What is Acceptance and Commitment Therapy?

By Lucas Myers and Jill Stoddard, Ph.D.

Perhaps you've come across Acceptance and Commitment Therapy (ACT) online or even on our website. Maybe you have encountered it through the popularity of Mindfulness, a “hot topic” in psychology and self-help with strong ties to Buddhist traditions. You may have read, or heard an anecdote about how ACT is helping normal people everywhere to cope with anxiety, depression, and stress. So what is ACT?

ACT is a type of psychotherapy that helps people to accept difficult inner experiences, like negative thoughts and uncomfortable feelings, instead of trying to suppress or avoid them. Why, you might ask, would I want to accept feeling badly? Because pain is universal. There is not a human on the planet that has not or does not experience difficult thoughts and feelings. ACT (informed by Buddhism and other traditions) suggests that pain is not the problem. Rather, it is our attempts to avoid or eliminate pain that cause true suffering. We call this pursuit of pain relief “experiential avoidance.” Take the person who uses alcohol or drugs to cope with upsetting experiences by numbing himself to avoid the unpleasant feelings that follow. While this might work in the short term, the substances ultimately don’t “fix” the pain and, in fact, lead to more suffering when relationships, work, and other areas of functioning are negatively impacted. In a less extreme example, consider a person who feels self-conscious about her appearance or intelligence and avoids dating for fear of rejection. Again, this may bring some protection from feelings of vulnerability, but it doesn’t solve the self-consciousness. Worse, it prevents the possibility of having a loving relationship even if this is something that's personally important.

So why would you want to accept difficult feelings? Because experiential avoidance often doesn’t work, frequently makes things worse, and typically comes at the cost of pulling you away from the things that matter most. , The alternativeis acceptance. ACT focuses on teaching acceptance of internal experiences in the service of moving toward a life that is guided by values—a life that is characterized by meaning, fulfillment, and vitality.

While there are many different strategies employed to create meaningful change, ACT focuses on building three main skills:

1. Defusion - distancing and letting go of unhelpful beliefs, thoughts and memories

2. Acceptance - acknowledging painful feelings, sensations, and urges and allowing them to pass without struggling to avoid or eliminate them

3. Contact with the present moment - being present in the here-and-now and engaging each moment with openness and curiosity

These skills enable a person to fundamentally change his or her relationship with painful thoughts and feelings, freeing him up to make valued choices. Examples might include spending time with friends and family, pursuing a hobby or career, expanding one's skills, or contributing to one's community, just to name a few.

Defusion involves recognition that thoughts and feelings that are sometimes overwhelming are often passing images or irrational statements we tell ourselves. Learning to step back and observe thoughts as entities separate from ourselves reduces the degree to which we allow ourselves to get “hooked” by their content, or mistake thoughts as facts. Defusion allows us experience thoughts as just words, and words as sounds and syllables instead of meaningful truths we must pay attention and react to. Defusion practices allow thoughts to come and go, passing like leaves floating down a stream. The leaves have no power over the stream.

Acceptance, also called Willingness, begins with recognition that our reactions to distressing thoughts and feelings can be changed. Five strategies for acceptance include:

1. Giving oneself permission not to be perfect

2. Acknowledging weaknesses 

3. Acknowledging an unpleasant thought or feeling instead of running from it 

4. Letting feelings and thoughts pass without giving in to the compulsion to act on them

5. Letting go

Contact with the present moment, sometimes referred to as “mindfulness” involves non-judgmental, present focused awareness of both internal and external events. ACT encourages people to check in with themselves and question their responses to life's challenges in each moment. Mindful attention is given to awareness of thoughts, emotions, and physical sensations. Increasing awareness of experience can lead to better mastery of one's reactions to the problems and difficulties that life brings. Energy that would otherwise be invested in avoiding unpleasantness can then be invested in actions that change life for the better. An individual can learn to get in touch with his deepest values and allow this knowledge to act as a guide to a rich and meaningful life.

A unique and even fun aspect of ACT is its reliance on the use of therapeutic exercises and metaphors to help clients experientially derive meaning from the treatment concepts that are presented. . For example: your therapist might play a little game of “Simon Says” with you. But in this version of the game, Simon represents your mind commanding you to act in a certain way. You hear those commands but then DO whatever you want! If Simon says, “raise your hand,” you can hop on one foot instead. The idea is to experientially “get” that you don’t have to obey Simon any more than you have to listen to what your mind is telling you. You might also hear an ACT therapist say, “don’t believe this is true because I’m saying it is so; what does your experience tell you?” Your ACT therapist wants you to learn by experience.

ACT is often summarized using two simple acronyms. The core causes of many problems are represented by FEAR:

Fusion with your thoughts

Evaluation of experience

Avoidance of your experience

Reason-giving for your behavior

As an alternative to these behaviors, ACT!

Accept your reactions and be present

Choose a valued direction

Take action

Acceptance and Commitment Therapy is generally a short-term treatment. With the help of a good therapist, anyone can learn to accept the pain and stress of life, as it comes and goes, to make room for a new commitment to values and living a life with purpose and meaning.

In addition to its widespread use for anxiety and depression, ACT has been adapted to effectively treat substance abuse, body image issues, PTSD, chronic pain, tinnitus, smoking, borderline personality disorder, and others.

If you would like to learn more about ACT contact us.

References:

Acceptance and Commitment Therapy. Retrieved from: http://www.actmindfully.com.au/acceptance_&_commitment_therapy

Hayes, Steven. ACT. Rectribed Sept 23from: http://contextualscience.org/act

Serani, Deborah. Two Takes on Depression: Acceptance and Commitment Therapy. Retrieved  from: http://www.psychologytoday.com/blog/two-takes-depression/201102/acceptance- and-commitment-therapy

Stoddard, Jill. Introduction to Acceptance and Commitment Therapy [Powerpoint Slides]. Retrieved from personal correspondance September 28, 2013.