What is ACT, how is it different than other therapies, and how can it help me?
Acceptance and Commitment therapy (ACT) was created in 1986 by Steven Hayes, a clinical psychologist who runs the leading Behavior Analysis PhD program at the University of Nevada. ACT was considered to be a part of a new wave of therapies focusing on mindfulness and acceptance, such as DBT (dialectical behavior therapy), MBCT (mindfulness based cognitive therapy), and MBSR (mindfulness based stress reduction), all of which differed from traditional therapies such as CBT (cognitive behavior therapy). While it shared some core features with these therapies, it remained to stand out from the rest due to ACT’s focus on values and life goals, rather than focusing on a reduction of problematic symptoms.
This makes it sound like ACT would be more suitable as a coaching strategy, however studies have found that ACT has made a significant difference for many psychological disorders including schizophrenia and bipolar disorder, addictions, OCD, chronic depression, eating disorders, as well as helping those with chronic pain and terminal illness -- all while not prioritizing a reduction in symptoms (Zettle & Raines, 1989; Twohig, Hayes & Masuda, 2006; Bond & Bunce, 2000; Dahl, Wilson & Nilsson, 2004; Branstetter, Wilson, Hildebrandt & Mutch, 2004). The key here is, that when the focus is removed from getting rid of problems, the problems somehow naturally begin to fall away as a side effect of the compassionate exposure and radical acceptance used in ACT.
Most approaches rooted in clinical psychology are centered around a diagnosed “disorder” and treating a “problem”, ushering in an idea of a ‘healthy normality’. A ‘healthy normality’ posits that a naturally healthy life should be free of pain and suffering, and if there is any discomfort present, something must be wrong and it must be fixed. As natural problem solvers, humans react to “problems” with a strategy to get rid of them, avoid them, or control them- while these solutions typically work for a variety of things in everyday life, and can work at some emotional levels, it ends up being quite impossible when the diagnosed problem is at a certain level of severity. As a result, these efforts of “trying to fix” the problem are what actually leads to the bigger problems that end up driving us to the counselor’s couch -- “I need help because I’ve lost/almost lost my job at this point” “I need help because I don’t have any social support at all anymore” “I need help because my health is failing now” -- sound familiar?
This is where ACT being a spin off of behavior analysis makes a huge difference. ACT therapists want to know what thoughts, feelings, and sensations you are struggling with, and they want to know how you have been trying to avoid, get rid of, or control your struggles. An ACT therapist will begin with helping you to see where your efforts have been backfiring on you, and will ask thoughtful questions and bring you to a bigger life perspective that will open you up to trying something new, and possibly even being willing to set aside your hell bent mission to avoid and control in the service of making your life more meaningful and worth living.
Once you get here, you begin to realize that it makes sense that having ‘anxiety about your anxiety’ or ‘depression over your depression’ is definitely not going to improve your situation. This is where the fun begins and ACT starts to look very different than other approaches. Your therapist will help you learn how to look at your thoughts, feelings, and sensations from an outside perspective, as the “noticer” or "observer" of your experience. You will learn how to “play” with your thoughts and shift your relationship with your mind from one of “fusion” to one of “defusion”, where you aren’t identifying with your thoughts- rather, you are only noticing them. You can expect anything from imagining your thoughts in different ways, writing down your thoughts in creative ways, to singing your thoughts or saying them in funny voices. The lightness inherent in ACT makes the whole process comfortable and reassuring, and may even include humor, so it isn’t a process that is daunting or scary.
I definitely want to note here that ACT looks different for EVERYONE, it is highly customizable, so defusion techniques will look very different for people experiencing anxiety versus people struggling with trauma or deep depression. Your therapist will be very sensitive to the content and source of your suffering so as not to devalue anything you are going through. The goal of defusion is to begin experiencing difficult and unwanted thoughts and feelings as nothing more than words, sounds, images, etc, rather than as harsh truths, strict rules, and threatening facts that need to be avoided in order to feel safe and content. Stripping away judgments and labels play a big role here.
Inherent in taking a step back from your experience is providing a safe space for it. Accepting your “inner demons” isn’t about liking them or inviting them into your life, rather it is about giving up the struggle with your suffering, and giving it permission to be there so that you can finally put your energy elsewhere. At this point, you can expect to start rediscovering your identity by outlining your core values and what matters the most to you. This is where you begin learning that you are not defined by your private, inner experience - rather, you are defined by your choices in how to behave and act in your day to day life. Your life and successes are not reflections of your inner experience, it is a reflection of the hard, observable work that you have (or have not) put into it.
Mindfully contacting the present moment will become very important here as you begin to practice specific mindfulness techniques to remain aware of your actions, and bring them in line with your values, as well as make space for any difficult experiences that may arise and attempt to interfere with your commitments. Your therapist will help you outline goals that resonate with you and will help you to make a roadmap to these goals that are realistic and flexible. This is where the ‘commitment’ in ACT becomes most evident. In ACT, we want to set you up for success and life satisfaction, no matter how difficult your mind may be at times.
In the process of ACT, you can expect your therapist to be kind, non-judging, relatable (we are allowed to self-disclose a little more in ACT than in other therapy modalities), unconditionally supportive, and highly collaborative. We will have conversations with you, we will guide you through important exercises, and you won’t ever find yourself sitting on a couch with an unresponsive, blank therapist. From session 1, your therapist will begin teaching you how to practice self compassion, and you will start some work together on rediscovering yourself and distancing yourself from your mind. Not once will your ACT therapist engage you in evaluating your thoughts, disputing your thoughts, or turning a negative thought into a positive thought. A great thing about ACT as well is that it can be formatted in a way to be brief, completed in as little as 4 sessions or less- or it can be spaced out after the big milestones have been hit to help promote maintenance and long term practice. And the best thing is that in most cases, the symptoms that you set out to avoid and get rid of- and then learned to accept and let go of- end up slipping away without you even noticing. Or, on the other hand, the best thing is that your life is already so much better, with all of the new things that you got the courage to start doing under the coaching of your ACT therapist :)
In sum, here are the core ACT concepts that liberate you from your struggle:
Being present // contacting the present moment
Cognitive Defusion // changing your relationship with your mind
Acceptance // being flexible with and opening up your inner experience with self compassion
Values // defining yourself by what matters to you
Observer Self // taking a step back and finding your inner voice
Committed Action // Acting in line with your goals for a life worth living
Who knew that BF Skinner and his endless experiments on pigeons spinning in circles and tapping at buttons would lead to such a revolutionary therapeutic approach, centered in mindfulness meditation, self compassion, and values driven commitments? Knowing that this gentle and refreshing approach is rooted in the fundamental basics of cut and dry behavioral science makes it even more worth a shot!