Acceptance and commitment therapy, or ACT, is receiving increased interest from both patients and professionals for its ability to offer an effective treatment option, particularly in cases of treatment-resistance. ACT is guided by the idea of mental health acceptance, with patients learning how to realign themselves with the values they wish to live by, while coming to terms with aspects of reality that are beyond their total control. Read on to find out more about this thought-provoking form of therapy.
Belonging to the third wave of cognitive psychotherapy, acceptance and commitment therapy builds on the action-focused first wave of behaviorism, and the second wave of cognitive behavioral therapy (or CBT) that examines the automatic thoughts, feelings and reactions that arise in highly triggering situations.
As its name suggests, a central feature of ACT is its emphasis on acceptance. ACT aims to promote a sense of openness, helping patients not just survive the adverse situation or trigger that pushed them to seek therapy, but a willingness to go through it. This is not to say that ACT promotes suffering through painful experiences, only to say that it helps the patients separate what can be changed in one’s life, what cannot, and how the patient might be able to effectively approach situations that, in the past, had left them frustrated and emotionally wounded.
Incorporating the idea of mindfulness into its approach, ACT helps the patient remain present even during highly unpleasant situations in their life. Staying in the moment allows the patient to experience their own strength and endurance. As they go through more of these experiences and develop their ability to examine how they manage them, patients hopefully begin to respond less automatically, avoid overreacting, and choose instead how they wish to proceed during challenging moments and periods of their life.
Accumulating more and more experiences where they were able to decide how to work through dilemmas that had previously overwhelmed them, many patients of ACT find they have developed a greater flexibility. Gradually, they are able to move away from the rigid and inefficient defense mechanisms they had developed to survive past hardships, and consider how they would like to navigate the situation they are currently in. As they try out new methods of response, their sense of agency grows, reflected in their ability to enact change both internally and in the world around them.
Preceded by CBT, ACT shares a number of its predecessor’s central features: as part of the behavioral movement, both branches put a great deal of importance on behavioral change, and not just greater awareness (something Freud and many of the psychoanalysts who followed him would take umbrage with).
Unlike CBT, though, ACT does not directly set out to develop their self-control. While CBT looks to help patients rely (among other tools) on logical explanations to reduce their sense of anxiety, ACT encourages the patient to observe themselves and notice their reactions from a close, but not suffocating, distance.
One way of looking at the difference between ACT and CBT is to compare them to two literary points of view that reflect their respective positions in the history of behaviorism: ACT is like the third person in a novel, with the narrator describing what the hero is going through, describing their actions and how they carry themselves (“showing”), while offering occasional explanations as to why they chose to do so (“telling”), all without losing themselves in the action completely. CBT, on the other hand, offers more of a second person perspective, with the narrator talking directly to the character about what they are experiencing, at times trying to talk them down from a particularly distressing ledge.
A core concept of ACT that grew out of its emphasis on observation is self-as-context. It focuses on the patient’s potential to take themselves out of the current situation, through metacognition, and try to identify the thoughts and emotions they are experiencing, without taking immediate action to defuse them.
The importance of self-as-context becomes clearer when considering the debilitating effects guilt can have. Finding themselves in a particularly difficult situation, a patient may lash out, or feel helpless in the face of what they experience as a personal attack, both of which can be followed by guilt or self-criticism. Self-as-context offers a more understanding approach to what they are going through, reminding patients they are not the sum of their thoughts and feelings, but that they are the observing context of the self, which has the ability to take a look at what they are experiencing, without being swept away by it.
With ACT looking to offer greater cognitive breadth when entering distressing situations that push them to react automatically, over time patients are granted a slightly longer moment to consider what they are feeling and thinking. This, in turn, will eventually allow them to consider their own, personal values, and work toward responding in an effort to live by them.
The concept of values in ACT differs from goals, or rather, from standalone goals. A parent, for instance, may wish to yell less at their children, in what would be considered a standalone goal. With ACT, the aim is to connect this behavior-based goal to the individual’s more fundamental set of values, so that they look at their actions in an effort to better understand how they relate to, say, the value they see in being a generally patient parent.
Identifying one’s values helps give meaning to one’s actions, which have the potential to bring them closer to greater actualization. Instead of setting out to yell less, while avoiding the aggressive thoughts that arise in moments of anger, ACT helps patients acknowledge the unpleasant thoughts that pass through their mind, and reminds them of their core values, even as they struggle to maintain them in external reality.