What is Acceptance and Commitment Therapy?
Acceptance and commitment therapy (ACT), which was developed in the mid- to late-1980s by Steven C. Hayes, Kelly Wilson, and Kirk Storsahl, is a part of the cognitive-behavioral therapy (CBT) tradition. In many ways, ACT is the newest form of CBT.
If you are not familiar with CBT, let me break it down. Basically, traditional CBT focused on helping people change their unhelpful thought patterns as a way of changing their mood and their behavior. Traditional CBT works well, but there is one major problem: changing your thinking is not always easy. Some thoughts are just really stubborn! But, there is a really effective alternative: mindfulness and acceptance.
ACT is less focused on changing thoughts as a way of changing feelings and behaviors and more focused on practicing mindfulness and acceptance of thoughts, feelings, and physical sensations to reduce unhealthy ways of coping.
Let me give you an example, in traditional CBT someone with depression or anxiety might have very negative thoughts about themselves or assume the worst case scenario. With traditional CBT, you would have challenged these kinds of thoughts and work towards developing more balanced or realistic thinking. Again, this is great, but often times these types of thoughts don't just disappear. Also, sometimes, even just engaging with these kinds of thoughts puts you in a kind of struggle and you can find yourself really tangled up in them.
With ACT, you focus on using mindfulness and acceptance to recognize that these thoughts are mental events, not facts. In other words, you don't need to buy into them. You can have unrealistic negative thoughts about yourself and irrational worries about the future and not be distressed by them. You can just notice them without judgment and come back to the present moment, which is where you can enACT the kinds of changes needed in your life to build the life you want for yourself. Your thoughts don't need to get in the way!
The Six Core Processes
Defusion, which is short for cognitive defusion (remember cognitive means thoughts or thinking), refers to the ability to take a step back and observe your thinking rather than being lost or tangled up in it. The goal is to become defused from your thinking to help create more flexibility in your thinking. This allows us to see our thoughts as thoughts and let them guide us, if they are helpful, rather than dominate our views and dictate our ACTions.
Acceptance refers to allowing rather than avoiding or resisting your experience even if it is difficult. That means that even when difficult thoughts, memories, images, emotions, urges, impulses, and physical sensations show up, you welcome them in.
3. Present Moment
Present moment means making contact with the present moment. You might be thinking how do I make contact with the present moment or aren’t I already making contact with the present moment? Well, how present are you now right now, really? As you are reading these words are you actually making contact with the present moment or are you somewhere off in your own mind? Maybe you have gotten lost in the storytelling mind. Are you planning or remembering? Or maybe, you have mentally time traveled somewhere into the future. Maybe you are having a conversation in your mind with someone who isn’t even here right now. That’s not making contact with the present moment! Making contact with the present moment is being present with whatever is actually a part of your present moment experience, whether it is your external environment (i.e., your surroundings) or your internal environment (i.e., your thoughts, feelings, or physical sensations) rather than being lost in mind. This book will teach you how to make more contact with your present moment experience, rather than resisting it, avoiding it, or simply getting lost in the storytelling mind, all of which create suffering.
4. Self as Context
Self as context gets a little bit abstract or can be a bit difficult to wrap your mind around. Basically, self as context is the part of you that observes the mind, the “observer self,” as opposed to the part of you that gets lost in the mind, or the “thinking self.” Can you connect with your observer self? What are you thinking? Can you notice that you are having thoughts rather than just thinking them? This is self as context. One way of understanding self as context is the part of you that has always been present or remains unchanged.
Values are what you care about, the things that are important to you that bring you a sense of meaning, purpose, and fulfillment. Everyone’s values are different and there are no right or wrong answers. Values are different from goals in that goals can be accomplished whereas values are ongoing and provide direction in terms of the way you want to live your life. For example, a goal may be to lose weight or exercise 3-5 times a week, whereas a value is physical/mental health. Values typically fall into certain areas or domains of one’s life, for example, family, intimate relationships, parenting, friendships, career, education, recreation, physical/mental health, spirituality, and community.
6. Committed ACTion
Committed ACTion means making a commitment to move in the direction of your values despite whatever discomfort might arise as a result of doing so. Often times people know both what they value and what ACTions are needed but fear or discomfort gets in the way of living out their values through committed ACTion. For example, you might know that you value intimate relationships but difficult thoughts, insecurities, and feelings of inadequacy get in the way, and you don’t date. Committed ACTion can be both external in terms of behaviors and internal in terms of the way in which you relate to yourself and your inner experience. For example, if one of my values is mental health, I may need to commit to getting out of my storytelling mind, which tell me a story like,”this person wronged me” and learn how to be present with my pain, grief, and loss. ACT requires making a commitment to move towards discomfort in the service of living out your values with the goal of creating a less restricted and more full, expansive, and meaningful life.
The goal in ACT is psychological flexibility. What is psychological flexibility? Basically, it is being able to think about things in a way that is less rigid and with less attachment. This is important because it helps us act in a way that is flexible as well. And ACTing flexibly allows us to move towards the things that bring us meaning!
Reasons I Love ACT
1. ACT is Evidenced-Based
ACT is evidenced-based meaning that it has been studied and is supported by science; it is not just theoretical in nature. You can learn more about the support for ACT at the Association for Contextual Behavioral Science’s (ACBS) website or at the American Psychological Association (APA) Division 12: Society of Clinical Psychology website.
2. ACT Works Really Well!
In a meta-analysis by A-Tjak et al., (2015) of 39 randomized controlled trials on the efficacy of ACT, ACT outperformed control conditions at post-treatment and follow-up assessments. It was superior to waitlist, those receiving a psychological placebo, and treatment as usual. If some of this language is confusing, it basically means a bunch of studies were studied all together and they concluded that ACT works better than the alternatives that people typically receive.
3. ACT Helps with a Large Number of Mental Health Concerns
ACT has been shown efficacious for a wide range of issues including stress, depression, anxiety, obsessive compulsive disorder, social anxiety disorder, substance abuse, as well as things like psychosis, and more (Bach & Hayes, 2002; Bohlmeijer, Fledderus, Rokx, & Pieterse, 2011; Bond & Bunce, 2000; Dalrymple & Herbert, 2007; Gaudiano & Herbert, 2006; Smout et al., 2010; Ossman, Wilson, Storaasli, & McNeill, 2006; Roemer, Orsillo, & Salters-Pedeault, 2008; Twohig, Hayes, & Masuda, 2006; Vøllestad, Nielsen, & Nelsen, 2011).
4. ACT is ACTion oriented
ACT is not just about gaining insight; it is ACTion oriented! The ultimate goal of ACT is to create enough psychological flexibility so that you are able to change your ACTions in a way that allows you to move towards the things you value and build a meaningful life.
If you are interested in learning more about ACT, you can order my book here.
You can also hear me talk all about ACT in the following podcast episodes:
Please note that the information in this blog is intended for informational purposes only. It should not be used as a substitute for psychological or medical care. If you are looking for professional help, visit my resources page for guidance on how to find a therapist. If you are experiencing a mental health emergency, call 911 or go to the nearest ER.
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36. https://doi-org.lib.pepperdine.edu/10.1159/000365764
Bach, P., & Hayes, S.C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139. DOI:10.1037//0022-006x.70.5.1129.
Bohlmeijer, E. T., Fledderus, M., Rokx, T. A. J. J., & Pieterse, M. E. (2011). Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49(1), 62–67. https://doi-org.lib.pepperdine.edu/10.1016/j.brat.2010.10.003
Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5(1), 156–163. https://doi-org.lib.pepperdine.edu/10.1037/1076-89184.108.40.206
Dalrymple, K. L., & Herbert, J. D. (2007). Acceptance and commitment therapy for generalized social anxiety disorder: A pilot study. Behavior Modification, 31(5), 543–568. https://doi-org.lib.pepperdine.edu/10.1177/0145445507302037
Gaudiano, B. A., & Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results. Behaviour Research and Therapy, 44(3), 415–437. https://doi-org.lib.pepperdine.edu/10.1016/j.brat.2005.02.007
Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35(1), 35–54. https://doi-org.lib.pepperdine.edu/10.1016/S0005-7894(04)80003-0
Ossman, W. A., Wilson, K. G., Storaasli, R. D., & McNeill, J. W. (2006). A preliminary investigation of the use of Acceptance and Commitment Therapy in a group treatment for social phobia = Una investigación preliminar del uso de la Terapia de la Aceptación y el Compromiso en un tratamiento del grupo para la fobia social. International Journal of Psychology & Psychological Therapy, 6(3), 397–416. Retrieved from https://search-ebscohost-com.lib.pepperdine.edu/login.aspx?direct=true&db=psyh&AN=2007-00820-008&login.asp%3fcustid%3ds8480238&site=ehost-live&scope=site
Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76(6), 1083–1089. https://doi-org.lib.pepperdine.edu/10.1037/a0012720.supp (Supplemental)
Ruiz, F. J. (2010). A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology & Psychological Therapy, 10(1), 125–162. Retrieved from https://search-ebscohost-com.lib.pepperdine.edu/login.aspx?direct=true&db=psyh&AN=2010-05335-008&login.asp%3fcustid%3ds8480238&site=ehost-live&scope=site
Smout, M. F., Longo, M., Harrison, S., Minniti, R., Wickes, W., & White, J. M. (2010).
Psychosocial treatment for methamphetamine use disorders: A preliminary randomized controlled trial of cognitive behavior therapy and acceptance and commitment therapy. Substance Abuse, 31(2), 98–107. https://doi-org.lib.pepperdine.edu/10.1080/08897071003641578
Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing Willingness to Experience Obsessions: Acceptance and Commitment Therapy as a Treatment for Obsessive-Compulsive Disorder. Behavior Therapy, 37(1), 3–13. https://doi-org.lib.pepperdine.edu/10.1016/j.beth.2005.02.001
Vøllestad, J., Sivertsen, B., & Nielsen, G. H. (2011). Mindfulness-based stress reduction for patients with anxiety disorders: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49(4), 281–288. https://doi-org.lib.pepperdine.edu/10.1016/j.brat.2011.01.007