Acceptance and Commitment Therapy or ACT (pronounced like the word “act”) is a relatively new therapeutic orientation. If you check out my “Approach” page, you’ll see that I regularly use ACT in my practice. If you are one of my clients, you know that I’m a little…passionate about this method!
Photography by Arah McManamna
Throughout graduate school I never felt like Cognitive Behavioral Therapy (CBT), which is currently one of the most commonly taught therapeutic approaches, was quite right for me. When I learned about ACT, something clicked, it felt right for me and for so many of my clients! While it’s not the be-all and end-all approach for everyone, it really is fantastic, versatile, and empirically supported to be effective in treating a myriad of issues.
ACT’s development began in the late 1980s by Drs. Steven C. Hayes, Kelly G. Wilson, and Kirk Strosahl. It is based in functional contextualism and relational frame theory. These are big concepts labeled with confusing, technical words that can scare people away. The truth is, when you look behind all of the jargon, the message is quite simple and something that many of us already practice at least to some extent in our daily lives! I’m going to do my best to break down the essential concepts of ACT here.
Psychological Flexibility
ACT aims to increase psychological flexibility, the ability to connect with the present moment in a more mindful or conscious way. Practicing psychological flexibility results in the ability to maintain or change your behaviors to be in alignment with your personal values. Basically, it’s being able to connect with the present moment (not being stuck in the past or the future) and doing or thinking in such a way that is in accordance with what you find important.
Think of it as being very similar to physical flexibility. When you are training for a race, a huge part of that is becoming more flexible and limber. If your muscles are tight, you are more prone to injury and less likely to achieve what you set out to do! Even a small rock in your path might be enough to take you down and leave you in the middle of the race with a sprained ankle. If you work on stretching your muscles often, however, you’ll have the ability to bounce back from minor missteps and bumps in the road!
This is established through practicing the following six core processes:
1. Acceptance
Acceptance is the active embracing of thoughts, memories, or experiences without attempting to change their frequency or form. It’s an alternative to experiential avoidance (avoiding experiencing events, places, people, thoughts, or triggers that are feared to be unpleasant or uncomfortable). Attempting to change or stop unwelcome thoughts can be counterproductive and make them even more frequent.
Example: In ACT, clients struggling with anxiety are taught to feel anxiety, fully and presently without defense or resistance.
2. Cognitive Fusion
Here’s one of those jargon-y terms. Cognitive (thoughts) fusion (melding or merging) happens when we become so entangled with our thoughts or memories, that we allow them to bully us and push us into behaving in a way that no longer serves our values or what’s important to us. Cognitive fusion often leads to experiential avoidance.
Example: Say you have a fear of being rejected by others (a pretty common concern) and get invited to a party. When you are fused with fearful thoughts of “what if they don’t like me” or “I might say something stupid” you may avoid that very unpleasant feeling of being rejected by not going to the party, even though you highly value friendship.
In ACT, one goal is to work toward cognitive defusion or disentangling your self from your thoughts. It helps you get some distance from your thinking patterns so when they occur, they don’t upset you as much or dictate your behavior.
3. Being Present
Mindfulness is the practice of being in the present moment, intentionally. Notice that I used the word “practice”. I think there is an important distinction here because mindfulness is not necessarily something that can be achieved and crossed off a list—it is something that needs to be practiced regularly. Practicing mindfulness helps you refrain from over identifying with your thoughts and experiences. It promotes a nonjudgmental interaction with your thoughts and environment, allowing you to notice negative, unwelcome thoughts but recognize that they don’t define you and don’t dictate your behavior. This is helpful in the cognitive defusion process.
4. Self-As-Context
This can be a tough one to explain and understand. In ACT, you are encouraged to view yourself as the observer of your experiences rather than having what is basically a set of rules about who you are and what is possible for you. We often give ourselves labels, such as “I am a nurse, I am a graduate student, I am X, Y, and Z”, which can be helpful in certain contexts but are not the entire experience of who you are. The constant is your observation of what happens in your mind and outside in your environment. You experience thoughts, memories, and emotions but there’s a you behind that, always observing and aware. The more you can build up a personal awareness and identity, the less those memories, thoughts or emotions take you over. They bounce off you rather than tie you down.
5. Values
Values work is a vital part of ACT. Values are chosen qualities that lead you in the direction you want your life to go. They are not a goal that can be achieved but rather a process, a compass, or a lighthouse, guiding you toward the person you want to be. In ACT, values work is done to help increase awareness of what values you truly hold and remain mindful of them while weakening your connection with things you merely think you “should” value.
6. Committed Action
ACT is a part of the behavioral therapies family and encourages clients to set goals consistent with one’s values (remember that values and goals are different!). Work is done in session as well as out of session as “homework” to help clients achieve behavior change goals in the short, medium, and long-term. As barriers are encountered, they are attended to through other ACT processes like acceptance, cognitive defusion, etc.
All of these processes work together and support one another working toward improving psychological flexibility. The important thing to keep in mind is that this is all a process and a practice. It takes time and work but can result in being more connected with the present moment and experiencing a wide, rich range of emotions, which aid in leading a full and satisfying life on your own terms!