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 focuses 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: ACT.
ACT is less focused on changing thoughts as a way of changing feelings and behaviors and more focused on practicing acceptance of things outside your control including thoughts and feelings to reduce unhealthy ways of coping and making a commitment to the things within your control to build a meaningful life; hence the name acceptance and commitment therapy, which is pronounced "ACT" all as one word rather than as separate letters A-C-T, to emphasize the importance of ACTion.
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 challenge these kinds of thoughts and work towards developing more balanced or realistic thinking to improve their mood. Again, this is great, but often times these types of thoughts don't just disappear. Also, sometimes just engaging these kinds of thoughts gets you tangled up in them and removed from the present moment, where you can take ACTions to build a meaningful life.
With ACT, you focus on using mindfulness and acceptance strategies to recognize that these thoughts are mental events, not facts, and allow for painful feelings in order to engage in meaningful behaviors. You can have unrealistic negative thoughts about yourself and irrational worries about the future, 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. Your thoughts and feelings don't need to get in the way!
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/10.1037/1076-8918.104.22.168
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