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Thursday, September 19, 2013

What is Acceptance & Commitment Therapy (ACT)?

Have you spent a lot of time and money on psychotherapy or self-help books, yet you still feel stuck in unhealthy habits? Knowing why you are depressed, anxious, or feeling pain  doesn't necessarily make you feel any better.  Understanding what is most meaningful to you in life (such as commitment to your health, family, or work) and committing to taking specific, manageable actions to achieve your goals in these areas can put you back in the driver's seat of your life. Acceptance and Commitment Therapy/Training (or ACT) is an intervention approach used in psychotherapy or workplace setting. 

ACT can help you in the following ways

  • break out of negative thought cycles, 
  • accept what you can't control
  • stop running away from pain
  •  tolerate risk, failure, and uncertainty to 
  • reap the rewards of living a meaningful, engaged life.

Some core principles of ACT are:

(1)  Experiencing the Present Moment

Similar to Mindfulness practitioners, ACT therapists use exercises to help clients remain present and focused on the breath or their moment-to-moment thoughts and feelings, rather than trying to avoid or judging internal experiences. Feelings themselves are momentary, changing experiences in your body and mind. However, because of childhood learning experiences, you may develop negative judgments about feelings and what it means to have them - like "You're depressed again - You're such a loser!"  When you pay attention to the feelings and describe them in language (e.g., my chest feels tight - seems like anxiety), they become less threatening. You realize that feelings will not make you die or fall apart, that you can tolerate them, and that they will pass. Watching feelings rise and fall in your body, gives you a sense of them as transient experiences, rather than part of who you are in essence.

(2) Being Willing to Be Where You Are

Acceptance is a term that is often confused with passivity. In ACT terms, acceptance means "being willing to experience the present moment, even if it's not what we would have chosen."  Acceptance means accepting your life for what it is, including trauma or suffering. ACT helps you realize that you can never completely obliterate or make up for negative experiences. At the same time, you have a choice about what to do with your life now. You do not have to let your views of ourself and your actions be determined by old automatic habits.

Changing habits takes time and effort. Therefore, you need to be willing to be uncomfortable You need to commit and persist even when your efforts aren't bringing any concrete rewards, you don't see major change, or you have a relapse. It takes time to change your brain pathways or to have other people notice you are different and behave differently towards you.

Being willing means you no longer avoid uncomfortable thoughts, feelings, or situations by zoning out, not showing up, turning to addictions, using anger to hide hurt feelings, or procrastinating. If you want to be healthier, you first need to be able to look at and experience how unhealthy you are right now. At the same time, you can commit to doing what you need to do in small daily actions that move you towards health. Lifting the veil of self-deception or avoidance can go a long way towards getting us on the right track.

(2)  Defining Your Core Values

Core values are the things in life that are most meaningful to you and that enrich your life. They include such things as "Being healthy," "Taking care of my family,"  "Being honest and accountable," or "Contributing to society."  When people come to therapy, they are often so overwhelmed with distress, anger, or struggles with pain or addiction, that they have lost touch with what really fulfills them. Even if they know "I want to be a good parent," their day-to-day behavior may not reflect this because they are preoccupied with seeking escape from daily stress or worrying about the future. ACT therapists use imagery and writing exercises to help clients define their individual core values and proactively seek out activities and people that enhance these values in their lives.

(3) Committing to Motivated Action

ACT therapists educate clients that, to live according to your values and live a meaningful lifs, you need to take reasonable risks, get out into the world, and tolerate uncertainty and anxiety. Exercises focus on setting manageable, attainable, meaningful goals - commitment to taking specific, small steps that help you live according to your values. The focus is on taking action, not expecting a particular result, since outcomes may be at least partially out of your control.  To be successful is not necessarily to always feel happy or pain-free, but to live a full life despite the anxiety or pain. By facing what you fear, the fear will eventually lessen, and, even if it doesn't you will know you have done the best we can. This takes you out of the cycle of self-doubt, regret,  and second-guessing.

(4) De-Fusing Your Self From Your Thoughts

A fundamental principle of ACT is that your thoughts, feelings, and sensations are not entirely who you are. ACT includes mindfulness, imagery, and language-based exercises to help you connect with your "observing ego" that can observe your thoughts and feelings, and can deliberately choose how much attention to pay them. Although your thoughts may  feel true, they are not necessarily the truth, because they are biased by your expectations from past experiences. A major ACT principle is that you do not need to let your thoughts and feelings determine your behavior. You can choose how to behave, based on your direct experience (what you see, hear, feel, observe - independent of thoughts or judgments) and your core values. You can evaluate a thought: "Is it kind? Is it truthful?,.." and so on. Based on the answer, you may take the thought seriously or let it pass on by. Rather than changing the content of your thoughts, you can choose to change how much to let them influence you. Thinking you are stupid or fat does not make you stupid or fat - it's just a thought, even if it feels like reality.

Issues and Populations Addressed

ACT Therapy  has been used with substance abusers, people suffering from chronic pain and illness, or patients with obsessive thoughts, anxiety, and depression. ACT works well with clients  who are tired of letting uncontrollable symptoms rule their lives and are willing to take a more active role.

According to SAMHSA's Registry of Effective Programs,

"ACT has been shown to increase effective action; reduce dysfunctional thoughts, feelings, and behaviors; and alleviate psychological distress for individuals with a broad range of mental health issues (including DSM-IV diagnoses, coping with chronic illness, and workplace stress)."

For more information about ACT, go to this link:

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