ACT Therapy: Acceptance & Commitment Therapy (ACT)

ACT is a psychological intervention we regularly use with clients.

ACT works by reducing 'experiential avoidance'. We define this phenomenon as any attempt to suppress, block, or avoid unwanted thoughts, images, memories, feelings, or accompanying physical sensations. In this way, we lose contact with the present moment. Mental time travel to the past or future can result in unhelpful thinking patterns (e.g., predicting a catastrophe).

An ACT therapist supports clients to give up the struggle for control of challenging experiences. The focus then moves to committed action in pursuit of core life values.

ACT has been applied to a wide range of psychological problems ranging from substance abuse and chronic pain to anxiety disorders and treatment of depression. Evidence suggests ACT is an effective treatment for these and other issues (1).

The downside of trying to control thoughts

A central assumption in ACT is that negative or difficult psychological experiences are a part of life.

We make problems worse when we engage in experiential avoidance of these experiences (e.g., anger, anxiety, racing heart, a knot in the stomach, mental images of past failures). Language and cognition traps (words and thoughts) can contribute to this avoidance.

Mental suppression often results in a 'rebound' effect, as demonstrated by this instruction:

I want you to try as hard as possible to stop the image of a pink elephant from appearing in your mind.

Cognitive defusion

Thoughts can become a substitute for reality or 'truth'. We call this 'cognitive fusion' in ACT.

Most people would find the thought 'I'm turning into a giraffe' ridiculous. There's little chance of buying into this thought because it is impossible. In other words, you are defused from this thought.

But, many people readily believe thoughts like:

'I will fail the test'
'This meeting will be awful'

There's no difference between these negative thoughts and the one about the giraffe. They are just things produced by your brain with no physical influence on the world around you. However, many people act as if thoughts are reality (e.g., not studying for a test, avoiding the meeting). This perception is unhelpful to long-term mental health.

This mental fusion creates psychological distress. Therefore, a major goal of ACT is to unhook from these thoughts.

Moving into this observer mode develops psychological flexibility. This skill allows people to tolerate and observe distress. Leaning into these experiences creates opportunities for learning and the use of helpful behaviours.

Many defusion techniques are available. You can read more in this article on 'notice, name, and normalise'.

Cognitive defusion shares similarities with mindfulness skills. Techniques to 'observe' the brain and body have formed the basis of other recent developments in psychological treatments (e.g., mindfulness-based cognitive therapy).

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The role of values

With an ACT approach, we look to focus on the present moment, lean into and allow all psychological experiences, then take actions consistent with core values. Examples of core values include:

Humour
Authenticity
Relationships
Autonomy

We use values as a behavioural guide for many reasons:

They cannot be 'wrong'
We can use them to generate goals
They bring meaning to our activities

We can come up with a values-based response to psychological difficulties:

How can I respond to this anxiety in a way that takes me toward the person I want to be?
What response to this anger would demonstrate my core value of relationships?

A values-based response to difficult psychological states can improve overall quality of life (2).

Acceptance and Commitment Therapy techniques

Mindful acceptance of difficult inner states is part of the ACT approach. Experiential exercises (learning through doing) are key to skill development in this area. Trained mental health professionals will help you get the most from these techniques. However, here is an example of how to lean into difficult experiences: