Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment therapy is a type of psychotherapy that focuses on a person’s emotions. To be human is to have negative thoughts from time to time; it’s inevitable for everyone. Sometimes, though, those negative feelings can overtake a person’s life, hampering their self-esteem, relationships, and daily activities.

This is where Acceptance and Commitment therapy comes in. In ACT, a person works to accept their negative thoughts and emotions and then to commit to making changes in their life that match their values. A therapist will help a client set goals, define their values, explore their thoughts and feelings, and change their behavior.

ACT is useful for treating a variety of conditions, such as anxiety, depression, substance abuse disorders, OCD, and PTSD.

Acceptance and Commitment therapy was started in the 1980s by psychologist Steven Hayes.[1] He and his colleagues were seeking to create a more flexible, values-oriented approach than the symptom-focused therapies of the day.

ACT is based on six core processes:

• Cognitive Defusion: This is the practice of separating oneself from one’s thoughts, recognizing thoughts as bits of language or images and not as frightening or threatening as they appear.
• Acceptance: In this process, a person accepts that they will have negative thoughts and does not avoid them or focus on them.
• Being Present: This is the practice of focusing on the present moment, minimizing attention on future plans or worries.
• Observing the Self: In this step, a person understands themselves as separate from their thoughts, emotions, urges, sensations, etc.
• Values: This is the practice of setting standards for oneself, not defined by others.
  Committed Action: In this step, a person sets goals that are aligned with their values and then takes steps to meet those goals.

These six processes are built around the idea of psychological flexibility, which is the concept that one is not driven by one’s emotions and can stay grounded in the present, whether one is experiencing positive or negative thoughts or situations.

In 2012, Matthew Smout completed a meta-analysis of more than 50 studies that examined the efficacy of ACT. He found that several studies showed the efficacy of ACT in treating chronic pain. Others showed that it has been used to effectively treat “obsessive-compulsive disorder (OCD), psychosis, smoking, tinnitus, epilepsy, and emotionally disordered eating after gastric band surgery.” It has also been useful in treating non-clinical conditions like workplace stress and weight loss.[2]

In 2020, Andrew T. Gloster et al. performed another meta-analysis, examining over 100 studies. Gloster et al. found that “ACT is efficacious for all conditions examined, including anxiety, depression, substance use, pain, and transdiagnostic groups” and that studies have found no counterindications.[3]

While there may be room for more research to be done and more alignment of methods between studies, it is clear that ACT is at least as effective as other types of therapy, if not more so.

Thoughts

During an ACT session, a therapist will direct the client in certain activities that will help the client recognize and accept their thoughts, whether positive or negative.

Some common activities include things like the “leaves in the stream” exercise or “helicopter view.” In the first activity, the client imagines their thoughts are leaves floating by on a stream. This helps a person identify, recognize, and let go of thoughts as they come, not avoiding them or fixating on them.

In using a “helicopter” view, the patient imagines looking down at their thoughts from high in the air. This produces a similar effect, where one does not have to pass judgment on their thoughts or experience all the emotions that come with each thought. Essentially, the client can understand themselves as separate from their thoughts and emotions.

Values

The therapist will also ask the client to discuss their core values and explore their vision of an “ideal” self. Understanding these things will help the patient set goals that align with their values and allow them to make changes in their behaviors that match their values.

If a client is not sure where to begin, the therapist may have them look through “values cards” to give them ideas and allow them to visually move the values around, deciding which is most important to them.

Action

Lastly, the therapist will ask the client to make commitments to changes in their behaviors that will align with their values. This usually continues into daily life beyond each session.