The circles of suffering

The circles of suffering are an ACT exercise that can help us to realize the costs of avoidance of difficult topics in our life. We start with the main issue we avoid and then analyze the suffering that happens on top of it. That way we might get convinced that overcoming the avoidance and tackling the issue is the lesser evil. This is not an exercise that will make you feel comfortable and I only want you to try it when you actually have the capacity to reduce avoidance and you have proper support and therapy to help you through the process. It makes no sense to do this outside of a therapy context unless you know you can manage the issue alone. Don’t try it if you already feel bad or unstable.

 

Maybe you have heard the quote that pain is inevitable but suffering is optional. This is what this exercise is all about. We all have pain in our lives. If we don’t manage it, we need strategies to numb it somehow or to distract ourselves or cope in some way. These strategies are usually problematic long-term and cause a certain amount of suffering. So now we walk around with unresolved pain and the suffering created by our maladaptive coping. To numb that additional suffering we pick up even more problematic strategies and surprise: they add more suffering. We end up creating completely optional suffering that can often get bigger than the initial pain. Realizing that this is happening is a great motivation to manage the pain instead of avoiding it even longer.

 

We can make the dynamic visible when we work with circles that spread outward.

1. We start with one circle in the middle that stands for the initial issue we are avoiding. Write down the feelings, thoughts, memories, relationship issues etc that you have when you think of it. What is the core pain and the experiences connected to it?

 

In this example we are using a trauma experience as core pain.

 

The Trauma experience:

• feelings of guilt and shame, fear, loss of control,
• thoughts that it is all my fault, that I am broken or dirty
• attachment issues
• experience of being a victim
• …

 

2. Then we can think back and find out what our initial response to that pain was when it first entered our life. We write these things down in a circle around the core pain. How did we numb, distract or otherwise cope? How did we manage the situation? Try not to blame yourself. We usually did the best we could.

 

In the first circle we might find

• withdrawing from people, distance =safety
• not saying anything to keep the shame down
• disordered eating for a sense of control
• not letting anyone see the real me
• dissociation
• …

 

3. Now we look at the effects our coping had on our life long-term. What kind of problems developed because of what we did there? How did it influence our emotions, thoughts, relationships and experience? If our problematic strategies were seeds, what are we reaping? Notice where it adds to the original pain or repeats a problem. We write all of this in a new circle around the other ones.

 

This circle shows:

• no support,
• crushing loneliness
• more shame and guilt
• being perceived as odd, followed by bullying
• no close relationships, even less trust in people
• people projecting their problems on me because there is so little of me visible
• dissociation, loss of control and disrupting life
• ….

 

4. Then we create the next circle by reflecting on how we tried to manage these thoughts, emotions, relationship issues or other experiences. How did we cope with them? What were the strategies? Did we repeat and increase old ones or did we add new ones?

 

To cope we did:

• Self-harm to interrupt the dissociation
• turning inside or toward a fantasy world
• vulnerable for grooming and unhealthy relationships to break the isolation
• numbing feelings through alcohol
• chronic shame
• more dissociation
• ….

 

5. And in the next circle we examine how those strategies affected our life, how they made us feel, what they did to our thoughts, what changed in our relationships etc.

 

The effects of that are:

• ER visits
• being noticed as mentally ill, stigma, more shame
• thoughts that I am broken
• repeated victimization, ‘it is all my fault’
• work problems
• loneliness, relationship problems
• loss of control
• …

 

You can repeat this many times, adding as many circles as you have experiences. Always look at the strategies, then their effects and then back at strategies to manage the effects.

When we do this for our personal situation we might notice that a lot of problems don’t get solved with our strategies. They show up in the next circle unchanged or even worse. Continuing like this won’t get us anywhere.

 

Look at all the circles around the initial pain. All that is real suffering. And it built up like that because we were unable to manage the core pain at that time. When we overcome our avoidance and face the pain we can slowly diminish the impact on our life. We remove the need for all our maladaptive coping and its consequences. Comparing the pain with the amount of suffering it causes might show us that facing the pain is the lesser evil. What a great motivation to overcome the avoidance.

The example shows a big topic everyone can relate with. You can use the same technique for smaller topics like your fear of going to the dentist or talking to the landlord. We all have these things in our life that tend to spin out of control because we avoided them for too long.

 

 

This exercise can be applied to any pain in your life but I find it especially helpful for the characteristic ‘phobias’ in DID treatment. It is very common to cope with the inner experience through denial which only leads to more dissociation, amnesia, out of control behavior, broken relationships, overall confusion and chaos and a deep sense of shame about it all. The suffering becomes so much greater than the pain we will face when we turn toward the other parts.

These are the phobias you might want to analyze:

• Attachment/attachment loss
• inner experience
• dissociative parts
• traumatic memories
• intimacy
• integration
• change and a normal life

These phobias aren’t all relevant at the same time. The first are important in the stabilization phase, the last will only become relevant after trauma processing. Choose what you look at depending on where you are in therapy right now and don’t try to fix problems you aren’t ready for.

 

When we look back like this we need to make sure to use radical acceptance. Even if we see the pattern today we were incapable of seeing it earlier and if we could have done things better back then we would have. We didn’t have any help. Since this is in the past there is nothing we can do about it, we need to accept that this is how things developed. It is normal to feel regret and grief about that. It is not helpful to drown ourselves in shame. (For a gentle understanding of coping behaviors)

It is a misunderstanding that radical acceptance includes just leaving the situation as it is. There is no need to just sit there, experience our suffering and mindfully notice how bad it is. That is how you manage emotions that will naturally pass, not situations or perfectly treatable symptoms. Changes are possible today. It is our responsibility to make sure they happen. We can expect compassion for our pain. We cannot really expect that people understand when we sit in our suffering without doing anything about it. That is where our avoidance will impact our relationships. Radical acceptance is only for things that cannot be changed. When we approach our problems we just need simple acceptance that this is the situation we are in and a commitment to face our pain.