Introduction to Acceptance and Commitment Therapy
From an evolutionary standpoint, avoiding pain is rooted in human nature as it protects us. However, nowadays, avoiding or suppressing uncomfortable and difficult feelings like anxiety, guilt, or shame can deteriorate our well-being and development. This empirically-based intervention approaches such issues unconventionally. It views experiencing pain as an unavoidable and innate part of our existence. It encourages not only accepting but also embracing all disturbing thoughts and emotional states instead of fighting them. ACT therapists use different acceptance and mindfulness-based techniques, essential in the process of learning the skill of psychological flexibility. It enables us to engage with the present moment consciously and choose to behave in a way that brings us closer to our values and dreams in life.
ACT is a therapy that offers tools facilitating an experience of an abundant, meaningful life and a theoretical model that can become a philosophy to live by.
ACT helps us commit the actions that enrich our lives while accepting and recognising pain as a natural part of our shared human experience.
How does ACT work?
Those who experience unsettling emotional states such as being stuck or lost in the meanders of the negative thought patterns can benefit significantly from ACT treatment. It’s aimed at providing clients with tools to support them during mentally challenging times and bring them closer to their true desires. Acceptance in ACT means freeing oneself from judgment and creating space to look at the problematic thinking patterns from a distance. Acknowledging painful feelings for what they are instead of suppressing or fighting them is an essential first step in making progress. Avoiding these negative beliefs, memories, or emotions works only short-term for us. Robert Anthony once said: “The fastest way to escape from a problem is to solve it”. It makes sense since fleeing from an issue can only pull us away from solving it. Committing to confront the unsettling beliefs and emotions with self-compassion, psychological flexibility, and emotional openness is the second premise of ACT. We change these thinking patterns that no longer serve us by practising consciousness of the present moment and following our values in life. ACT is used most often as an individual intervention. However, it can also be adapted to a group setting. Even though there’s no universal endpoint to this treatment, it is relatively short-term.
What is ACT effective against?
ACT has a substantial body of empirical data supporting its effectiveness in treating many different disorders like depression, anorexia, anxiety, OCD, PTSD and even schizophrenia. The treatment has also proven to effectively overcome various clinical issues, e.g. chronic pain, workplace stress, addictions, obesity, and substance abuse. A 2002 study conducted by Bach and Hayes demonstrates how ACT is effective in treating schizophrenia. Only 4 hours of the intervention reduce hospital re-admission rates for schizophrenic patients by 50% over the upcoming six months. Another study conducted in 2016 (Parling et al.) on women with diagnosed anorexia and binge eating disorder offers evidence to suggest that ACT is an effective treatment that foster positive outcomes.
In what situations is ACT not recommended?
ACT is generally not suitable for clients with very severe mental conditions. It means that people who suffer from acute depression, anxiety or psychosis might need to seek different treatment first as other interventions may address their needs better.
ACT against anxiety and depression
ACT effectively reduces the symptoms of depression and anxiety. A 2016 study tested how effective ACT was when applied to a group of 30 women with breast cancer.The patients assigned to an experimental group received ACT training classes for two weeks. Their results, when compared with a control group, clearly displayed that applying ACT can help in diminishing depression and anxiety experienced by breast cancer patients.
In 2015 a team of researchers (Walser, Garvert, Karlin, Trockel, Ryu & Taylor) recognised ACT as an intervention that mitigated the intensity of depressive syndromes among 981 veterans diagnosed with depression and suicidal ideation. The treatment also increased the experiential acceptance of the veterans. The study reported that “66% of the patients completed 10/10+ sessions or finished early due to symptom relief”.
Another study examined ACT’s efficacy in treating depression and anxiety among students suffering from social phobia. The experimental group underwent ACT treatment. The results verified that applying ACT effectively decreased depression and anxiety symptoms among those who experienced social phobia.
Various techniques used in ACT
There are three broad categories of techniques practised in ACT: Acceptance Humans are naturally wired to quickly judge everything around them as either right or wrong, smart or stupid, abundant or worthless etc. Once we actively choose to create space for pain to come and go, once we open up to the unpleasant emotions and memories without fighting or denying them, we liberate ourselves from the vicious circle of experiential avoidance. That is precisely why clients learn many acceptance-based techniques throughout the treatment. Mindfulness When we practice awareness of the present moment, free of the desire to manipulate or resist the experience, we distance ourselves from unhelpful thoughts and behaviours. Cultivating cognitive defusion, which fosters changing our reactions to various thoughts and feelings, enables us to confront and benefit from negative experiences. These mindfulness-based techniques stem from a notion of ‘the self’ promoted by ACT. Commonly, humans view themselves as the entirety of experiences, emotions and thinking patterns. The alternative perspective suggests that we also function outside of the present moment, in the background that provides the context in which we can anchor ourselves. Not only our experience has the power of defining us. It is also our reaction and interpretation of it that shapes who we are. Commitment & Values Values are like an internal compass, offering meaning and direction in life. Often, on an instinctive level, we prefer to suppress, deny or fight uncomfortable experiences. With time we forget what we truly desire or dream about; we only remember all the feared and stressful things that should be avoided. That’s why ACT looks at the bigger picture and puts an emphasis on making the commitment of striving for a meaningful life in accordance with one’s values.
The beginnings of ACT
ACT was developed in 1986 by Steven C. Hayes – a psychology professor at the University of Nevada. Driven by the desire to cope with his panic disorder, Hayes became keen on creating an alternative approach in psychotherapy that would emphasise the role of emotional openness and acceptance in the journey of healing. He started studying how our thinking patterns and the words we use to shape our internal experiences. This work later came to light as the Relational Frame Theory. The basic premise of this concept states that people’s ability to connect seemingly unconnected words, situations, emotions and ideas can be either beneficial or detrimental to our mental well-being since it can facilitate judgment and harmful thought patterns.
Hayes, who grew up as a Californian 60s child, was deeply inspired by Eastern philosophies and strove to incorporate mindfulness practices alongside acceptance methods in the framework of ACT. Today, many people apply the groundwork of this treatment laid by Steven Hayes to the therapeutic process and, on a larger scale, to their belief system.
Books about ACT
“Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy” – Steven C. Hayes & Spencer Smith This read is an optimal description of the foundations of ACT. Many people use this self-help workbook to aid Acceptance and Commitment Therapy or as an excellent self-development tool. The authors address issues such as self-destructive behaviours and experiential avoidance. They also stress the importance of perceiving painful emotions as an innate part of our human existence. Hayes and Smith invite readers to build a meaningful, abundant life by accepting the suffering woven into the fabric of our existence. “A Liberated Mind: How To Pivot Towards What Matters” – Steven C. Hayes This book takes a more personal perspective on ACT, with Steven C. Hayes sharing his personal story and what compelled him to create the treatment. Stories and examples of patients are intertwined with the explanations of ACT basic premises and foundations, placing them in a realistic context. The author offers many activities and useful tips to overcome negative thought patterns and uncomfortable emotions. He invites readers to “turn pain into purpose” and start a life in alignment with their ideals. You can get a physical copy of the book or the audio version, narrated by Steven C. Hayes himself. “The Happiness Trap: How To Stop Struggling and Start Living” – Russ Harris This best-seller is a go-to recommendation as a perfect opening to ACT. The main ideas are explained in an understandable, digestible way. The book fosters the process of liberating yourself from anxiety, depression and insecurity. Russ Harris offers a refreshing, compelling perspective, which is likely to positively influence your entire life.
Different exercises in ACT
Exercises of ACT support cultivating psychological flexibility, which facilitates an experience of abundant life with all its pleasant and distressing elements. The mindfulness exercises help us understand when and how uncomfortable thoughts and feelings arise and how they limit our lives. By taking a closer look at them, we can reduce their powerful impact on us. After all, this negative chatter isn’t dangerous if we choose to see it as a suggestion, not a universal truth. Language in ACT is a tool to de-dramatise and disarm the inner critic. Words like “bad, broken, sick, abnormal” are not used throughout the treatment. Instead, the content of dialogue concentrates on what works for clients. Many values-based exercises use stimulating metaphors to illustrate an alternative perspective on life. They often help in identifying the self-defeating, avoidant behaviours as a source of our suffering. Some are also great in visualising the distance between our current situation and the embodiment of a meaningful ideal. All of these thought-provoking exercises lead us to answer the often-uncomfortable questions like: “Is this how I honestly want to spend the rest of my days here?” “Is my behaviour fostering an experience of abundant life full of meaning?” “Are my decisions aligned with my values?” Most importantly, they equip clients with crucial tools on a journey of healing.
ACT vs CBT and DBT?
Cognitive Behavioural Therapy (CBT), as one of the most popular forms of psychotherapy, is applied worldwide. It serves as the foundation from which third-wave therapies like ACT and DBT stem from. Traditional CBT primarily focuses on detecting, recognising and reframing self-destructive thinking and behaving patterns into ones that foster a healthy, balanced life. CBT’s principles boil down to identifying negative, false beliefs; then testing and restructuring them. Dialectical Behavioural Therapy (DBT) shares many similarities with CBT except for one. In DBT, clients are encouraged to acknowledge and accept uncomfortable thoughts and feelings. Coping with these challenging patterns is facilitated by talking them through with the therapist and client’s support system. The treatment accentuates the role of validation, acceptance and behaviour change in interpersonal relationships. Discussing the problematic past is the key to designing a hopeful future by creating a gradual recovery plan and developing improved coping strategies. Acceptance and Commitment Therapy goes one step further and takes on an experiential approach. Like in CBT and DBT, it focuses on changing negative beliefs into healthy ones during individual therapy sessions. What’s even more important here is fostering the notion of accepting oneself unconditionally and committing to readjusting one’s behaviour. ACT does so through various mindfulness techniques, which teach clients to be fully conscious and grounded in the present moment. Those skills create a foundation for opening up emotionally to uncomfortable thoughts and feelings. According to ACT principles, once we stop avoiding or suppressing them, we can access a clear sense of personal values. That, in turn, allows us to commit to living a healthy and meaningful life.
ACT criticism
As part of a third-wave movement, ACT has gathered some criticism over the years from traditional CBT therapy proponents. There is some controversy among academic research concerning the misinterpretation of the empirical evidence while comparing the mechanisms and effectiveness of CBT and ACT. An interesting criticism towards ACT concerns the spiritual aspect of Eastern philosophies underlying the treatment. Some patients may perceive meditative and mindfulness-based techniques of ACT as religious practices which clash with their own religious beliefs. On the other side of the spectrum, some Buddhists claim that Acceptance and Commitment Therapy does not represent “true Buddhism”. ACT – NHS Cognitive Behavioural Therapy, as the most commonly used treatment, is accessible through the NHS psychological therapies service. Acceptance and Commitment Therapy, as an extension of CBT, is also reimbursed by the NHS.