What is Acceptance and Commitment Therapy?
At the core of the ACT model are the two pillars in the title. Acceptance of dysfunctional thoughts, feelings, symptoms and activities – and commitment to actions that improve the client’s position in the moment.
Acceptance does not mean that problems are ‘ok’. Instead it means that negative thoughts, low moods, anxiety and bad habits are all part of the human experience. Resisting these human experiences gets us further entangled with them, and creates self-blame, which adds to the the list of problems. The trick is to recognise these experiences for what they are, and to bypass them altogether. Focusing instead on possibilities for improvement, and committing to behavioural change.
Four problems addressed in Acceptance and Commitment Therapy.
Psychological inflexibility.
This refers to the way people get stuck in problems. Through fixed ways of thinking and feeling, reacting to situations, and giving up in defeat. For example, a client with social anxiety may see it as something awful and overwhelming. Rather than work around it the client decides that it is ‘impossible’ for them to meet people, and stays at home.
The conceptual self
The conceptual self is based on the conditioned mind. It is filled with self-judgments and unexamined assumptions about people and life. When stuck in this ego clients categorise themselves in rigid, self-defeating ways, that hinder them from pursuing their goals. For example, defining themselves as ‘stuck’, ‘hopeless’, or ‘weak’. This blinds them from recognising possibilities for improvement
Fusion with thoughts
The human tendency is to see thoughts as facts rather than speculations. For example, the thought ‘I can’t cope with work’ does not have a factual reference. Instead it is a prediction of sorts. Dwelling on this type of thought creates anxiety, stressed feelings or depressed moods. These, in turn create more ‘sticky’ thoughts that declare that change is impossible, given how bad things feel. Thus making it less likely that change can occur.
Experiential avoidance
When we are frightened the temptation is to avoid confronting and overcoming our fear. Overwhelmed with sticky thoughts and distressing feelings, clients conclude that their only option is to give up. Instead of going to that party, or to the office, or to hold that challenging conversation, they run and hide. Each time they do this they reinforce the power of the conceptualised self and its register of limiting thoughts. Thereby increasing psychological inflexibility. Each avoidance reinforces anxiety, making it stronger as time goes on. Ending up in avoidance of new behaviours that might make a difference.
How the ACT approach works
Psychological flexibility
The aim of Acceptance and Commitment therapy is to free up clients from their limiting thoughts and self-definitions, and move them towards awareness in the moment, problem-solving and behavioural change. To do this ACT therapists employ all or any of the techniques below.
Self-in-context
The self-in-context is the individual in a specific time and place, with concrete wants, needs and objectives, and a set of possibilities available in that moment. For example, people may have a conceptualised self that dictates they are unable to control their anger. But the self-in-context is a person with thoughts, feelings and values in the moment, in relation to the person in front of them. If their value is to sustain good relations with this person, then they look for the alternative choices available to them. Moving away from psychological inflexibility towards behaviours that match their values.
Mindful awareness
ACT therapists include mindfulness practice as a standard in their behavioural repertoires. The reason for that is that mindfulness enables clients to become more aware of their unhelpful thoughts, behavioural avoidances, and the way that the conceptualised self dominates their choices. As they switch to mindful awareness they are able to access the self-in-context, and the choices available to them.
Radical acceptance
The human problem lies not in our distress, but in our resistance to it. Based on the judgment that we should not have to endure bad experiences, and reality should be different from the way it is. From there we are likely to ignore our bad experiences, and repress the emotions that come with them. As the therapeutic cliche states: what you resist, persists. Doing that we add personal suffering to our pain. Radical acceptance lies in accepting all that happens to us, without resistance, and without judgment. While, at the same time being open to a different experience.
Acceptance and Commitment therapy recognises that many therapeutic problems arise from our trying to escape from other problems. For example, we may take over-eat in order to soothe our agitation. Or fly into destructive rage due to our insecurities. In that way false solutions become further problems. Acceptance of the original problem enables us to give up these escapist strategies, and focus on the real issue.
Identifying values
Motivation for change is closely linked to our values in life. Our values, in turn, are linked to our best hopes for ourselves and for others. For example:
- To be fit, well and happy
- To enjoy good relationships
- To belong to a community
- To pursue satisfying work
- To achieve success
- To give and receive love
- To raise children
These values are powerful sources of motivation which enable us to go outside our comfort zones and face down our anxieties, our rage, and give up self-defeating behaviours.
Thought defusion
Acceptance and Commitment therapy differs from Cognitive therapy in that it does not teach clients to question unhelpful judgments and beliefs, but to simply accept them for what they are: passing thoughts. Gracefully disengaging from them with defusion techniques.
One simple defusion technique is to see thoughts as passing by on a conveyor belt. Some are helpful, some not, and we have the power to decide which ones we pick up, and which to let go. An anxious thought, for example, can be allowed to pass on back into the thought factory, as we pay attention to other, more helpful thoughts displayed on the belt.
Behavioural activation
This is the final step in the ACT process. Having exercised mindful awareness of what is happening in the moment, accepted our distress, identified our value, defused from unhelpful thoughts, aware of our possibilities in the now, we select one thing we can do to improve our position in the moment.
For example:
- Jon wakes up in the morning and notices his depressed state: tired, lethargic, with depressing thoughts buzzing around in his head.
- He practices radical acceptance, and reminds himself that this is a passing experience created through thoughts and the unpleasant feelings that come with them.
- Using mindful awareness, he connects to the self-in-context: a person who has the job of getting out of bed and going to work.
- He connects to his values: the desire to get well again, and his wish to provide for his family.
- He defuses from the thought that he might as well give up and stay in bed, recognising that this is the ‘depression talking’.
- He accepts another thought (possibly learned in therapy) that working on small steps to improve his position will also improve his mood.
- Committing to action, he gets out of bed and works on some stretching exercises.
The whole process is repeated with each successive step: showering, getting dressed, going out the door, driving to work, entering the office, and starting on his first assignment.
ACT is an educational process
Acceptance and Commitment therapy is a goal-focused approach that assists clients towards changes in awareness, motivation, thought and action. Thereby increasing psychological and behavioural flexibility. As such clients are given assignments in between sessions in order to further this process. Such assignments may include:
- Mindfulness practice
- Exercising acceptance and self-compassion
- Considering personal values
- Identifying, and defusing from unhelpful thoughts
- Learning to tolerate discomfort when going outside the comfort zone
- Replacing problem behaviours with solution-focused behaviours
- Keeping a journal
