Today I want to share with you an extremely easy, fast, and effective intervention used in Acceptance and Commitment Therapy or ACT. The ‘absurdity’ of this intervention does NOT refer to a lack of efficacy or to an unsubstantiated and outlandish proposed mechanism of action. Instead, ‘absurd’ refers to the patient’s experience of the absurd that is triggered by the intervention itself and that makes the intervention work. Let me explain. The intervention that is our focus is called “deliteralization of language” and is one from a family of cognitive diffusion or distancing interventions.
Deliteralization of language is the use of language in such a way that the semantic meaning of what is said is lost. One easy and effective way to achieve this loss of meaning is to repeat a word or phrase over and over as quickly as possible. Normally, when we hear words, we immediately experience the idea behind the word or phrase. With fast repetition, it is as if our brains get fatigued to the meaning of the word or phrase and their meaning-free sound comes to the fore. What is said then sounds strange or even absurd, as if we are hearing that word or phrase for the first time or in a language we don’t know. It’s an eerie feeling. The discoverer of this phenomenon is Leon Jakobovits in a doctoral dissertation published in 1962. He called this phenomenon ‘semantic satiation.’
The goal of semantic satiation or the deliteralization of language when applied to psychiatric treatment is to have a person achieve distance from painful or difficult thoughts by ‘disarming’ these thoughts of their painful meanings and associations. Let’s say I have a patient who is depressed and socially avoidant because he feels and believes he is ugly, and not simply ugly but monstrously and hideously so. His feelings and beliefs related to his ugliness are instantiated as thoughts multiple times a day in multiple contexts, perhaps hundreds of times a day. Thus, when a thought about his ugliness arises, he can be guided to repeat quickly and aloud the thought for about 30 seconds, with the goal of the loss of this thought’s ability to make him feel ugly and depressed. In this case the patient would repeat, for example, ‘I’m hideous. I’m hideous. I’m hideous. I’m hideous. I’m hideous. I’m hideous. I’m hideous. I’m hideous…” I tried saying this and could repeat it 41 times in 30 seconds.
There are many other equally simple ways of achieving cognitive diffusion, of distancing oneself from one’s thoughts. These other ways do not depend on words losing their meaning, but rather on them losing their ability to be taken seriously. One example is to imagine hearing goofy music, such as carnival music, playing as one repeats the offending thought. Another is to repeat this phrase in a silly voice, like that of a cartoon character. Written forms could be to write this phrase over and over in flowery script or to write it in crayon or perhaps with one’s non-dominant hand. My own interpretation is that all these techniques are forms of desensitization through cognitive exposure, whereby we expose ourselves to painful thoughts that we make weaker in one of the ways described and thus less able to cause us hurt and therefore more likely to be successfully desensitized to.
Before you prescribe this to patients, try it yourself for a taste of the absurd.
“Ecstatic absurdity: it’s the confrontation with meaninglessness.” ― Errol Morris
“If at first the idea is not absurd, then there is no hope for it.” ― Albert Einstein
“Happiness and the absurd are two sons of the same earth. They are inseparable.”― Albert Camus
“Thus I draw from the absurd three consequences, which are my revolt, my freedom, and my passion.” ― Albert Camus
“I am a cage, in search of a bird.”― Franz Kafka