Acceptance and Commitment Therapy (ACT) – acceptance and flexibility in everyday life

Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that helps us accept our thoughts and feelings without judgment, while staying true to our values. Learn about ACT and find out how to incorporate elements of acceptance and commitment into your life. Build greater resilience to change and give meaning to your actions.

Acceptance and Commitment Therapy – strategies for life

Acceptance and Commitment Therapy (ACT) is an empirically validated psychological method rooted in Cognitive Behavioral Therapy (CBT). It is a so-called third wave CBT therapy. The method was developed by Steven Hayes. The main goal of ACT is not to eliminate symptoms, but rather to cultivate a set of psychological skills, including the willingness to make room for uncomfortable emotions while pursuing personal values. Instead of suppressing or avoiding, ACT is based on the assumption that acceptance and mindfulness are more adaptive responses to the inevitability of life.

ACT therapy and psychological flexibility

Much research on ACT indicates that psychological rigidity, or lack of flexibility, is associated with the development of psychological symptoms, their chronicity, and the complexity of problems such as depression, anxiety, addiction, chronic pain, and somatic illnesses.

ACT interventions focus on increasing psychological flexibility (psychological flexibility model) and reducing control over one’s own thoughts and internal feelings. For example, in the case of a chronic somatic illness, the primary goal is not to eliminate it, but to increase flexibility in experiencing and responding to it. The ACT therapist gives the patient new possibilities and perspectives on the problem. The overarching goal of ACT is to increase psychological flexibility, which is associated with greater openness, acceptance, contact with the present moment, and commitment to one’s own values.

Cognitive-behavioral therapy (CBT) and ACT

Despite many similarities between cognitive behavioral therapy (CBT) and the transdiagnostic model of ACT (Acceptance and Commitment Therapy), there are also significant differences. The traditional CBT model uses a rational way of countering thoughts. The content-based CBT model aims to challenge distorted, negative, automatic thoughts. ACT does not seek to combat distorted thinking, but rather to change the relationship with difficult, uncomfortable experiences. The ACT approach does not aim to change the content of thoughts or emotions, but rather to focus on whether our thoughts and emotions bring us closer to specific needs and values. This intervention allows us to focus on goals and values in a therapeutic way, rather than on barriers.

The ACT process – main components

Psychological flexibility is achieved through the application of six interrelated basic processes (known as hexaflex).

1. Readiness, also known as acceptance. This readiness refers to actively staying in touch with current internal experiences. This process involves creating space for emotions, impulses, and feelings that we might suppress or avoid.
2. Cognitive defusion is a strategy that involves objectively recognizing our experiences, while minimizing the categorization of our thoughts, e.g., into categories of threats or facts. In defusion, our feelings are simply feelings, not harbingers of impending doom. Thoughts are thoughts and are not necessarily true, wise, or important. Cognitive defusion is the opposite of fusion. The term cognitive fusion refers to what happens when someone becomes overly attached to disturbing internal experiences. For example, cognitive fusion with the past involves ruminating and regretting past events, or fusion with rigid rules might sound like, “I must not make a mistake, I must always be 100% prepared.”
3. Contact with the present moment. An important aspect of psychological flexibility is flexible focus on the present moment, which is an important skill because it minimizes regret about the past and anxious preoccupation with the future. Being present supports awareness of how we currently feel, both physically and mentally. Instead of dwelling on the past or worrying about the future, connecting with the present involves being fully engaged in the “here and now.” ACT exercises, self-compassion, and mindfulness exercises are helpful in this regard.
4. Taking a different perspective refers to broadening the perspective from which we can observe our own actions, thoughts, and emotions. It is an inherent attribute of being conscious. This observation of the “self” is the opposite of thinking about ourselves solely in terms of content, where we often feel inextricably fused with our own history of experiences and emotions.
5. Explaining values and recognizing personal values is extremely important in ACT, because it is then that we create a sense of purpose and meaning. Without identified values, a person becomes lost, often going blindly through life. Try asking yourself the question, “If I allow this thought to dominate my functioning, does it bring me closer to the life I want to lead, to the goals I want to achieve?”
6. Committed action refers to directing one’s behavior in such a way that it is consistent with one’s values.

Criticism, fear, stress. The application of ACT

The ACT model can support anyone, regardless of whether they are struggling with mental health issues or not. The ACT model is a kind of preferential program that can be applied to any area of life, especially in situations of difficulty or failure. A good way to think about the potential applications of ACT is to consider its basic goal— promoting psychological flexibility as a way to improve well-being.

In an educational context, ACT can be seen as a way to support students and teachers in general tasks related to academic life. Acceptance and commitment therapy is also playing an increasingly important role in the context of sports, where its impact on performance has proven to be very promising.

From a clinical perspective, ACT is used to treat many areas of mental health, including depressive disorders, anxiety disorders, addictions, eating disorders, and trauma experiences— post-traumatic stress disorder (PTSD). The therapist works to increase the patient’s flexibility and acceptance of the symptoms they experience and unpleasant emotional states.

The metaphor of a passenger on a bus—acceptance

One way to think about our barriers is to think of them as passengers on the bus of life.

Imagine that life is like a journey and you are the driver of your bus. You want to go to different places and do what is important to you.

Throughout your life, different passengers get on the bus. They reflect your thoughts, feelings, and all kinds of internal states. You like some of them (e.g., happy memories or positive thoughts), you are neutral towards some, and there are passengers you wish were not there or would like to get off your vehicle.

So you are riding your bus of life with all kinds of passengers on board. Unpleasant, sometimes scary passengers may threaten you, wanting to be at the front of the bus. You can try to avoid them, distract them, or throw them off the bus, but they are your inner states, so you cannot get rid of them. You can also try to communicate with the passengers; you will give in and do what they tell you if they agree to remain quiet in the back of the bus. This may be a little easier than fighting them, but it means that the passengers are in control of the direction your bus is going.

If you fight, avoid, or give in to unpleasant passengers, you, as the driver, have no control over your life’s journey and are probably not heading in a direction that is important to you.  

Although these passengers (your cognitive and emotional experiences) seem scary, unpleasant, and threatening, they cannot take control unless you allow them to. Choose the route you want, after all, you are holding the steering wheel, treat negative passengers as noise, do not let them take over your actions.

Exercise in accepting thoughts and feelings. Mindful experience.

This exercise is about mindfully acknowledging our experiences. It is mostly intuitive, and your pace will reveal itself as you go along. Try to adapt this exercise to your own rhythm, your breath, and the sensations in your body.

1. Start by sitting comfortably in a chair, in a relaxed position with your arms and legs uncrossed. Slowly and gently close your eyes, then calmly feel the breath entering and leaving your body. Notice any physical sensations that arise.
2. Spend a few minutes noticing how you feel in your chest, in your lungs, as the air passes through your nose, throat, and stomach. Don’t worry about the pace or depth of your breath. Try to focus on your bodily sensations, and as you take time to be with the present moment, other thoughts will drift in—simply acknowledge their existence and try to make some space for them.
3. As you inhale, imagine making more space in your body for these thoughts. Recognize that they are just thoughts. Memories are just memories, and emotions are just emotions that come and go. If it helps, name them for what they are and gently bring your attention back to your breath. Worries or fears may also arise, and you can name those too before returning to the present moment. You may catch yourself having self-critical thoughts, but there is a place for them in your body before you let them go again. See if you can observe them without treating them as truth. If they persist, remind yourself that you are only observing your own experience.
4. End the exercise when you feel more acceptance for what you are experiencing. What is it like? How do you experience acceptance for your own experiences? How did you feel it in your body?

Exercise – values (adapted from Kelly Wilson’s Life Values Questionnaire)

What is important to you deep down? What kind of qualities do you want to cultivate? How do you want to be in your relationships with others? Values have the deepest meaning. They are principles that can guide and motivate us as we go through life.

Values are not the same as goals. Values are a direction, a process of following; goals are results, what we want to achieve. A value is like a direction—north; a goal is like a river, mountain, or valley we want to cross.

Below are areas of life that may be important to you. Not everyone has the same values; this is not a test to see if you have the “right” values. Think of each area in terms of general directions in life, not specific goals.

1. Family relationships. What kind of sister, daughter, or aunt do you want to be? What personal qualities would you like to bring to these relationships? What kind of relationships would you like to build?
2. Marriage, intimate relationships. What kind of partner would you like to be in an intimate relationship? What personal qualities would you like to develop? What kind of relationship would you like to build?
3. Parenting. What kind of parent would you like to be? What qualities would you like to have? What kind of relationship would you like to build with your child?
4. Friendships/social life. What qualities would you like to bring to your friendships? If you could be the best friend, how would you behave towards your friends? What kind of friendship would you like to build?
5. Career/employment. What do you value in your work? What would make it more meaningful? What kind of employee would you like to be? If you lived up to your own ideal standards, what personal qualities would you like to bring to your work? What kind of relationships would you like to build at work?
6. Education/personal growth and development. What do you value in learning, education, training, or personal development? What new skills would you like to learn? What knowledge would you like to gain? What further education appeals to you?
7. Recreation/fun/leisure. What hobbies, sports, or leisure activities do you enjoy? How do you relax and unwind? How would you like to have fun? What activities would you like to pursue?
8. Spirituality. Whatever meaning you attach to spirituality is acceptable. It can be as simple as communing with nature or a specific religious belief. What is important to you in this area of life? What values would you like to find? How would you like to nurture them?
9. Citizenship, environment, social life. How would you like to contribute to the development of your community or environment (e.g., through volunteering, supporting specific groups, foundations, organizations)? What kind of environment would you like to create at home and at work? In what environments would you like to spend more time?
10. Health, physical well-being. What are your values related to maintaining physical well-being? How do you want to take care of your health in terms of sleep, diet, exercise, smoking, alcohol, etc.? Why is this important?

Please refer to the values sheet below.

Valued direction – for each of the ten domains, write a few words summarizing your valued direction, e.g., “being active, having more physical energy.”

Importance – rate how important this value is to you on a scale from 0 (not very important) to 10 (very important). It’s okay if several values have the same number.

Success – rate how effectively you have lived this value over the last month on a scale from 0 (not at all) to 10 (very much).

Rank – finally, rank these valued directions in order of importance, i.e., 10 as the highest rank, 9, etc.

If you want to develop ACT thinking, make an appointment for online psychotherapy.

Bibliography:

Mindfulness and Acceptance Workbook for Anxiety (Forsyth & Eifert, 2016)