What is Acceptance and Commitment Therapy (ACT)?
Acceptance and Commitment Therapy (ACT) is a unique, evidence-based psychotherapeutic intervention with an emphasis on acceptance, mindfulness, self-compassion, and connecting to a grounded sense of self.
The goals of ACT center on increasing distress tolerance instead of decreasing distress and symptoms (but it happens anyway). It aims to increase psychological flexibility, defined as the ability to be in and aware of the present moment while changing or persisting in behaviors that serve one’s values.
ACT helps clients accept themselves and their experiences by letting go of the belief that they can control their internal and external world. Instead, ACT supports clients in identifying what is in their control and working toward realistic, healthy goals. It is a mindfulness-based behavioral therapy that is not manualized, but tailored to each client’s specific needs and experiences. It’s different from other behavior therapies in that it supports behavioral change while also allowing space for and embracing existential questions, identity formation, and the interpersonal process of therapy.
How do I know if ACT is a good fit for me or my child?
ACT aims to support clients in creating a meaningful life guided by values and through committing to those values through action. Inevitably, distressing internal and external experiences arise while living that life. Because ACT does not aim to reduce specific symptoms, but instead builds one’s ability to tolerate distress and take action that support values-driven goals, it is proven effective for a range of clinical presentations including:
Depression
Generalized and social anxiety
OCD [used in conjunction with Exposure and Response Prevention (ERP)]
Disordered eating
Trauma
Stress (workplace, school, etc.)
Chronic pain
Stress caused by chronic health conditions
Personality disorders (often used in conjunction with or after Dialectical Behavior Therapy for Borderline Personality Disorder)
Mood disorders, including Bipolar Disorder
What are the principles of ACT?
Defusion
When working on cognitive defusion, clients learn that thoughts do not equal truth. Instead of fusing with thoughts (believing that thoughts are truth, must be obeyed, or are threatening experiences to get rid of), mindfulness practices are used to observe thoughts without judgment and accept that thoughts are nothing more than fleeting internal experiences. A metaphor often used is to view thoughts and feelings as clouds passing in the sky; we cannot control what clouds are in the sky or how long it takes for them to pass, but we can notice them without judgment.
Acceptance
When practicing acceptance, we make room for all uncomfortable experiences without trying to control them, get rid of them, or give them a large amount of attention. Acceptance supports ACT’s goal of distress tolerance and builds the client’s acceptance that distressing experiences are an uncomfortable but inevitable part of life, instead of something to anxiously dread and try to control.
Mindfulness
Clients learn mindfulness strategies in order to connect with the present moment and observe, without judgment and with acceptance, their thoughts, feelings, and experiences. Mindfulness is particularly helpful to clients who struggle with staying in and enjoying the present. When working on mindfulness, clients practice connecting mindfully with the present moment using their five senses and allowing distracting thoughts to come and go without engaging with them.
The observing self
The observing self is a safe perspective from which all experiences can be viewed and is separate from thoughts and feelings. While thoughts and feelings are ever-changing, the observing self is always present. This builds clients’ awareness; instead of being their thoughts and feelings, they are their consciousness (self) observing their thoughts and feelings. Clients are then able to observe their ever-changing experiences from a grounded, safe place. The distinction emphasized is between (1) thoughts and feelings that arise and (2) observing thoughts and feelings. When we take the perspective of the observing self, thoughts are not controlling, threatening, or dangerous.
Values
Clients identify what is most important to them, the type of person they want to be, and what they stand for. Values often identified are connecting with others and forming meaningful interpersonal relationships, being genuine and working from a place of honesty, advocating for self and others, and forgiveness. Clients are supported in working from their values and behaving in ways that honor their values. Acceptance and willingness come into play here. For example, if a client who experiences social anxiety also identifies forming meaningful friendships as a value, the therapist may ask the client if they are willing to experience some anxiety (though uncomfortable) in order to develop meaningful friendships.
Committed action
This is when clients set goals guided by their values and commit to taking action. While goals can sometimes be overwhelming, this part of ACT works to identify small goals and build on them. For example, a client may identify a goal of being more vulnerable with close friends. They may start with sharing one feeling about school or one bit of personal information each day with a friend, then move toward doing this more often, with more vulnerable feelings, and even with feelings within the relationship (i.e. “I felt disappointed and hurt when you canceled plans at the last minute to spend time with another friend”). Clients set increasingly challenging goals that align with their values and use ACT principles to tolerate and accept discomfort along the way.
