Acceptance and Commitment Therapy

(ACT)

why do you use act?

In my career as a mental health provider, I’ve used many different modalities with many different acronyms over the years (CBT, DBT, MI, etc). They each have their appeal, but all are limited in certain ways. Many cognitive modalities, for example, focus on changing negative or anxious thoughts into more positive ones. While this can be very helpful in some contexts, I find the benefits can be more difficult to sustain in many of these approaches. ACT moves beyond arguing with our thoughts and feelings, and instead allows us to see past those barriers and move forwards towards the life we truly want to live. Sound a little weird? That’s okay, because it’s highly effective, with decades of research backing its efficacy. To learn more about ACT’s evidence base, visit the website of the Association for Contextual Behavioral Science.

What is ACT?

ACT (pronounced “act” like the verb, not “A.C.T.”) can be defined as a psychological intervention based on modern behavioral psychology (including Relational Frame Theory) that applies mindfulness and acceptance processes and commitment and behavior change processes to the creation of psychological flexibility (source: The Association for Contextual Behavioral Science, www.contextualscience.org).

Some people hear the word “mindfulness” and immediately assume ACT is about meditation. Others hear “acceptance” and think this therapy is simply about accepting how much your life sucks and learning to deal. Neither of these are accurate, but if you can move past your brain’s fears around these words, we can see what ACT is really about by examining its six core processes:

cognitive defusion

“But how can I move past those fears? When I hear “acceptance” I get really scared that you’re going to tell me to suck it up, or that I’ll be asked to do things I’m not comfortable with, and I just can’t handle that!”

That’s okay, we can work on that with defusion. Defusion (literally de-fusion) is the act of separating yourself from your thoughts. Most of us spend most of our lives completely fused with the stories that run through our heads. In ACT, we learn how to step back from these thoughts and see them for what they are (just thoughts) rather than as what they say they are (commandments, threats, predictions, facts, rulings). Stepping back like this gives us the space we need to do what we really want to do with our lives, regardless of what our brain tells us we can or can’t do.

acceptance

Since we’ve been taught from an early age that happiness is the be-all-end-all of life, many of us spend a lot of our time and energy trying to avoid what we perceive as negative feelings (sadness, anger, fear). But as you may have already discovered, happiness is not just the absence of “bad” feelings. In fact, most of us would miss these “negative” emotions if we were suddenly deprived of them (imagine not being able to cry at a funeral for a loved one, or not feeling the rush of adrenaline when you try something new and exciting). In ACT, we learn how to accept the natural and healthy range of our internal experiences (thoughts and emotions) and even to appreciate this diversity rather than avoiding such experiences. This frees up our time and energy to focus on more important things, like building the life we want to live.

contact with the present moment

In ACT, we learn how to bring ourselves back to the present moment as opposed to being trapped in rumination about the past or worry about the future. While thinking about the past and future can be essential at times, most of us spend far too much of our lives mired in time periods we have no current control over, leaving us feeling powerless and exhausted. By learning to contact the present moment, we learn how to act in the now rather than waiting for the future or regretting the past. This helps to increase behavioral flexibility and helps us improve our responses to life events big and small.

self-as-context (or the observing self)

If you’ve ever meditated (don’t panic, I won’t force you to meditate!) then you’ll know what self-as-context is even if you’ve never heard the term. The part of your mind that is present during meditation is a non-judging, unattached version of yourself that can observe mindfully without being sucked into thoughts or feelings. By using this part of your brain more and more, you’ll reduce self-judgment and increase cognitive flexibility.

values

Here’s where I really lose some people. When I say “values,” some people hear “religion” or “how my parents wanted me to be” but I’m not talking about other people’s values. I’m not even talking about my own values, as these are irrelevant to you. I’m talking about YOUR values, whatever they may be. Not sure what your values are? That’s okay, that’s part of the work we do together in ACT. By exploring and clarifying which things in life are most important and fulfilling for you, we create a compass to help guide your actions in the future. This part can be scary, because many of us will find we aren’t living life the way we really want to be living it. That’s okay though; that’s why we’re here.

committed action

Once we’ve discovered and clarified our values, we need to put those values to work. By practicing committed action (choosing a valued way forward and following through) we learn how to ignore the discouraging or fearful thoughts running through our heads and to focus on what really matters in life. This takes practice, but neuroplasticity is a powerful force. With time, you’ll learn how to feel more empowered by taking steps (big and small) towards your values every day. Sound scary? Good. Sit with that fear for a minute, watch how it affects you, notice it without judging it… Then book an appointment anyway! And just like that, you’ve already on your way to further committed action…