Acceptance and Commitment Therapy (otherwise known as ACT)?

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Acceptance and Commitment Therapy (ACT) is a form of CBT in that it focuses on the links between a person’s behaviour, feelings and thoughts. It then teaches you to change your thoughts so as to change problematic behaviour and feelings.

The difference, however, is that it does this in a calm, accepting manner rather than by challenging and confronting as is the case with traditional CBT.

For me challenging and confronting are negative concepts which might trigger negative raised arousal. This is something which, as I have explained on other pages, is undesirable. 

I have trained many CBT therapists in ACT when they became curious about it and each one has been unwilling to revert back to using traditional CBT as they did previously.

The aim of all psychotherapy is to teach or encourage the client to see their world differently. No matter what has happened to someone in the past, the fact it happened can’t be changed. All that is left, if the person wants to be able to cope better with whatever it was, is to change the way they think about what happened.

So what does ACT therapy involve?

ACT is closely related to Mindfulness.

(As was shown on the page about Mindfulness-Based Treatments) Mindfulness has three components which are depicted at the points of an equilateral triangle because each is equally important.

In ACT there are six components but tree of these are Mindfulness ones. ACT is shown as a Hexaflex with six points, each of which is connected to every other and the equal sides show each is equally important.

The six components are as follows:

AWARENESS - in ACT this is specifically about being aware of yourself and is often referred to as self-as-context. It's about being aware of your own views and choosing whether or not you act on them rather than doing so out of habit. (this includes the non-judgment of Mindfulness)

IN THE MOMENT - this is about being consciously aware of the here and now. It's about not engaging in one activity whilst your mind is elsewhere.

ACCEPTANCE - as in Mindfulness this is about not resisting what is, not wishing things were different. But it's about accepting it for what it is.

The next three components are additional to those of Mindfulness:

VALUES - knowing what you value for your life and acting on it.

DEFUSION - becoming aware that our thoughts are not reality. The phrase used is "You are not your thoughts". Your thoughts may be telling you something but you don't necessarily have to act as if what they're saying is true or desirable.

COMMITMENT - This is the one that asks whether you really want what you say you want. For example, how many of us have said we wanted to lose weight and have then taken another biscuit? Commitment says that everything you do needs to be taking you in some part towards your goals or values. If it doesn't, why are you doing it?

Overall ACT talks about the need for Psychological Flexibility. To be prepared to change the habitual way in which we view our world especially in those areas which have caused us problems.

None of us can necessarily change the way some things are because they're outside of our control. Instead, we choose to stop wishing we could and focus on something which we can achieve instead. This is especially true of many mental health symptoms.

In clinical practice I usually teach Mindfulness to groups of clients first, because the concepts and skills can be taught as theory to everyone without participants having to discuss personal issues.  I then develop this basic knowledge and apply it to the client’s own personal difficulties in 1:1 or small group sessions by adding in the remaining ACT components.

Another difference with ACT as a therapy is that it focuses on getting the patient to come to the necessary conclusions for themselves - like having an ah-ha moment. Much of the material in ACT is delivered by the use of metaphor, in the form of stories with a meaning.

Conclusions that are reached by our own thought processes are more powerful than just being given instructions to do things a certain way.

Does ACT work then?

ACT was developed by Steven Hayes and associates and in the US has attained evidence-based status. That means there is proof it works!

That is not to say that other therapies don't work. Psychological therapy can be complex because each person comes to it with a different personal history and interpretation of their own life events. It is not as straightforward as medical intervention where the patient is generally passive and, with some exceptions, each person is affected in much the same way by a given treatment.

Acceptance and Commitment Therapy is regarded as a third generation CBT.

Where to find out more about ACT

ACBC text logo

Information about ACT can be found on the ACBS website. Here you will find much greater detail about the theory behind ACT and ongoing research.

There is also a section for those looking for an ACT therapist HERE

logo for In the Moment blog

There are articles based around everyday living along ACT principles in the "In the Moment Blog". You can add your own comments to these.

image of cover of Can't Meditate Won't Meditate book

The book "Can't Meditate, Won't Meditate" gives a step-by-step approach to overcoming anxiety using and ACT/Mindfulness-Based approach.

woman relaxing on garden swing

The Online course "Overcoming Anxiety the Feelgood Way" contains over 30 video lessons along with downloadable notes to take you gradually through the process of changing your life for the better.

  1. Overcoming Anxiety
  2. ACT