Acceptance and Commitment Therapy (ACT)

ACCEPTANCE AND COMMITMENT THERAPY (ACT) 

WHAT IS ACT?

ACT is an evidence-based treatment for many disorders. In fact, there is robust research supporting the use of Acceptance and Commitment Therapy in the treatment of OCD, Anxiety Disorders, Substance Use Disorder and Depression. There is also research suggesting it is beneficial in supporting those with Eating Disorders.

THE HISTORY OF ACT AND RELATIONAL FRAME THEORY

Steven C. Hayes, PhD, developed ACT in the 1980s. The therapy is based on Relational Frame Theory (RFT). This theory recognizes how our ability to draw verbal connections is both extraordinary and problematic. We don’t have to touch a stove to know that it will burn us. We understand when someone explains that the stove is hot that we should not touch it. Our ability to connect words with concepts allows us to problem solve and has made us the dominant species on planet earth.

When it comes to unpleasant experiences, we learn to avoid and change painful or uncomfortable circumstances. We draw connections and attempt to problem solve. But what happens when our ability to draw these connections shows up in the form of thoughts about problems that could occur as well as anxiety about an unforeseeable future? Unfortunately, our problem solving backfires when it is applied to “problems” that cannot be solved. This includes the private experiences that occur in our minds. If a thought or feeling pops up, we try to fix it so that we can get rid of it. But when it comes to these internal experiences, the fix it mentality that serves us so well in our external world doesn’t work. In fact, when it comes to thoughts, feelings, urges and sensations the rule is that these experiences become more prevalent when we are unwilling to have them.

This is why ACT focuses on making peace with your internal experiences through acceptance so that you can get back to the business of living your life in spite of your internal experiences.

HOW IT WORKS

There are many tenets that form the basis of ACT. While a single web page is far to small to detail them all, here are some of the ideals that form the backbone of this approach.

ACCEPTANCE

So many of the issues that we have are not with the pain inherent to life but with the resistance we have toward it. Certainly there are external situations that need to be addressed and resolved. But, much of our pain is related to thoughts, feelings, urges and sensations that no amount of problem-solving or resistance will fix. Whether it’s the obsessive thoughts or anxiety that people with OCD experience or the negative body noise that might arise for those with eating disorders, we cannot control or eradicate these private experiences.

All the same, we spend a lot of time trying to argue with our thoughts or talk ourselves out of certain emotions. This is time wasted that we might otherwise be spending living meaningful lives. The idea is to get out of your mind and into your life. Rather than play the game of tug of war you’ve been trying to win for years, you could just decide to drop the rope. Sure, the thoughts and feelings will be there still, but they will no longer be the central focal point of life.

COGNITIVE DEFUSION

In ACT, Cognitive Fusion refers to the idea that we tend to believe whatever we think. So if you have a thought like “Oh my gosh I left my door unlocked” the tendency is to believe that this is reality, even though it’s actually just a thought that may or may not be true. Getting some space from our thoughts, being able to see them as words rather than facts, is the central premise behind Cognitive Defusion. ACT uses a number of exercises to support people in taking a more objective view of their thoughts. In doing so, these thoughts are no longer the default driving factor behind people’s behaviors.

There are many different defusion exercises. For example, one might pause and add the phrase “I’m having the thought that” to the beginning of their thought. This is the difference between “I could murder my family” and “I’m having the thought that I could murder my family.” Recognizing that one is having a thought about something, they are no longer just taking the thought as a fact.

That said, the aim in viewing thoughts objectively is not to determine whether they are true or false. From an ACT perspective, we’ve spent enough time battling our thoughts. The focus, instead, is on determining whether or not these thoughts are helpful. If the answer is no, then whether they are factual is irrelevant.

For instance, many have anxiety about loved ones dying. Those with this anxiety may very well lose their loved ones at some point in their lives. Think of those who are afraid of losing a parent. In most cases, this individual is likely to outlive their guardians. That being said, ruminating about this thought simply isn’t helpful. Sure the thought is likely a reflection of reality but engaging with that thought won’t keep one’s parents from dying. The only thing it will accomplish is creating misery in the present and distract from one’s ability to be with their parents while they are still alive.

BEING PRESENT

Humans tend to live outside of the present moment quite a bit. The trouble is that we don’t actually live when we are outside of the present moment. Instead, we think, ruminate, analyze, worry, plan, review, bemoan, wish, yearn for and chase after. The here and now is the only place where we can engage with the world around us – the only moment that we are ever guaranteed.

Given this, ACT encourages individuals to bring their attention into the present when they find themselves lost in thought.

VALUES

This term values gets used to mean different things in a variety of contexts. In ACT, Values refer specifically to the qualities that are most important to you. To determine your values you might ask yourself:

• What ideals do I want to stand for?
• At the end of my life, what traits do I want to be remembered for?
• When I look at other people, what characteristics do I admire and aspire to?

Values are different than goals. Goals are outcomes that you can work toward and achieve. Values are qualities that can be brought to any life circumstance. That said, just because you employ them in a certain setting doesn’t mean that you can check them off of a to do list. Values and goals are both important, but the focus on goals really empowers the individual to practice living a meaningful life regardless of circumstances.

Viktor Frankl, father of Logotherapy and Holocaust survivor, is the perfect example of this. In his book, Man’s Search for Meaning, he talks about how he was able to cultivate meaning in Auschwitz and Dachau. How? By embodying the traits and qualities that mattered most to him.

By infusing our everyday with the qualities that are most meaningful to us, we, too, have the power to shape lives of purpose. In doing so, we can develop lasting contentment. This goal is more attainable and sustainable than the search for immediate gratification that leads to so many problems in the lives of those with mental illness. Translation: we can’t stop fear or sadness or any feeling from happening. When we try, our lives get derailed in our attempts to control our emotions. The good news? We can breed an ongoing sense of well-being by letting our values be our guide.

COMMITTED ACTION

Letting values guide our behaviors is what committed action is all about. What does this look like? It depends on the disorder. For someone with Pure O who values empathy, allowing values to guide their actions could involve making the choice to disengage from compulsive rumination in order to empathize with a loved one. Similarly, those with eating disorders who want to restrict their food intake for fear that they will gain weight might express their value of kindness by choosing to treat their body in a kind manner. Those with depression might prioritize their value of service by asking a friend how they are in spite of the fact that they want to isolate.

Working toward goals that reflect our values can also be a manifestation of committed action. For example someone who values compassion, submitting transcripts for nursing school could be a value-driven goal. The qualities we want to embody are independent of specific behaviors. That said, some goals lend themselves toward certain values. While we cannot control whether all goals come to fruition, we can make efforts toward them and can always let our values inform our decisions .