Acceptance and Commitment Therapy (ACT)

What is Acceptance and Commitment Therapy (ACT)?

Acceptance and commitment therapy (ACT) is a type of psychological therapy, or talk therapy, that focuses on changing the way people respond to negative emotions and experiences. Unlike other therapies, which aim to reduce negative feelings, ACT helps people accept these feelings and reduce the harmful behaviors that occur as a result. ^[1]

ACT is based on principles of traditional behavior therapy and cognitive behavioral therapy (CBT). It helps people stop avoiding or being afraid of negative emotions and accept that they are inevitable, and it illustrates that responses to distress can significantly influence the value and quality of life. ^[2]

ACT can be used in the treatment of multiple mental and physical health conditions. It can be beneficial within substance use disorder treatment, to help reframe past experiences and traumatic events that have contributed to substance use, and to identify and adapt avoidant behaviors. ^[3][4]

Studies of the effectiveness of ACT indicate positive outcomes, such as decreased distress and anxiety, reductions in drug use, and fewer avoidant behaviors, particularly when used alongside other treatments, such as medications. Further research is required to demonstrate the effects of ACT in treating specific conditions. ^[4][5][6]

Core principles in acceptance and commitment therapy (ACT)

A key aspect of ACT is mindfulness, focusing on the present moment, rather than thinking about past or future events. This also involves embracing feelings as they arise and thinking of the self and all life experiences as a whole. ^[3]

The six core principles of ACT overlap and co-occur throughout treatment and life experiences. These six principles are: ^[1]

• Acceptance: Acknowledging and embracing the full range of thoughts and feelings that occur without hiding from or denying negative emotions.

• Defused thinking: Detaching the self from thoughts and feelings, observing and recognizing them without judgment and without allowing them to influence behaviors.

• Experiencing the self as an observer: Acknowledging psychological experiences, while remaining stable in the sense of self and recognizing that personality and identity are not defined by the thoughts and feelings experienced.

• Being present: Focusing on the thoughts and feelings of the current moment, rather than looking at the past or future, while being self-aware and aware of surroundings.

• Adhering to chosen values: Making choices about the values, principles, and behaviors that are seen as important, rather than altering behaviors to meet the expectations of others, avoid distress, or control situations.

• Being committed to action: Defining the steps and actions to be taken to meet personal values and goals and learning the skills to implement them. Then, continuing to behave in these ways, even when faced with psychological challenges.

What conditions can ACT treat?

ACT techniques and tools

ACT includes teaching the individual the following tools and techniques: ^[2][7]

• Mindfulness techniques: Focusing on the present moment, instead of dwelling on the past or fixating on possible future events.
• Defining personal values: Considering what behaviors and actions are important to the individual and how they can maintain these values, even while emotionally aroused.
• Setting goals: Committing to engaging in actions that are aligned with core values to meet clearly defined goals.
• Exploring emotions and thoughts: Recognizing and accepting challenging emotions as observed thoughts that do not need to be acted upon and viewing the self as the observer of these thoughts and not someone who is defined by emotions or experiences.
• Changing language: Learning how not to speak negatively following a negative event or emotion to prevent the perpetuation of its impact.

ACT in practice: What to expect

Acceptance and commitment therapy begins with the therapist discussing with the individual their aims and desires and how they want to improve the quality and value of their life. The individual will be asked how they have attempted to meet these goals previously and what strategies they used to avoid or hide from discomfort or distress in the process of trying to achieve them.

The therapist will help the individual identify the negative strategies they have previously used, such as substance use, overt avoidance, or refusing to engage in emotional conversations. The therapist also helps the individual understand how these strategies have harmed overall well-being and life quality. ^[7]

Following this, psychoeducation is used to help the individual understand the unpredictability of life and accept distressing experiences. This is demonstrated through exercises and stories that help illustrate harmful thought processes and provide an opportunity for the individual to practice accepting and embracing these thoughts, thus improving their self-awareness. ^[1]

As the individual identifies their values and learns to accept life experiences, new goals can be set. Strategies and schedules are put in place to pursue these goals while utilizing new skills to overcome psychological barriers.

Throughout this process, the therapist guides the individual, modeling acceptance through appropriate self-disclosure and diffusion skills with their language. ^[7]

Is ACT right for you?

ACT may not be suitable for children or young people, as it requires an element of abstract thinking and principles that may be challenging for children to understand. Adults utilizing ACT may experience the best results if they are able to engage in the psychological exercises and thought processes involved in ACT. Some people may find these techniques difficult.

People who have in the past struggled with or avoided distressing emotions or attempted to control challenging situations might benefit the most from ACT. It might also be a good choice of therapy for people who have engaged in other types of behavioral therapy in the past with little success. ^[1]

Choosing the right therapist

When choosing a therapist for ACT, it is recommended to ensure that they are a qualified and licensed mental health professional, such as a psychologist, mental health nurse, or social worker. Additionally, it may be beneficial to find out:

• Their experience providing ACT
• If they have received ACT training
• The types of conditions they have treated
• The outcomes of their past clients