of collecting it in a wine glass and drinking it down is repellent; the disgust is manufactured entirely by the idea. Aaron Beck's term for noticing one's own thinking was distancing, and Hayes notes that his own therapy was first called comprehensive distancing. The difference is what happens next. In cognitive therapy, distancing is the first step toward testing and changing a thought; Hayes stops at the noticing and calls the stopping the treatment. He wants the reader to look at a thought rather than from it, the way one takes off a pair of yellow sunglasses and holds them at arm's length instead of concluding that the world is yellow.

Defusion is taught as a set of manoeuvres rather than a doctrine, and the most quoted of them is one the book calls almost a hundred years old. Say the word milk aloud, as fast as you can while still pronouncing it, for between twenty and forty-five seconds. The meaning thins; what remains is a noise and the movement of the jaw. Then reduce a punishing self-description to one short word — baby, stupid, bully — rate how distressing and how believable it is, repeat it the same way, and rate it again. In Hayes's studies about ninety-five per cent of people report the believability falling, with the effect arriving by twenty seconds and peaking around forty-five, which is why the timing is specified. The word still means what it meant; what has faded are its derived functions, while the direct ones, the sound and the muscles, have come forward.

The other techniques work the same seam. Label the event before its content — I am having the thought that I am worthless rather than I am worthless. Put each thought on a leaf and watch it go down a stream. And separate descriptions from evaluations: the table is wooden whether or not anyone exists, and the table is good only inside somebody's interaction with it. Much suffering, Hayes argues, is mistaking the second kind for the first.

If I'm not my thoughts, then who am I?

The seventh chapter opens with a client. He had been defusing from one negative self-description after another, the mood in the room lifting as he let each go, and then it changed and he began to cry and asked, with fear, who he was if he was not his thoughts. Hayes says it was as if the man were dying, and that in a sense he was.

The answer is that verbal ability produces three senses of self, of which only one is safe to stand on. The conceptualised self is the summary I am — old, anxious, kind, unlovable — a stable story built from everything one has bought about oneself. Hayes calls it the most dangerous of the three, for a reason that has nothing to do with whether it flatters. Once you are invested in a label you have an investment in being right about it, so the world gets read to confirm it and the suffering acquires a secret defender. The exercise is to write the story of one's troubles, underline only the facts, strike out every clause containing because, and build a different story with a different ending from the same facts. The point is not that anything is possible, but that facts do not determine the story they sit in, and the story is the part that can move.

The second sense of self is ongoing awareness: flexible, present-tense noticing of now I am feeling this, now I am remembering that. Alexithymia, the inability to say what one feels, correlates strongly with experiential avoidance, because not knowing is itself a form of avoidance. A dominant conceptualised self suppresses this sense too, since a person who is always helpful and sweet cannot afford to notice resentment arriving.

The third he calls the observing self, and derives it from the perspective relations of language rather than from mysticism. Here is not an address; it is the place observations are made from. Now is not six o'clock; it is the time they are made from. I is the same kind of term, learned only by demonstration because it is not a thing. Hayes asks the reader to recall an early childhood memory and look out from behind those eyes, then this morning's breakfast the same way, then to notice who is reading — and that the same one was present at all three. Because all knowing is referred to a knower, this sense has no experienced boundaries, which is why he calls it a no-thing self.

The image that carries the argument is a chessboard extending to infinity. The pieces are thoughts, feelings, memories and sensations, in two teams, joy against fear, at war for years. Each side must fight, because if I am a bad person is entirely true then I am a good person is destroyed. The reader has been riding the White Queen and calling her himself, which is why leaving the battle has felt like a death sentence. Hayes then asks what happens if none of the pieces is you, and rules out the player, who still wants a side to win. Only one part of the picture is in contact with all the pieces, and at board level two things are available and only two: hold them all, and carry them along as the board moves.

From there the book turns to mindfulness, and Hayes is explicit about what he has added to an old practice: a model of its components, and methods that do not require years of sitting. The exercises are ordinary — naming what draws the attention three times over on a silent walk, saying there's a thought or there's an urge as each event arrives, eating a raisin slowly enough to notice that no two are alike, following the breath while just sitting. He rules out the use that would undo them. Mindfulness and distraction are opposites; being mindful enough not to feel the pain is another story the word machine tells.

Willingness: learning how to jump

Acceptance in this book is not resignation. Hayes takes the word back to capere, to take, and glosses it as taking completely, in the moment, without defence; willing he traces to a root meaning to choose. The stance is active: respond to a feeling by feeling it, the way one reaches out to feel the texture of a sweater, and to a memory by remembering it. He states the goal in a pun he means literally: "instead of trying to feel better, willingness involves learning how to feel better."

The evidence he assembles is the part of the book that reads least like self-help. In chronic pain, objectively assessed physical damage bears almost no relation to reported pain or disability; what predicts functioning is willingness to experience pain and the ability to act while experiencing it. In head injury and heart attack, acceptance of the condition predicts rehabilitation better than the degree of pathology does. People with equal levels of post-traumatic stress diverge over time by how willing they are to have the memories. His favourite demonstration is behavioural. Richard Brown set three tasks for smokers about to quit — hold your breath as long as you can, do accelerating arithmetic until you give up, breathe carbon dioxide until you ask to stop — and most of those who did well on all three quit, while very few of the others did. If you cannot feel your distressing feelings, Hayes concludes, you cannot look after your own health. He then runs the test on the reader, who holds a breath at the start of chapter four and a second one at the end, this time locating the urge and treating each pang as something created deliberately rather than inflicted.

Most of chapter nine is spent on what willingness is not, because minds cannot do it and will counterfeit it. It is not wanting: the guest you did not invite still gets shown where the punch bowl is, and the alternative is to spend your own party holding the door shut while everyone else drifts away. It is not conditional on content. Learning willingness is like learning to jump, the same action from a sheet of paper as from an aeroplane; stepping down from the sheet of paper keeps you in control at every point and teaches nothing that transfers. A limit of time or place is therefore safe — willing for five minutes, willing inside this one shop — and a limit of intensity is not, because I am willing if it does not get too strong means not willing at all. And it cannot be a manipulation, because once willingness is real the old measurement goes with it. A good day can no longer mean a day with less anxiety.

The practice chapter turns this into graded steps, and Hayes insists the dial be set to ten while the time and place shrink to whatever is doable. He tells of a woman whose marriage, work, friendships and health had all gone and who had survived a suicide attempt, and who could not agree to feel her loneliness until the offer was reduced to one second without defence; a decade later she called him, with a degree, a job, a partner and a purpose. Physicalizing puts the feeling four or five feet away on the floor and asks its colour, size, shape, weight and texture, then does the same with whatever resistance the first object provokes — and here Hayes reports the finding that matters most. For many people the second object is the harder one, and dropping the struggle with it shrinks the first. The power of avoided events comes more from the unwillingness than from the events. The Tin-Can Monster then disassembles the target, since a thirty-foot monster made of cans and wire and string is impossible to face whole and manageable one can at a time. Acceptance in Real-Time takes it outdoors, with ten scenarios ranked by difficulty and avoidance off the table.

What are values?

The last three chapters answer the question the rest of the book has deferred: willing for the sake of what. You drive a bus called your life and you have picked up passengers — memories, urges, conditioned emotions — and some of them frighten you. You cannot make them get off, since time runs one way and a painful memory once aboard is aboard for good. So you strike a bargain: if they will slouch down out of sight, you will drive where they want. That bargain is the whole of experiential avoidance, and its price is the destination. The sign at the front of the bus, Hayes says, reads Values.

He defines a value as a chosen life direction, and defends both words. A direction is not a place: drive east across a valley of gravel roads and there is no moment at which you arrive at east, because values are qualities of unfolding action, verbs and adverbs rather than nouns, and there is always more loving to do. A choice is not a judgment. A judgment applies an evaluative yardstick to alternatives, which works well, but the yardstick must itself be picked, and if that picking is also a judgment there is another yardstick behind it, without end. Values are where the regress stops: a selection made in the presence of reasons but not because of them. Hayes trains it on something trivial — two letters, pick one, notice the reason your mind supplies, and pick the other anyway.

The distinctions that follow are drawn carefully enough to be usable. Values are not goals: goals are obtainable events, and confusing the two is why depression sometimes follows a degree, a wedding or a promotion, since when the goal was the direction there is nowhere left to walk. Goals stay useful as landmarks to sight along, near enough to reach and far enough to steer by. Values are not feelings, because feelings cannot be controlled and a direction can, which makes I value feeling good about myself a category error. Values are not outcomes; they behave like gravity acting on water in a bowl, specifying a direction that shows itself through any opening and stays invisible when there is none. And values are not separable from pain. A social phobic dreads the party because connection matters to him; in our pain we are pointed at our values, and in our values we find our pain. Hayes tells of a client who insisted he did not want a family, and who came back a fortnight later having wept over a hamburger at the sight of a mother and father and two children sitting down at the next table.

The method for finding them is deliberately uncomfortable. Attending Your Own Funeral asks for two eulogies: the one the reader's present path is composing, and the one they would want if their life were true to what they most care about, compressed afterwards into an epitaph on a drawn headstone. The exercise is not about facing death but about facing life, Hayes says: avoiding the knowledge that life is finite is what makes it possible never to be about anything. Ten domains follow, filled in one at a time: intimate partnership, parenting, family, friendship, work, education and growth, leisure, spirituality, citizenship, health. Each value is tested with one question — if no one knew I was working on this, would I still do it — and rated twice, for how important it is and for how far current behaviour reflects it. The difference is the life deviation score, and the largest gaps are both a sign and a source of suffering.

Committed action is the last step and the plainest. Take one value, set a long-term goal and the short-term goals beneath it, and write specific situated actions with a beginning, an end and a context: build friendships is not one, call friends is still too vague, call Sally is an action. Include at least one you can do today. Then write down in advance the barriers the action will produce, and name the moves you will use — not to remove them, which Hayes warns is the old agenda returning in new clothes, but to make room. He quotes a patient who described having once run from pain and now inhaling it. Goals carry their own trap, which he illustrates with a skier who tells a stranger on the lift that she means to reach the lodge and is promptly flown there by helicopter. The complaint is not that she failed to arrive. The goal existed to structure the skiing.

The conclusion draws a fork in the road, and Hayes refuses the obvious contrast. Both paths lead to problems and both lead to pain. On the right, the path of control and avoidance, the pain is deadening and predictable and the problems are the ones you already have; on the left the problems are new and harder, since moving toward loving relationships exchanges the problem of alienation for the problem of vulnerability. Each fork returns, which makes the picture not a circle but a spiral, widening or narrowing depending on which way you keep turning.

Since 2005

Hayes closes with an appendix that is unusually candid about what was and was not known. Relational Frame Theory studies were approaching a hundred papers. Randomised controlled trials and controlled time-series studies of the therapy were approaching two dozen, with supportive results in anxiety, depression, smoking, substance abuse, chronic pain, psychosis, diabetes management, stigma and employee burnout, and in the published head-to-head comparisons it had done as well as or better than established methods. Several exercises, word repetition and the finger trap among them, had been tested alone by measuring how long people would tolerate cold, heat or shock after hearing a passage read aloud. Hayes states plainly that partial validation is not validation of the book, that the research programme is young, and that the reader's own experience is the only bottom line.

What came next was formalisation. The following year Hayes, Jason Luoma, Frank Bond, Akihiko Masuda and Jason Lillis published a statement of the model in Behaviour Research and Therapy that named the target psychological flexibility and drew the six processes as a hexagon, each linked to its rigid opposite. The workbook's thirteen chapters map onto it exactly, though the figure does not appear in the book. Then came volume. The two dozen trials of 2005 passed a thousand within twenty years, and the therapy entered guidelines: Britain's National Institute for Health and Care Excellence recommended it, or cognitive behavioural therapy, for chronic primary pain in 2021, judging the evidence small in quantity but favourable and the treatment cost-effective.

The contest has been over size and mechanism rather than direction. Lars-Göran Öst reviewed the trials in 2008 and again in 2014, and the second review was harsher than the first: across sixty randomised trials and 4,234 participants the mean effect had fallen from 0.68 to 0.42, the methodological quality had not improved, and against other cognitive and behavioural treatments the advantage was 0.16 and not significant. A meta-analysis by A-Tjak and colleagues in 2015, covering thirty-nine trials and 1,821 patients, reached a similar verdict: better than control conditions, indistinguishable from established therapies. The mechanism has fared worse than the outcome. Most mediation claims rest on the Acceptance and Action Questionnaire, whose second version appeared in 2011 and which correlates so strongly with neuroticism and general distress that critics argue it measures how bad a person feels rather than how they hold what they feel — which, if true, leaves this book's central claim, that the relation to pain is separable from its quantity, without its main instrument. Relational Frame Theory has kept a laboratory going without persuading the wider field that it explains cognition, and the defusion exercises replicate well as short-term effects on believability without settling why they work.

Hayes's own response was to follow the logic further than the therapy. With Stefan Hofmann he argued in 2019 that the trouble lies in the assumption underneath the whole enterprise, that named disorders are treated by named packages, and proposed replacing the question which package works for which disorder with which processes should be targeted for this person, in this situation, toward this goal. That is the position this workbook already occupied, having been written for no syndrome in particular on the ground that its processes are shared. It has stayed in print, sold in the hundreds of thousands, and appeared in a twentieth-anniversary edition in September 2025 with a new preface and the original text intact.