A guide to acceptance and commitment therapy
In a previous article, we looked at cognitive behavioural therapy. It's worth mentioning this because acceptance and commitment therapy or ACT (pronounced as the word ACT rather than A.C.T) is considered a third wave therapy. This means that originally there was the first wave of cognitive and behaviour therapies, then the second wave where these two therapies were combined to make cognitive behavioural therapy. Now we have some newer third wave therapies such as ACT, dialectical behavioural therapy (DBT), and mindfulness-based cognitive therapy (MBCT).
The history of ACT
ACT was originally published in 1999 and comes from relational frame theory, which is a behaviour theory of human language and cognition. This is in addition to applied behavioural analysis, which is a powerful model for predicting and influencing behaviour that has impacted almost every branch of modern psychology. Finally, ACT has been influenced by the philosophical viewpoint of functional contextualism. Functional contextualism is the philosophy of how things function in specific contexts. For example, we might view a three-legged chair as broken, however, in other contexts, it can serve many purposes, such as being part of a practical joke, being art, or demonstrating flaws in a furniture-making class.
ACT is based on the principle that not being psychologically flexible is the cause of our distress. That is to say that throughout our lives pain is to be expected; it is a natural experience we all go through. From the principles of ACT, it believes that the struggle with pain, and attempts to avoid it and push it away, are what maintains it. So we must learn to be separate from our thoughts, be aware of how we evaluate our experiences, learn to be present, and accept these experiences. ACT is particularly useful for people who find themselves in situations that they cannot change, or do not have control over, and research has shown it can be effective when working with stress, anxiety, depression, chronic pain, obsessive-compulsive disorder (OCD), schizophrenia, borderline personality disorder, substance use, and people experiencing physical illnesses such as cancer.
What does ACT involve?
ACT is a very active therapy and is learnt through lots of exercises. This is tailored to your specific problem and where you struggle to be 'psychologically flexible'. ACT aims to increase psychological flexibility by;
- Cognitive defusion - learning to take a step back from your thoughts so that your thoughts are separate from you. For example, just because you think you are something does not mean that you are that something.
- Acceptance - learning to allow unwanted thoughts, feelings and urges to come and go without struggling with them.
- Contacting the present moment - learning to be aware of the here and now through mindfulness.
- Developing self as context - learning to access a sense of self that is above your normal experience, being aware of your conscious and its continuation.
- Values - discovering your values.
- Committed action - setting goals that match your values and taking action to live by them so that life is meaningful to you.
The number of sessions of ACT can vary depending on how psychological flexible someone already is. This therapy can take time to get used to, and usually, it is recommended to start with around 12 sessions.
Is ACT for me?
ACT can be beneficial for everyone because it enables us to be more;
- psychologically present
- in touch with your values
- able to make room for unavoidable pain
- able to defuse from unhelpful thoughts beliefs and memories
- able to take effective action in the face of distress
- able to engage fully in life and appreciate each moment regardless of how we are feeling
However, it is particularly useful for people who feel stuck and are plagued by painful thoughts, feelings, and experiences regardless of the diagnosis.