I consider Acceptance and Commitment Therapy (ACT) foundational to the therapeutic process and it is by far one of my favorite modalities to draw from. ACT is considered a brief intervention, meaning it does not have to take years of therapy to start making a difference in your sense of fulfillment in life. It addresses many presenting problems such as stress, anxiety, depression, trauma, OCD, addiction, and even psychosis. In addition to mental disorders, ACT is used to treat physical pain associated with some medical conditions. 

No matter where you are in your therapeutic journey, ACT is helpful and its concepts are simple to integrate into daily life. In fact, I utilize ACT in my own life often.

I find ACT so helpful that I wanted to introduce it in a blog in the hopes that whoever comes across my website can take some skills away with them. 

Brief History

Acceptance and Commitment Therapy (ACT) is a relatively new evidence-based therapy developed in the late 1980s by Dr. Steven C. Hayes. It uses principles from mindfulness, behavioral, and cognitive-behavioral modalities to increase psychological flexibility. 

A very paradoxical nature of ACT is that it does not try to change you, and yet, when you commit to practicing ACT, you notice your life changes to allow you to live more in alignment with your values and are free of the negative thoughts that cycle through your mind. 

The theory behind ACT is that it is counterproductive to try to control painful emotions or psychological experiences; suppression of these feelings ultimately leads to more distress. ACT adopts the view that there are valid alternatives to trying to change the way you think, and these include mindful behavior, attention to personal values, and commitment to action. By taking steps to change their behavior while, at the same time, learning to accept their psychological experiences, clients can eventually change their attitudes and emotional states.

Your Thoughts Are Separate

The ACT approach states that your pattern of thinking directly affects your mood, which then affects your behavior. So if you change your thinking or “self-talk”, you will feel better. Sounds simple, right? But I think as we all know, it is not that easy to change your self-talk. Sometimes, the inability to change or control your thoughts makes you feel even worse about yourself, or more hopeless about your situation. 

However, if you accept your thoughts as just stories or mental events, you realize your thoughts are just beliefs/narratives you have developed and not the absolute truth.

ACT is all about changing how you relate to your thoughts. You don’t try to stop or control them. You just learn how to observe your thoughts and emotions, without attachment or judgment.

For example, if you use ACT with the thought: 

“I am boring and no one would like to be friends with me”. 

First, recognize it is just a mental event and it is okay to have thoughts like this sometimes. You are human after all. You can then create distance from this thought by labeling it “thought” or “ I am noticing I am having this thought that I am boring and no one would like to be friends with me”. Notice the difference between “I am boring” versus “I am noticing I have this thought that I am boring”. This is a technique to create space between you and your thoughts and emotions. By doing this, you can then consciously choose to believe or disregard any thought that pops into your mind.

It is also useful to evaluate your thoughts as “helpful” or “unhelpful”. Thought Labeling is a skill from CBT that ACT can borrow. To determine if a thought or emotion is helpful or not, ask yourself if believing that thought will lead you toward actions that are aligned with your values. If not, it’s probably the story-telling mind taking you for a ride.

We have a tendency to hold onto thoughts and emotions that are negative because humans are unconsciously and sometimes consciously, on the lookout for danger. This bias towards the negative allowed our ancestors to survive, but we can question how much they really thrived. In modern times, this negativity bias often leads to negative self-talk, which more often than not follows with reactionary and self-limiting behavior, rather than consciously choosing values-based action.

You Can Choose How to Take Action

The next step in our example of utilizing ACT skills: you choose to commit to socializing more because it is meaningful to you to have fulfilling connections and friends, and you are important to them too. 

When people believe all the thoughts that enter their mind, their thinking becomes rigid and inflexible. As a result, they stop moving towards the things they want in life that will ultimately bring them fulfillment. This is a life controlled by intrusive thinking.

If you rigidly believed the thought, “I am boring and no one would like to be friends with me” you would probably spend a lot of time alone, which only keeps you stuck in the negative pattern that rigid thought created. 

You don’t have to believe every thought that enters your mind. Humans have a story-telling mind, which is neat, but we may come up with stories that are not true, nor helpful, and they may be narratives we have internalized from others at some point in our life — and these narratives likely don’t align with our present-day values and goals for ourselves.

You don’t have to let your thoughts dictate or control your actions. Relating to our example above, you can choose to ignore the thought, “I am boring”, and choose to be socially engaged and live a life with fulfilling connections. 

A helpful way to remember what Acceptance and Commitment Therapy is: 

• Accepting your thoughts/emotions and to be fully present in the moment

• Choosing a meaningful direction (or acting according to our main values)

• Taking values-based action

Passengers on the Bus

A metaphor that helps illustrate the ACT model is Passengers on the Bus.  You are driving a bus. In life, you will pick up passengers along your journey. Not every passenger you pick up will be pleasant. These passengers could be shame, anger, or inadequacy. You may pick up the “you’re not good enough” passenger, or the passenger that screams from the back of the bus, “What’s the point of even trying?!” There may even be a passenger with anxiety that tells you it’s safer to not drive at all. 

But the point is that they are passengers. They are not driving the bus. You are driving the bus, and you decide where you are going in life. The passengers on the bus do not control you or how you drive the bus. You may not get to choose which passengers hop on the bus, but you can choose to take them for a ride. 

Core Principles of ACT 

Although the process of therapy looks different for everyone, ACT has six main principles:

• Contacting the present moment: therapy does delve into the past occasionally, but to develop the skills for ACT, you must start with being in the here and now. Your therapist will guide you through and teach you the mindfulness skills needed to do this. Once you learn how you will always have the ability to bring yourself back to the present moment. 

• Defusion: (not a misspelling of Diffusion) This step is a skill in Mindfulness. To defuse cognitively is to separate yourself from your thoughts and to observe them as mental events that you can choose to listen to or ignore. Our thoughts come and go, and we don’t need to get tangled in them. We can also use skills from Cognitive-Behavioral Therapy at this step to gain more awareness regarding the relationship between our thoughts, emotions, and behavior. With awareness of our unhelpful thinking patterns, we can change how we relate and respond to our self-talk.

• Acceptance: by accepting difficult thoughts and emotions, rather than avoiding them, we give ourselves a chance to observe them, and accept what we are experiencing. From there, we are free to choose to take action towards what we value in life, knowing that the stories we think about ourselves are not always true or helpful, but are just a part of the human experience.

• Self-as-Context: this term refers to a self that observes or watches its thoughts with full awareness of what we are thinking and feeling. “We are not our thoughts. We are the one that observes them.” - Michael Singer

• Values: knowing what we uniquely value in life is important to ACT. Our values are our compass guiding us towards a meaningful and fulfilling life. 

• Committed Action: guided by our chosen values, we commit to taking the steps necessary towards our fulfillment in life.

While this therapy is effective due to the therapeutic and formulaic skills in its framework, my deepest appreciation for ACT is that it is collaborative, creative, and inherently empowering for clients to create desired change.