Woman shares excitement over not needing walker. Acceptance and commitment therapy (ACT) teaches mindfulness skills to help individuals live and behave in ways consistent with personal values while developing psychological flexibility.

Practitioners of ACT help individuals recognize ways in which their attempts to suppress, manage, and control emotional experiences create challenges. By recognizing and addressing these challenges, individuals can become better able to make room for values-based actions that support well-being.  

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History of ACT

For decades, researchers in the field of psychology have worked to develop science-based, time-limited interventions for people who wish to overcome mental health conditions. As a result, many people have had significant success in addressing and managing a range of concerns and experience greater well-being as a result. Still, long-term recovery and prevention of relapse remain significant as areas of potential difficulty for those seeking therapy for mental health conditions. Recently, new types of therapies, including ACT, have been developed in the hopes of increasing long-term success in the treatment of mental health conditions.

ACT is based on relational frame theory (RFT), a school of research focusing on human language and cognition. RFT suggests the rational skills used by the human mind to solve problems may be ineffective in helping people overcome psychological pain. Based on this suggestion, ACT therapy was developed with the goal of teaching people that although psychological pain is normal, we can learn ways to live healthier, fuller lives by shifting the way we think about pain.

Beginning in the late 1990s, multiple comprehensive treatment manuals have been developed to outline ways to use ACT to treat various mental health conditions. Treatment using these manuals has been researched empirically and has produced support for the use of ACT in the treatment of substance abuse, psychosis, anxiety, depression, chronic pain, and eating disorders. 

Understanding the Theory of ACT

ACT theory does not define unwanted emotional experiences as symptoms or problems. It instead works to address the tendency of some to view individuals who seek therapy as damaged or flawed and aims to help people realize the fullness and vitality of life. This fullness includes a wide spectrum of human experience, including the pain inevitably accompanying some situations. 

Acceptance of things as they come, without evaluating or attempting to change them, is a skill developed through mindfulness exercises in and out of session. ACT does not attempt to directly change or stop unwanted thoughts or feelings (as cognitive behavioral therapy does) but instead encourages people to develop a new and compassionate relationship with those experiences. This shift can free people from difficulties attempting to control their experiences and help them become more open to actions consistent with their values, values clarification and the definition of values-based goals also being key components of ACT.

Six Core Processes of ACT

Psychological flexibility, the main goal of ACT, typically comes about through several core processes.

  • Developing creative hopelessness involves exploring past attempts at solving or getting away from those difficulties bringing an individual to therapy. Through recognition of the workability or lack of workability of these attempts, ACT creates opportunity for individuals to act in a manner more consistent with what is most important to them.
  • Accepting one’s emotional experience can be described as the process of learning to experience the range of human emotions with a kind, open, and accepting perspective.
  • Choosing valued life directions is the process of defining what is most important in life and clarifying how one wishes to live life.
  • Taking action may refer to one’s commitment to make changes and engage in behaviors moving one in the direction of what is most valued.

These processes are overlapping and interconnected, not separate. All of these processes are introduced and developed through direct experiences that are identified and taken part in by the person in therapy over the course of treatment. Psychological flexibility can be defined simply as “the ability to be present, open up, and do what matters.”

Mindfulness and ACT

Mindfulness can be described as maintaining contact with the present moment rather than drifting off into automatic pilot. Mindfulness allows an individual to connect with the observing self, the part that is aware of but separate from the thinking self. Mindfulness techniques often help people increase awareness of each of the five senses as well as of their thoughts and emotions. ACT does not attempt to directly change or stop unwanted thoughts or feelings but instead encourages people to develop a new and compassionate relationship with those experiences.

Mindfulness also increases an individual’s ability to detach from thoughts. Challenges related to painful feelings, urges, or situations are often first reduced and then eventually accepted. Acceptance is the ability to allow internal and external experience to occur instead of fighting or avoiding the experience. If someone thinks, “I’m a terrible person,” that person might be asked to instead say, “I am having the thought that I’m a terrible person.” This effectively separates the person from the cognition, thereby stripping it of its negative charge. 

When people experience painful emotions, such as anxiety, they might be instructed to open up, breath into, or make space for the physical feeling of anxiety and allow it to remain there, just as it is, without exacerbating or minimizing it.

Values Clarification and ACT

Values clarification can help people define what is most important—their values, in other words—and take effective action guided by those values. A mental health professional will generally employ a variety of exercises to help those in therapy identify chosen values. These values often act as a compass in the direction of intentional and effective behavior.

Exploring painful emotions or overthinking an issue may interfere with one’s ability to choose purposeful and values-guided action. Through mindful liberation from this challenge, ACT can help people act more congruently with their values and live in a way that feels natural and fulfilling.

Who Offers ACT?

The ACT community does not offer official certification for therapists wishing to provide this type of therapy. The Association for Contextual Behavior Science (ACBS) maintains a voluntary registry of members who have identified themselves as ACT therapists, and this registry may be a good place for those interested in finding a provider of ACT to start.

The ACBS also provides the following suggestions for those interested in finding an ACT therapist:

  • Contact the psychology, social work, or psychiatry department at a nearby college or university. Members of the faculty or staff who are experts in behavior therapy or cognitive behavior therapy may know about a local ACT therapist.
  • The United States-based website of the Association for Behavioral and Cognitive Therapy maintains a list of providers of behavioral and cognitive therapies. These therapists may also provide ACT or may know of a colleague who provides ACT.
  • In countries other than the United States, organizations similar to ABCT may be a good place to look for providers who deliver ACT or who can make referrals to ACT-trained therapists.

References:

  1. Eifert, G. H. & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and values-based behavior change strategies. Oakland, CA: New Harbinger Publications, Inc.
  2. Hayes, S. C. (2005). Get out of your mind & into your life: The new acceptance and commitment therapy. Oakland, CA: New Harbinger Publications, Inc.
  3. Hayesw, S. C., Masuda, A., Bissett, R., Luoma, J., and Guerreo, L. F. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35, 25-54.
  4. Find an ACT therapist. (n.d.). Association for Contextual Behavioral Science. Retrieved from https://contextualscience.org/civicrm/profile?gid=17&reset=1&force=1