Acceptance and commitment therapy

Acceptance and commitment therapy (ACT) also known as ACT therapy, is a form of behavioural therapy that uses various mindfulness strategies to help us accept the difficulties we face in life. It was developed in America during the late 1980s and is gaining recognition as an effective treatment for a range of mental health issues and psychological disorders.

ACT therapy, which is predominantly a time-limited approach, takes the view that by accepting negative thoughts and feelings, individuals can choose a valued direction in which to take action and make positive changes. In this way, acceptance and commitment therapy does not aim to directly change or stop unwanted problems and experiences.

Instead, it teaches individuals to develop a mindful relationship with them - promoting psychological flexibility that encourages healthy contact with thoughts, reconnection with the here and now, a realisation of personal values, and commitment to behaviour change.

How does acceptance and commitment therapy work? 

Acceptance and commitment therapy involves a range of experiential exercises to reduce the power and significance of damaging emotive, cognitive, and behavioural processes. It aims to help individuals change their relationship with negative thoughts and feelings that are taking over their lives and, in some cases, are greatly impacting their health and well-being.

ACT does not attempt to change the content of irrational or negative thoughts and unpleasant or painful emotions, instead, the goal is to help people face these thoughts, see them from a different perspective and learn to respond in such a way that may be more helpful. ACT is about shifting life toward the things the individual cares about.

- In this article, we explore the use of acceptance and commitment therapy to treat eating disorders.

The approach takes a stand against 'experiential avoidance' - the attempt to avoid or get rid of unwanted unpleasant thoughts and feelings - and offers a long-term solution to future health and happiness. This is usually applied in one-to-one sessions with clients or in groups, where metaphors, visualisation exercises and behavioural homework will be used.

The number and length of sessions will depend greatly on the needs of those taking part and the practising methods of the counsellor. The overall duration of the treatment should be relatively short, however, this factor will too depend on the client and counsellor.

The ACT therapy model 

Although acceptance and commitment therapy is not a specific set of techniques, there are some core processes that therapists tend to follow. Each of these areas is conceptualised as a positive psychological skill - they do not serve as a way for individuals to avoid or prevent negative thoughts and feelings.

The acronym that encapsulates the entire model of ACT is:

Accept your thoughts and feelings and be present

Choose a valued direction

Take action

The following six core therapeutic processes demonstrate ACT as a combination of mindfulness and behavioural therapy. Each of the processes supports each other in helping an individual to overcome their problems.

Acceptance 

Taught as an alternative to experiential avoidance, acceptance involves embracing painful feelings and private experiences, without attempting to change their frequency or form. Clients of ACT therapy are encouraged to willingly open up and let go of their internal struggle with these unwanted problems. This can essentially help them to learn ways of coping with them.

Cognitive defusion 

Also known as emotional separation, cognitive defusion refers to a set of techniques that attempt to change the functions of negative thoughts and feelings, and how they affect an individual. Procedures that may be followed include encouraging the individual to externally observe their unwanted problems by giving it a shape, size, colour, speed or form.

In ACT, metaphors are often used to explain principles. For example, trying to get rid of thoughts and feelings can be likened to trying to push a beachball underwater in a pool - the more you try, the more it keeps bobbing back out of the water. Instead, through ACT, you can learn to take the ball (your difficult thoughts and feelings) and allow it to float in the water alongside you, and to be free to have fun and enjoy the pool!

- Learn more about the techniques used in ACT.

By recontextualising uncomfortable memories and experiences, individuals can learn to relate to them in a different way - one that does not involve attaching any particular value to them.

Contacting the present moment 

ACT therapy encourages clients to be psychologically present - making a conscious effort to connect with whatever is happening in the here and now. Enabling individuals to experience the world more directly is thought to make their behaviour and thoughts more flexible. This is to ensure their actions are more consistent with their personal values. Language (both written and verbal) is often used as a tool for individuals to describe current events, rather than predicting and judging them.

The observing self 

ACT views the mind as a combination of two parts. One part is the 'thinking self', which is responsible for a person's thoughts, beliefs, judgements, fantasies and so on, whilst the second part - 'the observing self' - deals with attention and awareness. The latter is the part of the mind that enables individuals to develop mindfulness skills - the ability to be aware of one's flow of experiences without attachment to them. This helps to foster acceptance and cognitive defusion.

Find out more about mindfulness on our dedicated fact-sheet.

Values

Values are the chosen qualities that individuals live by, and they are essential to the development of ACT goals. A variety of exercises are used to help clients choose a life direction in various domains, such as family and career. The realisation of these typically comes from an individual's ability to follow through the processes of acceptance, defusion and contacting the present moment.

Committed action

The final stage of the ACT model involves the establishment of concrete goals that are consistent with an individual's chosen values. It is considered essential that the person commits to these goals in order to foster the necessary changes to discover a greater sense of well-being and fulfilment.

This process consists of elements of traditional behavioural therapy, such as skills acquisition, shaping methods and goal setting, and often requires the individual to do homework in between sessions. These behaviour change efforts, in turn, help to address psychological barriers that are addressed in other ACT therapy processes.

The following video explores ACT and its six core processes:

What can acceptance and commitment therapy help with? 

Acceptance and commitment therapy can be beneficial for a wide range of individuals. The empowering message of the approach, to alter the function rather than the existence of unpleasant thoughts and feelings, makes it particularly useful in helping a range of clients.

Issues that are often looked at within ACT include:

The mindfulness elements of ACT therapy also make it effective for helping individuals to improve their athletic or business performance. In many models of coaching and therapy, mindfulness tends to be taught through meditation, yet ACT employs a range of tools to teach mindfulness strategies. This makes it a more appealing approach for those who want to quickly and easily master mindfulness without having to meditate.

If you think this type of therapy may work for you, speaking to a counsellor who offers ACT should be your next step. This way you can ask any further questions you may have and gain a clearer understanding of how the therapy could help you.

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