A Brief Look at Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) began in the 1980’s, when founder Steven C. Hayes, a Professor of Psychology, became curious about what techniques helped him cope, and which did not, with his Panic Disorder. You can hear about his personal story here: https://www.youtube.com/watch?v=o79_gmO5ppg&ab_channel=TEDxTalks (TED, 2016). Two other co-founders contributed to ACT: Kirk Strosahl and Kelly Wilson (Harris, 2021). Since the beginnings of ACT, there have been over 3,000 published studies (Harris, 2021) showing the positive results from implementing ACT in a variety of mental health and physical struggles. ACT has been found helpful in many areas including anxiety, depression, substance use, pain, and overall quality of life (Gloster et al., 2020; Ma et al., 2023).
Curious how ACT interventions help with so many different mental health and physical challenges? “Research has shown that symptom reduction is a by-product of re-engaging in life in meaningful ways and increasing acceptance of difficult internal experiences” (Dindo et al., 2017, para. 4). What does this mean? A premise of ACT is psychological flexibility, basically, the ability to stay present in the moment with all your feelings and thoughts, (yes, even the uncomfortable and hard ones), without judging them, while acknowledging that these thoughts and feelings are not necessarily dangerous (Hayes & Twohig, 2008). Often, our brains tell us that our feelings are “bad” when, in fact, they are natural emotions that we are having. We are also, at times, tricked to believe that our thoughts are truth instead of acknowledging that they are simply thoughts. Just because you have a thought like, “I am stupid”, doesn’t really mean you are stupid; it’s just a thought, not a fact. However, when you buy into that thought it can impact your low mood and anxiety causing you to miss out on the things that are important to you. How often has anxiety, or feeling of sadness, caused you to miss out on the things that are most important to you? How do you feel when you miss out on the things that you value? My guess is, it is usually worse! The idea behind ACT is to allow all those feelings to come along with you, WHILE you STILL do the things that are important and valuable to you (for example: work, relationships, hobbies). So how do you work towards psychological flexibility?
There are six core processes, or skill sets, that help us work towards psychological flexibility:
Staying in the present moment. Intentionally staying within the present moment, despite any negative thoughts/feelings, by being mindful of both the physical world around us AND what is going on within us (psychologically). This includes thoughts, feelings, and physical sensations. Often, we want to distract ourselves from uncomfortable feelings and ACT encourages us to be curious and lean into those feelings, instead of trying to focus on other things. Dr. Hayes uses the visual picture of having your favorite food in the room (like a donut) and trying to force yourself to not think about that food; go ahead and try, it’s nearly impossible. Distraction, or telling yourself to feel differently, isn’t very effective. (Dindo et al., 2017; Harris, 2021, TedX Talks, 2016).
Acceptance. Please note, acceptance is NOT to be confused with being passive and accepting any situation (Harris, 2021), acceptance within ACT is the idea that you allow uncomfortable, or unwanted, thoughts, emotions, memories, or any experience within yourself, to be present without judgement or attempts to force them away (Harris, 2021; Hayes & Twohig, 2008). We accept that we are having those emotions/feelings/thoughts; this is an action that we intentionally take (Hayes & Twohig, 2008).
Defusion. Often, we get “stuck” on a thought allowing the thought to dictate our behaviors/thoughts/feelings. Defusion is a skill where you become curious about your thoughts instead of viewing them as literal or factual; we “hold them lightly” (Harris, 2021). Defusion helps change our relationship with our thoughts. We acknowledge we are, simply, having a thought, a collection of words and/or pictures (Harris, 2021); instead of looking at thoughts as literal truths we step back and observe them (Dindo et al., 2017). Let’s take a thought where we label ourselves, like, “I am stupid”. You cannot help automatic thoughts – they happen; however, we can choose what we want to do, moving forward, with the thought. We could, in this case, either chose to continue on a negative spiral with additional thoughts of “I am so dumb; I am a failure; Here are all the ways this is true”, leaving us feeling terrible OR we can, instead, create distance between ourselves and the thought. One way to create distance is to put, in front of the thought, the following phrase, “I notice I’m having that thought that….”. In this case it would be “I notice that I am having the thought, I am stupid.” Take a minute and think about how intentionally responding to the thought with curiosity, and the using a phrase like, “I notice that I am having the thought”, creates distance (or defusion) with that thought. Being curious about your thoughts helps you to evaluate them more realistically and give them the space to move on.
Self As Context. This may be a bit confusing, so bear with me. Self as Context in ACT is the part of yourself that is “you”, the part that is observing each moment, the feelings you are having, the thoughts you are having, all the experiences internally and externally in each moment (Harris, 2021; Hayes & Twohig, 2008). This is the “you” that is timeless regardless of the situation you are in or the labels that you hold, you are you as a child, teenager, adult and senior. Sometimes we become fused (opposite of defusion) to a particular label we give ourselves; this can hold us back in life or make us experience discomfort as our values/life changes. If you take away the label, you are still you. I am still me whether I’m a mom, counselor, or any other label I may hold. I was still me as a child who was not yet the label of mom or counselor; as a child, teenager, and now adult, I observed the world around me and what was/is happening to me internally; that part of me is the same. This is the idea of self as context, the “you,” without all the labels, without all the “content” that labels you, the “you” that is the core of your being. Acknowledging that you are you can be helpful as you cope with various experiences in life.
Values. Becoming aware of your values in life gives you direction; a guide on how you would like to behave or treat yourself and others (Harris, 2021). This can be better explained using an example. Say you are a mom who has social anxiety and it’s quite difficult for you to join up with other moms and allow your children to play together. However, you value your family and realize that your children are suffering because of your social anxiety. Getting help for your social anxiety is no longer just about getting rid of the uncomfortable feelings of anxiety, your motivation comes from your value of family with a desire to allow your children the experience of playing with other children. Values are not goals. A goal may be “Going on one playdate every other weekend.” A value will motivate you to achieve that specific goal. Acknowledging your values will help lead you to continue to do the things in life that are important to you despite the uncomfortable feelings that may come along with those activities.
Committed Action. This is where goals come in. Taking the values you have identified and creating goals that you want to work towards. Committed Action uses all the previously mentioned skills: staying in the present moment, acceptance, defusion, recognizing self as context and living within your values while you take action to work towards your ultimate goals. (Harris, 2021; Hayes & Twohig, 2008)
All six of these processes help us to be more psychologically flexible enabling us to live life with a more open and accepting attitude of our own experiences and the world around us. Instead of being fused with thoughts, judgmental of ourselves, trying to escape uncomfortable feelings (which tend to hide under the surface if not faced) which impact our values/behaviors we are, instead, open to ourselves, willing to be curious about what it is we are thinking/feeling and allowing those thoughts to drift in and out while, at the same time, doing things that are important to us (things we value) enabling us to live a full, and authentic, life.
If these processes resonate with you; reach out. We are happy to help you learn the skills from ACT that may be useful to you and help you to live a full and value-based life despite the feelings/thoughts you may be having.
_________________________________________
Resources
Dindo, L., Van Liew, J. R., & Arch, J. J. (2017). Acceptance and commitment therapy: A transdiagnostic behavioral intervention for mental health and medical Conditions. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 14(3), 546–553. https://doi.org/10.1007/s13311-017-0521-3
Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181-192. https://doi.org/10.1016/j.jcbs.2020.09.009.
Harris, R. (2021). Trauma focused act: A practitioner’s guide to working with mind, body, & emotion using acceptance and commitment therapy. New Harbinger Publications.
Hayes, S. C. & Twohig, M. P. (2008). ACT Verbatim for depression and anxiety: Annotated transcripts for learning Acceptance and Commitment therapy. New Harbinger Publications.
Ma, T., Yuen, A. S. K., Yang, Z. (2023, March). The efficacy of Acceptance and Commitment therapy for chronic pain: A systematic review and meta-analysis. The Clinical Journal of Pain 39(3), 147-157. https://doi.org/10.1097/AJP.0000000000001096
Tedx Talks. (2016, February 22). Psychological flexibility: How love turns pain into purpose | Steven Hayes | TEDxUniversityofNevada [Video]. YouTube. https://www.youtube.com/watch?v=o79_gmO5ppg&ab_channel=TEDxTalks
