Heather Haslem: CASAT Podcast Network. Welcome to season six of CASAT Conversations, where we sit down with professionals who have spent decades in their fields like mental health, addiction treatment, business, sociology and more. In this special season, our guests share valuable wisdom from their careers and reflect on what has kept them grounded and inspired and offer advice for future generations. Whether you're new to the field, uncertain, about your next steps, or feeling burned out, these conversations provide guidance and reassurance from those who've walked this path. Let's dive into today's episode. Today I am honored to welcome Dr. Steven Hayes to CASAT Conversations. Welcome Dr. Hayes. I'm delighted to have you here today.

Dr. Stephen Hayes: I'm happy to be here and especially for CASAT and had a long history with all the things you do there. And pleased to be able to be with you here today.

Heather Haslem: Thank you. So I'd love for you to just share a little bit about your career trajectory for anyone who might not be familiar with your work.

Dr. Stephen Hayes: Okay. Well, I'm, recently retired, member of the faculty there at UNR over in psychology and came here after 10 years of being at north, Carolina Greensboro and spent 37 years here as a faculty member. But what I'm best known for is, acceptance and commitment therapy or act, and its underlying model, psychological flexibility, its basic science, relational frame theory, its general approach, contextual behavioral science. And lately taking a process based approach and all of that Alphabet soup winds up if they're able to say this. I've spent my life trying to drill down to the smallest set of things people can do. I call them processes of change. Processes from the Latin word that means a procession, a sequence, a parade. The small little steps you take that lift your life up or push your life down. And I wanted to get down to the smallest set, to the most good for the most people in most situations. And my most narcissistic thing you get me to say out loud is I think we've actually achieved that. We do have the smallest in terms of what science says, in all of science, we have the smallest set that does the most good for most people in the most situations. And I'm busy trying to put that into people's lives in every way shape form, unlike most forms of intervention that are just psychotherapy. Yeah, we're psychotherapy, but we're also, you can do it as employee training or you can do it in business. And what's the it help people, detect how to take the micro steps that make a difference in their Life and all the different ways that they want and avoid the ones that take you downhill. And I've lived long enough to be able to say that something like 95% of everything we know about how change happens in randomized trials with legitimate statistics fit with a model that comes out of that work that I can say in a sentence and then we can have a conversation. But the sentence is in all areas of your life, what you're going to need to do is learn to be more open, aware and actively engaged in a meaningful life. Extending that to your relationships and your body. Drop a pin, put a period on it, unpack those open, aware, actively engaged extension to social and physical. Unpack that and you'll have everything we know about how change happens in the areas you think of normally of mental, so called disorders, addiction, stepping up to the challenges of physical disease, having relationships that work, running your business well, being able to get a gold medal at the Olympics, whatever it is. So it's a grandiose claim, but I think I can live up to it. And we're sitting on top of acceptance and commitment therapy or training sits on top of 1500 randomized trials. On our website it says 1225, but that's because we haven't dropped the next 200. New one happens every three days around the world. Half of them are from lower and middle income countries. 33% are in DSM disorders, 40% are in behavioral health matters or addiction. And 40% are in performance, social justice, social wellness and all the other things humans are up to. So how's that for an introduction? Hello.

Heather Haslem: well, I am honored that you have agreed to join us today and share your career and what you've learned along the way. and I just want to say I appreciate all of the time and energy that you've dedicated to really exploring how to support people to live their best, optimal life.

Dr. Steven Hayes: I, and the community, while I started this thing that I just said it, you know, to be sitting on top 1500 NMS trials or to have the World Health Organization distributing your stuff right now in the Ukraine or you know, you go on to these kind of things, which sound great and grand. Yeah, that's a, hundreds of people made that happen. Not me. the way I usually say it is I lit a match and other people brought the wood and then there was a bonfire, but so I'm the originator and co developer but I'm not the developer founder, blah blah blah blah. You know, I just have lived long Enough that some things that happen in my own life, including in the addiction areas, you know, seeing suffering in my home of a dad being an alcoholic and other family members who struggled and so forth. But I've just lived long enough to see that if we, instead of quick running around and say, hey, I got a solution. You know, I did the first randomized trial of ACT in 1986 and didn't do the next one until 2002. Well actually we did them but we didn't publish them because the outcomes were too good. And I didn't want to put it into the stream until I understood it because I think all of the human beings out there, when they get pitched about do this, do that. From a scientist, there's two things you need to know. Is it likely to work and be helpful for me, not for some category, but for me. And do you know how it works? The answer is no to either of those questions. Just don't do it. And the YouTube influencers and the rest that most people now are getting their information from are feeding you a mix of good and bad, advice. And you know, we just can't afford in the modern world to be putting things out into the world that are not consistently helpful. But because everybody's an individual, that means how does it really fit you? And basically the science hasn't been properly done in my opinion. Even randomized trials are mostly done incorrectly. And I've spent the last five years focusing just on that. Not so much on ACT and getting it out in the world as to how to, but more how to personalize so that you know that what you're doing really fits your needs, goals and context, your culture, your situation. And that is a huge scientific challenge, but it's also a wonderful one because it's so different. And what we've been doing in evidence based care for 150 years that maybe we'll get into and some of the reasons why we've been doing it wrong are really dirty, they're awful, they're contaminated, they're shameful. But here it is. And people need stuff. And if anybody wasn't awake during the COVID crisis to be able to see that it's not one out of five who have a mental health disorder, it's five out of five of us who need help with mental resilience. well, open your eyes, look around, talk to your family in a deeper way and you're going to find that we're in this together.

Heather Haslem: The thing I'm Aware of as you talk about the research that's been done on the work that you've helped bring to the world is its translation to the global translation and that really, you're speaking to humanity and transcending cultural differences. It sounds like.

Dr. Stephen Hayes: Yeah, the cultural piece is really important because, you know, most of the things that are put out there come from m. The, Western educated, industrialized, rich and democratic quotes. We'll see. World. Well, that's weird. That's the weird world. And that's 11 or 12% of the world's population. It's also 95% of the scientific production that is attended to in 98 to 99% of the citations. Is that fair? Is that right? Of course not. Of course not. Nobody would look at that. Well, in fact, when you get a little more humble and you start looking at what would. What could we do that would lift up people around the world, you have to step back and say, well, it better be pretty much processes that can fit that culture. Let me give you an example. I've come out of the behavioral tradition. A principle like reinforcement applies everywhere. How contingencies work, how association principle like association and classical condition applies everywhere because it's so basic, so foundational. Well, now you get to something. Let's use one that sounds pretty juicy. It sounds like, oh, this is really cool. Values. Okay, which values? Well, this one and this one and this. Wait a minute. Do you know that indigenous peoples and I've spent a year working with knowledge keepers in, Canada. Indigenous peoples have an eight fact no, seven factor theory of values that is in the tribal traditions and not in every tribe, but it is pretty constant across at least North America. And that when you hear it, if you're just a regular, old white European dude, you go like, what? It takes a while even to understand it. so who are we in the industrialized world, et cetera, to be singing the songs that the rest of, creation need to dance to? Well, we're the arrogant ones. I mean that. So being able to slow down now, a lot of the songs that are sung, DEI and so forth were obviously into a shrinkage period. Now people are. And yeah, you know, playing gotcha with. Oh, you use the right gender pronoun or whatever. Oh, please. Come on. I get the issue, but come on, let's not play gotcha. And, how do we, for example, how do we fit what we're doing to, cultural, and social and ethnic issues, sexual orientation and gender identity and all? How do we do that? In a way that really is uplifting and allows us. Well, it can't be the word police. It just can't. I mean, get mad at me if you want to, but come on, you see the backlash, don't you? So be careful what you wish for because cultural change has to happen in a different way. In my opinion. It's not so much the right words, it's the right combination that empowers each person in a particular or each couple or family in a particular way. And that can be done. It can be done, but it requires some radical rethinking of how we're going to study how lives change and how we're going to put that information out in a way that doesn't overwhelm people. People aren't going to become Nobel prize winning scientists, you know, so just unable to get some help. But you can language about these processes in ways that are uplifting and relationship enhancing and culture enhancing, that allow us to take the next step. I mean we're the social primates. We evolved in small bands and troops. But time's up. The abandoned troop now is the whole earth. When you get to the point where, hey, by the way, we may go through a whole winter in Nevada and never have a freezing, day. What? Yep, yep. And by the way, my son lives in LA and had to, you know, maybe it was all packed up to run for his life. What? Yes, that's the world. And it's not going to get better, it's going to get worse. And so in that world with those kind of challenges, it's all hands on deck and we need to figure out a way to fit what we do with the reality of cultural development and evolution and how it impacts on human lives and all the other isms that can interfere. You know, sexism, ageism. Yeah, that needs to be confronted in a powerful way. Too long a rant. But I do think we have some possible solutions here. Maybe we'll get to.

Heather Haslem: Well, what I'm aware of as you talk about the complexity of the world that we live in, right in act at the beginning, is acceptance. Right. And there's so much judgment in the world. And as humans, when we feel judged, we shut down, we armor up, push away, hide all of these different pieces. but when we feel accepted, when we feel seen and heard and valued, and when we have the awareness to understand our own feelings and needs, that to me is creating a healthy world.

Dr. Stephen Hayes: Yeah, I think it is that acceptance and non judgment piece When I said, learn how to be more open, aware, actively engaged in a life worth living, extend it to your relationships in your body. You're talking about the opening processes. Because what you're doing is you're opening up the door to how your history informs this moment. You're opening up your ability to come here, and you're open up your ability to sense things that sometimes are not easily accessible verbally. They may be intuitive, they may be hectogenetic. They may be due. Just the kind of creatures we are like our yearning for belonging that is so basic that when you look at the eyes of a neonate who's less than a day old, it dumps natural opiates into its brain, and so does Mama. And there's no other creature on the planet that does that except dogs. And they've been hanging out with us for a long time. So, you know, we have a birthright and we. There's, you know, these streams are kind of interacting together, and you better take that on board. So acceptance doesn't mean tolerance or resignation. It means what the original Latin root meant, septaire, which means to receive. And it was used in initially and still in English, with the sense of as if to receive a gift. And so, if you have your grandmother's ring and you want to give it to your bride to be, you say here, would you accept this? And you don't mean, would you tolerate this. Would you resign yourself to having my grandmother's ring or something? You don't mean that. You mean, this is so precious, I want you to willingly take it. Well, life is asking you to do that. And what is the precious gift? It's a gift of wisdom that comes from your own history. And if you want to go, okay, but it means you're abused. You're more likely to be abused again. It means you got an addiction struggle. You're more likely to slip and fall again. Is that what you really want? If the answer is no, you're going to have to own up, and you're going to have to show up. And if, I say you have to, it's not the right words, but life is asking you to learn how to own up and show up. And so acceptance, the way we mean it, which is in English, but barely but, is to willingly take on your own history in the present and allow some of these things that are only intuitive and felt or they're barely even conscious, to sort of come into awareness. At least maybe not verbal awareness, but enough awareness that you can sense you Know, whatever it is, this guy's not safe to go home with. You can sense it. But if you're alexithymic and you can't even say what your emotions are, you're more likely not to sense it. How did you get there? Probably because you'd been, with your own history and we have painful histories, why wouldn't you do this? Of course you'd do this. Just like if you saw something horrific you might do that.

Heather Haslem: I'd love for you to share with us. as you look back at your career, what are some of those pivotal moments that influenced you along the way?

Dr. Stephen Hayes: Well, within my career, by far the most pivotal moment is the one that I talk about in my TEDx talk. I have two. If you search for the one that says, something about turning pain into purpose, it walks through the pivotal point of my whole life of hitting bottom on my own. Panic disorder. After a three year struggle, when I wake up in the middle of the night thinking I'm having a panic attack, I'd rather having a heart attack and I'm having a panic attack. And how I realize that and then it's like, gosh, I can't even go to sleep anymore. I mean, not only can I not comfortably go to meetings or phone calls or movies or drive or all the things that happen as your life begins to inside running away from your own emotions, it got to the point where there was no place to hide. In my home, in my bed, asleep still isn't safe. And as I describe it there, you know, I hit bottom and really think I have no way out, I'm going to lose my job, I'm not going to be able to teach because you know, panic attacks during class almost every time I went and et cetera, et cetera, et cetera. But somehow or there, you know, there's a concept in the addictions of hitting bottom. I hit bottom and didn't find a way out, but I found a way in. what I caught was in a sort of out of body experience was that I was being spoken to. Call it addiction for a reason. It was diction, it's being spoken to and this, you know, dictator voice within which is not trying to hurt me, it's trying to help me. But it's just one part of me that is constantly problem solving, comparing, judging, etc. We all have that voice. It turned on us when we were about six, seven or eight, you know, and it's part of our moral development, but it's Part of our neuroticism and all kinds of things that happen when you're able to turn knowledge into a tool to beat yourself about the head and ears. But anyway, I caught that it was a different voice and I declared my independence from it. the exact words, I think they're pretty close to what I said because I said it out loud at 2:30 in the morning after probably, probably about a two hour long struggle with whether or not I should call the ambulance for my so called heart attack. And then realizing with this out of body experience almost like a fugue state that now this I know what they're going to say. They're gonna say you're just having a panic attack and okay, well then what are you gonna do? I didn't know end my life? Stop here. I don't know. It would look to me like it was a dead end. What I said out loud, I remember that I said it out loud in the dark of night is I don't know who you are, but apparently you can make me hurt, you can make me suffer. I'm talking to the voice. I'll tell you one thing you can't do. You can't make me turn away from my own experience. I said it in a different way in the TedX talk. I said the way I said it then following a scream by the way, that was me hitting bottom that I'd only heard come out of my life once when I was caught in a machine at work, work in an aluminum factory and was almost chopped in half, still have a dent in my leg 50 years later. and they turned it off just in time to keep from being chopped in half and hitting bottom. And then in the TEDX talk and if I can say right before I got on stage this was a, ah, unr. This was five minutes before I went on stage. I got in front of my wife, said I can't do it, I absolutely cannot do this. It wasn't a panic attack about giving the talk. It was that I just was not going to go back to hell voluntarily. Just wasn't going to do it. But I thought I needed to just to help people who are in hell right now and who see no way out but do have a way in. And the mind will not present that to you as an alternative, doesn't know how to do that. That wizard of Oz voice in our head is telling you to run, fight and hide and what you need to do is turn towards it, own up and show up and that's just not logical. You're going to die if you do that. No, you're not. You're going to wake up. So hitting bottom in your addictions, spiritual experiences really, which is what that was used to be really looked up to. My first psychology hero was Abraham Maslow. You know, peak experiences, you know, only Eleanor Roosevelt can do it. No, if you ask the question right and you take away just doing it inside a theistic frame which will squeeat out a lot of people who are agnostic or atheist if you ask the question right, most adults have this experience and the numbers are actually up. In the high 90s, you've had times when you've had an experience of oneness and connection across time, place and person. Could be a nature walk, it could be looking at the eyes of a lover, it could be hitting bottom. But you had a place where. Yeah. And that part of us can be a place we stand. And from that place we can learn how to take on our history and show up, open, how to then see what's present in a way that's flexible, fluid and voluntary from the spiritual sense of self aware. And then when you've done that, how to turn towards what brings meaning and purpose into your life, which is, is what are the qualities of your own actions that you want to reveal in the world or make more manifest in the world and how do you build habits around that? And then the extension. And by the way, that includes your relationships and culture and that includes taking care of your body. Don't treat your body like shit. You know, I mean I look at folks who've been caught up in addiction and when they wake up sometimes. Yeah, and their liver is this big, that's not going away. And that's a hell of a thing to take on when you know you've ruined your family's lives. And by the way, your body now is going to limit your life and it's going okay, but still better to so own up and show up now than never. So, that was my transformational moment and I've written about it and it ended up being the source of my whole career really. so if I had to do it all over again, would I do that? Yes. But man, I wish I could have been wiser because I could have avoided some tragedies that I produced in my own life and lives of others. And I'm not going to beat myself about the head and ears about that. I'm going to try to empower people to own up and show up. And the things that are in 12 step, you know, try to repair the things that are there, acknowledge them, take responsibility for them. those are wise, parts of it.

Heather Haslem: There's this part that I'm also hearing of, like integration. So all these life experiences, good, bad and different, there's like this sense of integrating them into the present moment, and then making intentional conscious decisions, choices on how to move forward for what matters most to the individual.

Dr. Stephen Hayes: You know, that integration, we call it healing for a reason. And you know, the etymology of heal is whole. It's whole. So if you've been slicing and dicing yourself and breaking yourself up into pieces, and I only want this part but not that part, and, oh, that ugly thing that happened, oh, I'll just suppress that. Okay. But what that means is you're going to first buy into deep down there's something wrong with me, and then try to learn how to be here as a whole person. Good luck. Let me know how it turns out. Send me a postcard. And I can almost guarantee what's going to be written on it. Because you can't get there from here. You can't chop yourself in half and then be whole. You have to start whole. And by the way, you already are whole. Yeah, you're a human being. You've made mistakes. Great. Okay, take them on. Show up. own up. Show up. Well, so people sometimes wonder, how can that be done? Because they see it as a problem solving process. It can't be done that way. It's a fading process. And if you want a word for it that'll misdirect you, but it's true. it's self confidence. Confidence. Con means with fidense, comes from a Latin root that means faith or fidelity. Can you be with faith or fidelity with your own life, with your own awareness? It's a birthright. You don't have to earn it. And you knew that when you were a baby. you know, you dumped endorphins just because you met kind eyes. You were here. You're part of a group. You don't have to earn your way in, you know, but you left voluntarily because of the invitation of the dictator within. And that add diction, can be withdrawn. You don't have to. You can pull aside the curtain. And it doesn't look like widows at vase. It looks like a funny guy talking into a microphone. And so, yeah, something wrong with you. Thanks. Okay, great. I got that handled. Anything else you have to tell me? You have to do your taxes. Great. Thank you. I'm glad I got you. But do I want to turn my life over to you? No. No, I'm. I'm not a problem to be solved. I have a life to be lived and that's not a problem. I mean, yeah, there'll be problems in life, but they're the positive problems you put in by caring. So I have the positive problem of trying to change the world of psychotherapy and how we think about human problems and move from top down normative categories to processes that are empowering or disempowering one particular person, family, couple at a time that is so radically different than what's in human culture. After 150 years of Galton on down, you know, your IQ, your personality, your, you know, percentile, rank, it's all wrong, scientifically toxic. But we're teaching our kids. Oh, I'm so glad you. Oh, I saw your iq. Oh my goodness, you're going to be so successful to 8 year olds. Do you know what you're doing? Yeah, you're proud of your kids, but do you know what you're doing? M They're going to hide from you the places that will change that judgment and in so doing they'll buy into that judgment in a way that's going to hurt them. I mean, how many billionaires are reaching into their bottom drawer for a gin bottle or the gun they know that's down there or you know, I mean, so we have a challenge and that's my turning point. The answer to your question. And it is with me every day. And you know, when I pray, I pray for the, the willingness to be here in a whole way and help others be of use to others.

Heather Haslem: Can you speak a little bit more about. Really what I'm hearing is learning how to A, be aware, but B, befriend the dictator.

Dr. Stephen Hayes: Yeah, you actually can befriend it. It turns out, you know, it looks like a giant, but it's actually a little, little creature like thing and some of the things are out there, internalized family systems and things like that have a kind of a helpful way. It's in Act 2. But to sort of think about this in a ways that sort of brings it a proper relationship and the idea that something in you is 10 times bigger than you doesn't make any sense, does it? But that's what it feels like psychologically when the dictator gets going. You feel, you know, like, like wizard of Oz. No, it's in you. It's in you. It's just it's just a little small voice trying to be of use. so yeah, we're funny creatures and we have quite a challenge and science can help, but I really think science and therapy can transform all this. But all hands on deck, let's stop the wars between all the little traditions and all this silly castle in the sky ego stuff. Dig down the smallest set of things that can do the most good for most people, integrate it into what you do. And if something I'm saying sounds interesting to you, there's a gazillion ways to support it, some of which cost money and I will get money from it. But frankly, you could go to the World Health Organization and download their most downloaded book on the entire website. And it's a free, free act self help book called Doing what Matters in Times of Stress. And it's in the Ukraine right now. You know, it's in California with the fires right now. Who is putting it around the world so you don't have to spend money? Just if there's something I'm saying here that resonates with you, just pull on that strand of psychological flexibility or act and see where it takes you.

Heather Haslem: Thank you. You've mentioned a little bit about your intention over these last five years on looking at how science conducts itself. And so I'd love for you to speak a little bit more about your hopes for how we study in the future.

Dr. Stephen Hayes: Well here this gets really geeky really fast. So let me see if I can avoid the geek Geek. And I didn't give you a single sentence that summarized 40 years of work. That's pretty good. Let's see. But this is more recent so it's still way geeky. In fact, I'm about to meet my statistical team. I meet every week for two, two hours. We jokingly call ourselves One Size fits None and we're developing the stats that will that have already shown what we kind of knew was there once we discovered that there was a fundamental flaw in all of what you normally think of as normal biostatistics, the dsm, the icd, and how we think about human abilities and problems, which is normative and categorical by comparing people rather than ideographic and particularized by looking at what happens with in people over time. I mean if you just think about it, this would be kind of a dumb idea. Wouldn't it be? If I really understand Heather, I really want to understand her, I say quick, let's take a snapshot. Now how is Heather different than Sally how is she different from Joe? How is she different from Fred? and I'll do this like a hundred times and then I will understand you. Really? What do you think a mean and a standard deviation is? That's what it is. A standard deviation is. Deviation from what? From the average. What's true? The median, the mean, the average. We've socialized the entire world on this. Okay, what does that tell you what to do over time? Here's my answer. Almost nothing. And we now we're developing statistics where we do something different and with AI and with the computer in your pocket. And I'm in now, building and marketing AI tools to do this and so forth. I have a COI. So I have one that's not a COI. Go to ibh.com institute for better health. It's a charity. 45 years old, I'm president of it. I take no money from it. I give them money. But if instead you follow an individual over time and then you look at what lists them up or lists them down and then you say okay, now I've got you because I watched you across different situations and it took a while, but you can do it. I mean, heck, I've got my number of daily steps. Don't you? That's new. We can do the same thing with our mood. you've got that on your what? You can do the same thing with prosthesis of change. Are you open or you're closed? Are you aware or unaware? Are you focused on your values or not? Then when you do that, you can do a different kind of stats. What lifted you up? Okay, now we lock that down and we say no matter what, we're never abandoning you, Heather. Your life that's locked down. But there may be things that we don't see because we'd only see it if we looked at a number of others. So now we'll see other general principles. Are you part similar to others? Are there little subgroups having modeled you? And then here's. We had to invent a word to describe it. Here's what we do. We hang on to that knowledge about Heather, expanded by knowledge of apparently Heather like people who within their life are kind of like that because there's only so many ways to prosper or get screwed up. It's not an infinite number of ways. Right. the invented up word is idio. Nomic, ideographic, then nomothetic. Looking for general principles. This means general laws. But you only keep them if and only if most People are seen more clearly. It's like you only hold on to the things that clear your lens. If it helps you see if it's sandpaper. And now I don't even see you as well. We don't use it. Well, in our normative stats where we're turning people into error terms. Do you understand? If you go into big group design, you're an error term. That's what you are, you're an error term. What's true is the central tendency not of an intact group, but a collective of people. A big pile of pony poop, you know, George. Randomly selected, right? What? Yes, because the early statisticians had the idea if I compared people I would not really know what's true about them. Inside to empower. Why now? here's the question. Why did they do this? This will shock cut some people. And I'll answer it a different way. Take the heroes of stats. Carl Pearson. Pearson's R correlation. Ever take a stat class? R.A. fisher. Fisher Z. Frank Yates. The Yates correction on chi square. Francis Galton. Giant intellectual and the first person to ever come up the idea of standard deviation. Not belkers. That was actually quetelet, but first person. All right. These names I just mentioned, what were they? Professors of mathematics. Wrong. Try again.

Heather Haslem: I don't know that.

Dr. Stephen Hayes: Statistics? No, they created statistics. They weren't professors. Eugenics. Galton created eugenics. And the people I'm talking about were all eugenicists. Ari Fisher's professorship was in genetics. Eugenics. What is eugenics? How to figure out who's worthy to have children. You know, I have great aunts and uncles who died in ovens because of these people. M. Were they evil? No, they were trying to do good with crude evolutionary thinking. That was wrong. By the way, as an evolutionist, I had a meeting this morning with one of the best evolutionists on the planet. David Sloan Wilson. I meet everybody week with a whole group of biologists on evolution. I've written books on evolution. It's bad. Evolutionary science number one. Because it was so crude, it was so early, it was like, oh, Darwin must mean this. Survival of the fittest. That's not. No, that's not. Anyway, don't get me, but. And of course Galton is what? Erasmus Darwin's grandson. Just like Charles Darwin. And what would that did he like about Charles Darwin? Artificial selection, Origin of the Species, that chapter. And why did he think that? Because he thought the reason we have problems, the reason we have criminality, the reason we have addiction. Do you know that people with addictions were sterilized involuntarily, legally, in this country for decades? If you were now we're Nazi Germany, you know that you would be literally killed. That started before the Final Solution. It was called, what is it? Action T4, after the name of the street where the hidden things of the church wouldn't find out, where they had forced everybody to take all these tests. They'd find the ones who are deviant. They get a nice thing. We've got a special hospital for you, will help you with your addiction, with your schizophrenia, with your epilepsy, whatever it is, homosexuality, you name it. They would come and then the nurses would get the command about who dies that night, and they would freeze them or inject them with poison. They bury them in mass graves or burn them. And they'd send nice letters home to the. To the family saying, I'm so sorry your. Your son died of that wart on his foot. Because all the physicians in Germany had to put in the reports about who was deviant and who was different. That's where the Holocaust started. And who wrote the laws that enabled that? Psychologists. And who were they? Who are they being driven by? The early statisticians I just named. And what country did they live in before those laws in Germany were written? United States of America. Because the psychoanalysts fought like dogs in the UK and so forth to not let it happen. And we embraced it. I. When I gave this talk at my last lecture at unr, I dug into my own history and I looked at my mentors. Mentors. Mentor. Because I knew what I'd find. And sure enough, 1917, there he is, Ar Gilliland, otherwise brilliant psychologist, who trained Allen Edwards, who trained John cone to train me. Yeah. In a journal of the delinquency, saying that, delinquency was a genetic problem and in the same issue, that they should be sterilized, juvenile delinquents should be sterilized. So we have such a dirty history that we don't even talk about. There's no textbooks. We've been lied to about what these stats came to do. So I'm doing a rant now, on something that I'm writing a book about and I feel passionately about. But let me just say in a way that will land if you're a practitioner. Most practitioners believe what they see in the room and their actual relationship with the people they work with and the changes that happen over time, and they're told no no, no, no, no. You have to look into journals and see these smooth curves between groups. That's what's real. Clinicians are right, the scientists are wrong and they don't know they're wrong. They don't know their stats are lying to them. And I'm spending my life trying to correct it, which is really hard because some of the stats here I go really geeky. But multi level modeling, we will model every individual. We'll have individual growth curves. We know that each individual isn't the average. Yeah. And then you read the textbook where they do a compression squeeze. And if you don't fit the mean, even when we try to characterize you over time in multi level modeling, hierarchical level modeling, these modern forms, the trajectories can be all over the map and suddenly they're normative. And there's just a few exceptions because that's what the stats are trying to do. Even when they try to get out of the fact that stats do that because they don't. Stats, biostats don't realize that if you don't model the particular individual or couple or family and lock it down, you will be distorting the human lives and then you're going to be telling clinicians that they can see with their own eyes. Doesn't fit. It's m supposed to be like this and it looks like a bowl of spaghetti. Why? Because you haven't been given the tools to help disentangle and simplify. What I'm saying actually is I can defend which is help people learn how to be more open, aware and actively engaged in a life worth living. Extending that to relationships in your body. However, make sure they all go together. Because if you take any one of those and say only that's important. This is one of the humbling experiences I've had over the last four years. You take anything acceptance about one out of eight people, the more accepting they are, the more miserable they are. Values. It's about 1 out of 10. Why it has to all go together. And it has to fit you and your context and your religious beliefs and your culture and your background and your situation and your goals. How do we do that? Well, we've been doing it clinically for a long time, but the scientists haven't even been collecting the kind of data and analyzing the kind of way that could possibly answer that question. So they're giving you normative categorical answers to questions that are inherently particularized by people. There's a practicality to particularity. So to the clinicians, I hope there's enough of interest in there that maybe you can check out what's going on in the ACT world. You don't have to check any of your heroes or get a tattoo or, tithe to the founder. We've stripped all that away. There's no certification. We don't do that game. We will help you to see those processes in your clients and to put them together in a way that particularizes that human being and empowers what you're seeing and trying to manifest the therapeutic relationship. And, that's pretty new. I'm not the only one. But it's a small percentage of what's going on in therapeutic, and intervention science. But we're finally onto it. And I'm confident 20 years from now our field is going to be very, very different. I hope I get to see it. I'm doing everything I can to make it so.

Heather Haslem: This question that I have might be too big for the time we have left. So you can tell me if it is. but with everything that you just shared about the history of, science and how it's shaped psychology today, how has all of that impacted the dsm?

Dr. Stephen Hayes: The DSM is, a dead person walking. People just don't know it yet. You know, the last edition, There was a DSM 5 work group. And, they said, honestly, what is true, there's no sensitive and specific biomarkers of any DSM disorder. And they also say in the prologue of the book, read it, don't use this to pick treatment. Do people know that the book itself says don't do that because it hasn't been empirically validated for that. I think it's irretrievably broken. But we're in a system, and so you have to genuflect in front of it to even get paid in many systems of care. And the researchers needed to do it up until recently in order to get their grants and so forth. Well, the NIMH decided when INSO was the head, to stop doing that. They lost so much faith in the dsm. That said, we won't give you any more money to do randomized trials for the dsm. Focus on dsm. You have to do, what's called rdoc, research domain criteria, which are. But unfortunately, Tom, Insel said, and all these processes, positive and negative valence of emotions and cognitive processes, are, really ways of understanding neurodevelopment because we know it's the brain and genetics well, now he's done. He's left and written apology, said I was wrong. Yeah, but the billions were spent. You don't ask a science question and say, and before we study it, here's the answer. That's not what you do, Tom. Don't be telling me it's neurodevelopment. If you knew that, why are you spending the money? Well, it's the arrogance of, some of the wings of academic psychiatry are so confident that mental health and so forth are biological. Period, End of story. And is this Inida, do you think? I mean, I was on night of council if you're into drug and alcohol. Well, not alcohol, but drugs. Which is the 13 or 4 folks who give the anointing to the billion dollars of spent. I was on that. Donna Shalala appointed me. I saw every single grant and nida, come through and I had to raise my hand or you didn't get the money. Of course it's a big show. Of course we raise our hands. What else are we going to do? But, yeah, and, I know that, the data aren't there for a lot of things that addiction counselors are being told, are there when you come over to the biological side of things deliberately. I mean, I'll give you an example. We voted in the thing where we would have research centers that would get the cutting edge knowledge of addiction out into the practice community. And a huge, huge, multi, multi center. These centers, were funded. And I chaired the, evaluation committee for the first round of funding. Gave away, I don't know how many ridiculous amount of money, $100 million or something like that, I forget. But I chaired it and looked at it. It's all great. But the criteria for disseminating psychosocial information about addiction was at least two or three randomized trials from different teams. The criteria for disseminating medications. One randomized trial. Who did that? The head of NIDA did that. Why? Why do you think? And I was in the committee when that happened. And I said, this is wrong. There should be one standard. And I was constantly going back to Washington for all these cool NIDA things. I never went again because I was never invited again again, ever. And one of the right hand persons of the current director of nida, still, she's still there, came over, whispered in my ear and said, well, that's the last meeting you're coming to. And he was right. He didn't say it to taunt me. He said he knew it was going to happen. So It's a rigged game and driven by professional arrogance on the part of more biologically oriented folks who are on top and by a 1.5 trillion dollar industry that's behind it. So, am I saying that you shouldn't use. No. I've done a randomized trial to help drug and alcohol counselors use ACT to get more flexible themselves to use agonist antagonists when recommend it and support it with their clients. Why? Because if you're a heroin addict, you know, it's a heck a lot better to be doing that than be on fourth street. And so don't tell me I'm against medications. How many people have done randomized trials with therapists to help them support the use of medication? But no, we have a cultural problem here, top down normative categories that is now contaminated by insurance companies that are swilling down the money. Even the physicians don't get it anymore. Have you talked to your physician lately? Have you tried to, you know, if you looked at how many people want to be physicians nowadays and the big pharma. So that combination of insurance big pharma has given us, well in the United States of America, giving us what less than half the money in other countries do more good for actual health than what we do. So we have a broken system. It's been going on for a long, long time. I don't normally talk this loud, my out loud voice because do I want big pharma having me on their list of enemies? No, I don't want that. Because you know, it's not good to be there. Let me say it that way. But the truth is, I'm back to what I want to say and we're close to the end of our time together. I think for practitioners who are listening to me act, maybe have helped you. But beyond that, let me just say that your sense that the science isn't always lifting you up and empowering you is because the science isn't lifting you up and empowering you. And be a little cautious about what you're being told is certain knowledge in certain areas where there's economic interests and it's also linked to normative categorical ways of thinking. When you as a therapist can't do that and be present for another human being who is a whole human being. They're not broken. Yeah, they're being dictated to sometimes by the chemicals they put in their body regularly. Okay. We all know about that space in a way because we're all being dictated to by our history and our own Minds. So, let's see if we can create a world where from the bottom up, the practitioners can turn over this apple, cart. It is, sometimes more getting in the way than helping.

Heather Haslem: Well, I want to thank you for giving us so much to think about today. we've covered a lot of ground. and really I'll just say that I'm taking away two things. And that is, really leaning into our own curiosity as we work with individuals. leaning into curiosity. Curiosity about our own experience and, the importance of sharing that with others. So thank you for sharing yourself and your experiences that then has transformed into act that we know today. and then trusting. Like, I'm also hearing like this importance of trusting ourselves as practitioners, clinicians, for showing up and witnessing and supporting others lives.

Dr. Stephen Hayes: Yeah, I call it humble curiosity where you, you stand in that place, you're constantly open to new information and adjusting and being flexible. It's not out of arrogance and that you, you do start with a sense of trust. And especially I could say one thing, the trust that the person in front of you is not broken. I don't care what's happened to them in their life or how many things they've done that are just horrifying. When we were doing the first big randomized trial of ACT for addiction here in Reno, the first big one with, polysubstance abusing opiate addicts. We had a client who was so high that his daughter was being perpetrated on the back bedroom. And he couldn't get off the couch because he felt so good, and he had to walk through hell to show up, own up, build a relationship with his daughter again. So no matter how deep that goes, the person in front of you is a whole thoroughly made, perfect meaning factory per. You've been manufactured as a whole human being. Your birthright is to connect in consciousness with others. So let's learn how to rein in the dictator within, to own up, show up and support people in living whole human lives. And, it's holy work. We mimic a paedilof, but it's holy work that we have to do. And I, acknowledge the counselors, and clinicians who are listening to me now because, I know what you're up to and what you're doing is honorable and good for the world.

Heather Haslem: Well, thank you. I appreciate you being here today.

Dr. Stephen Hayes: And IU thank you foreign.

Heather Haslem: Thank you for listening to CASAT Conversations, your resource for exploring behavioral health topics. We hope you found, today's conversation timely and meaningful. Please share this podcast with your friends, friends and colleagues. If you want to learn more, visit us at our blog at casatondemand.org CASAT Podcast Network.

Heather Haslem: This podcast has been brought to you by the CASAT Podcast Network, located within the Center for the Application of Substance Abuse Technologies, a part of the School of Public Health at the University of Nevada, Reno. For more podcast information and resources, visit casat.org.