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The Passengers on the Bus Metaphor

By Amy Gowland



The Passengers on the Bus Metaphor: How we can utilise Acceptance and Commitment

Therapy (ACT) with Persistent Pain Management


As we know, living with persistent pain is a journey that is fraught with frustration, continual

searching for answers and a sometimes, a reduced engagement in a life that does not

always align with your values and where you want to be going.


What is Acceptance and Commitment Therapy (ACT)?


Acceptance and Commitment Therapy is a mindfulness based behavioural therapy that uses a combinations of metaphors, mindfulness skills, experiential activities and interventions that are guided by one’s values (Harris, 2006). The primary goal is to allow one to engage in a meaningful life, whilst allowing acceptance that pain (be that physical, emotional, psychological, etc.) will inevitably come with it.


Passengers on the Bus Metaphor:


The information for this section has been adapted from Jennifer Kemp’s Resource

(referenced below).


Imagine you are on a bus, you are the driver and only you can drive the bus, including

controlling the speed and direction that you take this bus. The road that you are travelling

on is one that is meaningful and important to you, allowing you to overcome challenges, no

matter how big or small they may be.


On your bus, there are various passengers, reflecting your thoughts, feelings, emotions,

sensations and memories. These passengers have all hopped on your bus at some point in

your life, for which some are kind and supportive, happily enjoying the journey, whilst

others are more intrusive, demanding and constantly want your attention. One of these

latter passengers is your inner or self-critic. They are always analysing and critiquing your

performance, getting up in your face and tending to insult you. As a result, it is not

uncommon for you to try and silence your inner-critic or those nasty passengers, including

pain. Some of the way that you might do this include:

  • Doing what your passenger says

Does it ever feel like you just need to do what your passenger says to keep it quiet,

or do you find yourself bargaining with your passenger to get short-term gains or

temporary relief? Whilst this may silence your passenger for a bit, often they re-

emerge resulting in a deviation away from the life that you want to live.

  • Fighting with your passenger

In order to keep your passenger quiet, do you ever feel like you are arguing, trying to

reason, trying to outsmart or begging with them to leave you alone? This in itself

takes so much energy and when you reflect about whether it has been successful in

the past, what is the overall result? Often you find yourself worn out further, with

reduced energy to spend on the things that are meaningful and important to you.

  • White-knuckling

Do you feel like you just put your foot to the floor on the bus pedal and push away

the passenger, constantly telling it to “go away” or “just leave me alone”? In doing

so, you have one hand tightly clenched to the wheel (white knuckles) and the other

arm is pushing away the passenger. Let alone this being exhaustive, it is so much

more difficult to control the bus with one hand and your progress down the road can

be much slower.


So what can we do?


ACT teaches us that one of the keys to assisting us to manage these passengers on the bus, including our pain, is to not feel as though we are having to fight or remove these

passengers, but adopting strategies to allow us to learn to co-exist with them.

Some of these strategies include:


Acceptance:

This acceptance does not imply giving up but rather, acknowledging that your pain is

currently a part of your life, therefore allowing a shift in your relationship with it. By

accepting your pain as an inevitable passenger on your bus currently, we can

redirect our focus towards living a fulfilling and meaningful life despite its presence.


Defusion and Mindfulness:

By recognising that our thoughts are not necessarily facts, we can create space

between ourselves and the pain-related thoughts. Through mindfulness exercises

and techniques, we can observe these thoughts without getting entangled in them,

allowing us to respond more effectively to our pain experience.


Mindfulness is a central component of ACT and plays a vital role in pain

management. By practicing mindfulness, we promote an open, non-judgmental

awareness of our present moment, including the presence of our pain. This allows us

to develop a curious and compassionate attitude towards our pain, rather than being

overwhelmed by it (this can be much easier said than done). Through mindfulness,

we can observe pain sensations without getting caught up in the distressing

narratives or catastrophic predictions that often, understandably, accompany them.


Values and Commitment:

Understanding our core values and committing to actions aligned with those values

is another critical aspect of ACT. By identifying what truly matters to us, we can

create a sense of meaning and fulfilment in various areas of life. Yes, pain may be

present, but it doesn't always have to dictate the direction of our lives. By

committing to actions that align with our values, we can move towards a more

meaningful and fulfilling life, regardless of pain.

Whilst these things can be much easier said than done and it does take time and practice to be able to adopt these concepts into daily life, it can work towards assisting us to build

resilience, find new ways to engage in a meaningful life, and regain a sense of control.

Remember, the passengers on the bus may always be present, but there are ways that you

can have the power to steer the bus towards your life.


References:

Harris, R. (2006). Embracing Your Demons: An Overview of Acceptance and Commitment

Therapy. Psychotherapy in Australia, 12(4), 2-8.


Kemp, J. (n.d.). Introducing the Passengers on the Bus. Jennifer Kemp.

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