Acceptance and Commitment Therapy

by Joel Guarna, PhD

http://actinnewengland.com/List%20Postings/08_2_April2008.htm

Acceptance and Commitment Therapy (ACT) gets it name from one of its core messages: to accept what is out of your personal control, while committing to do whatever is in your personal control to improve your quality of life.

The aim of ACT is to help people create a rich full and meaningful life, while effectively handling the pain and stress that life inevitably brings. ACT  (which is pronounced as the word ‘act’, not as the initials) does this by:

1. a) teaching you psychological skills to deal with your painful thoughts and feelings effectively – in such a way that they have much less impact and influence over you. (These are known as mindfulness)
2. b) helping you to clarify what is truly important and meaningful to you  – ie your values – then use that knowledge to guide, inspire and motivate you to change your life for the better.

The ACT View Of Mindfulness

Mindfulness is a “hot topic” in Western psychology right now – increasingly recognised as a powerful therapeutic intervention for everything from work stress to depression – and also as an effective tool for increasing emotional intelligence. Acceptance and Commitment Therapy is a powerful mindfulness-based therapy (and coaching model) which currently leads the field in terms of research, application and results.

Mindfulness is a mental state of awareness, focus and openness – which allows you to engage fully in what you are doing at any moment. In a state of mindfulness, difficult thoughts and feelings have much less impact and influence over you – so it is hugely useful for everything from full-blown psychiatric illness to enhancing athletic or business performance. In many models of coaching and therapy, mindfulness is taught primarily via meditation. However, in ACT, meditation is seen as only one way amongst hundreds of learning these skills – and this is a good thing, because most people do not like meditating! ACT gives you a vast range of tools to learn mindfulness skills – many of which require only a few minutes to master.

ACT breaks mindfulness skills down into 3 categories:
1) defusion: distancing from, and letting go of, unhelpful thoughts, beliefs and memories
2) acceptance: making room for painful feelings, urges and sensations, and allowing them to come and go without a struggle
3) contact with the present moment: engaging fully with your here-and-now experience, with an attitude of openness and curiosity

These 3 skills require you to use an aspect of yourself for which no word exists in common everyday language. It is the part of you that is capable of awareness and attention. In ACT, we often call it the ‘observing self’. We can talk about ‘self’ in many ways, but in common everyday language we talk mainly about the ‘physical self’ – your body –  and the ‘thinking self’ – your mind. The ‘observing self’ is the part of you that is able to observe both your physical self and your thinking self. A better term, in my opinion, is ‘pure awareness’ – because that’s all it is: just awareness, nothing else. It is the part of you that is aware of everything else: aware of every thought, every feeling, everything you see, hear, touch, taste, smell, and do.

Acceptance and Commitment Therapy (ACT) is a unique and creative approach to behaviour change which alters the very ground rules of most Western psychotherapy. It is a mindfulness-based, values-oriented behavioural therapy, that has many parallels to Buddhism, yet is not religious in any way; it is a modern scientific approach, firmly based on cutting-edge research into human behavioural psychology.

Duration And Delivery of ACT

ACT can be delivered in many different ways:

1. a) long-term therapy – for example, the Spectrum protocol for ACT with borderline personality disorder:  forty 2-hour sessions.
2. b) medium-term therapy – for example, JoAnne Dahl’s protocol for ACT with chronic pain: eight hours in total
3. c) short-term therapy – for example, Patty Bach’s protocol on ACT with schizophrenia: only four 1-hour sessions
4. d) brief therapy – for example, Kirk Strosahl’s work in primary care medical settings, where ACT can be highly effective even in one or two twenty to thirty-minute sessions.

 

ACT In A Nutshell

My own personal style for both coaching and therapy is what I call ‘ACT In A Nutshell’ – it is a distilled, simplified version of ACT, influenced very strongly by three factors: 1) the work of Kirk Strosahl, one of the originators of ACT, renowned for the simplicity, rapidity, and effectiveness of his interventions, 2) my previous training in solution-oriented counselling, much of which can be adapted to fit this model, and 3) most of all, by my own personal motto: ‘Simplicity, Clarity, Accessibility’. ACT has been around since the mid-eighties, so it comes with quite an amazing heritage of tools, techniques, interventions and strategies. However, some of these are unnecessarily complex or longwinded. I have made it my personal mission to modify, adapt or reinvent tools, techniques, and training methods wherever possible, in order to make ACT readily accessible to everyone and anyone – whether they are a health professional, therapist, coach, student, client, patient – or simply an interested member of the general public.

My personal preference in ACT is to work quickly and effectively, and as a result, the vast majority of my work would fall under categories b), c), and d) above. However, I do have a few long-term clients with multiple severe problems, that I have been seeing for several years. And this is one of the many things I love about the ACT model: its flexibility. I love the way it can so readily be adapted, and made as short or long as it needs to be, to suit the individual needs of the client, group, or organisation.

PSYCHOLOGICAL FLEXIBILITY & THE SIX CORE PROCESSES OF ACT

There are six core processes in ACT:

1. Contacting The Present Moment means being psychologically present: consciously connecting with whatever is happening right here, right now.
2. Defusion means learning to step back or detach from unhelpful thoughts and worries and memories: instead of getting caught up in your thoughts, or pushed around by them, or struggling to get rid of them, you learn how to let them come and go – as if they were just cars driving past outside your house. You learn how to step back and watch your thinking, so you can respond effectively – instead of getting tangled up or lost inside your thinking.
3. Acceptance means opening up and making room for painful feelings and sensations. You learn how to drop the struggle with them, give them some breathing space, and let them be there without getting all caught up in them, or overwhelmed by them; the more you can open up, and give them room to move, the easier it is for your feelings to come and go without draining you or holding you back.
4. The Observing Self is the part of you that is responsible for awareness and attention. We don’t have a word for it in common everyday language – we normally just talk about the ‘mind’. But there are two parts to the mind: the thinking self – i.e. the part that is always thinking; the part that is responsible for all your thoughts, beliefs, memories, judgments, fantasies etc. And then there’s the observing self – the part of your mind that is able to be aware of whatever you are thinking or feeling or doing at any moment. Without it, you couldn’t develop those mindfulness skills. And the more you practice those mindfulness skills, the more you’ll become aware of this part of your mind, and able to access it when you need it. (The technical term for this, in ACT, is ‘self-as-context’.)
5. Values are what you want your life to be about, deep in your heart. What you want to stand for. What you want to do with your time on this planet. What ultimately matters to you in the big picture. What you would like to be remembered for by the people you love.
6. Committed action means taking action guided by your values – doing what matters – even if it’s difficult or uncomfortable

When you put all these things together, you develop something called psychological flexibility. This is the ability to be in the present moment, with awareness and openness, and take action, guided by your values. In other words, it’s the ability to be present, open up, and do what matters. The greater your ability tobe present, open up and do what matters, the greater your quality of life – the greater your sense of vitality, wellbeing and fulfillment.

More About The ACT Model

ACT (which is pronounced as the word ‘act’) uses a wide range of experiential exercises to undermine the power of destructive cognitive, emotive, and behavioural processes. It helps clients to fundamentally change their relationship with painful thoughts and feelings, to develop a transcendent sense of self, to live in the present, and to take action, guided by their deepest values, to create a rich and meaningful life.

David Barlow, famous not only for his work on CBT with anxiety disorders, but also for his development of the scientist-practitioner model, writes of ACT:

“Once in a while, there is a unique contribution to psychotherapy.  Even more rare is the grounding of that contribution in sound philosophy, on the one hand, and firm data on the other.  Acceptance and Commitment Therapy represents such an effort.  In a truly creative leap forward, the authors present a new approach to behaviour change that is “must” for everyone in the field of psychotherapy….. Challenging the assumptions and methods of cognitive therapy, this is amongst the most significant new approaches to behaviour change of the past three decades.”  

ACT takes the view that most psychological suffering is caused by ‘experiential avoidance’, i.e. by attempting to avoid or get rid of unwanted private experiences (such as unpleasant thoughts, feelings, sensations, urges & memories). Clients’ efforts at experiential avoidance might work in the short term, but in the long term they often fail, and in the process, they often create significant psychological suffering. (For example, think of any serious addiction: in the short term it makes you feel good and helps you get rid of unpleasant thoughts and feelings – but in the long term, it destroys your health and vitality.)

In ACT, clients develop mindfulness skills (both traditional techniques, and many modern, innovative ones) which enable them to fundamentally change their relationship with painful thoughts and feelings. When clients practise these skills in everyday life, painful feelings and unhelpful thoughts have much less impact and influence over them. Therefore, instead of wasting their time and energy in a fruitless battle with their inner experiences, they can invest their energy on taking action to change their life for the better – guided by their deepest values.

A growing body of empirical data confirms that cultivating acceptance, mindfulness, and openness to experience is highly effective for the treatment of depression, anxiety disorders, substance abuse, chronic pain, PTSD, anorexia, and even schizophrenia. ACT is also a very effective model for life coaching and executive coaching.

ACT is one of the ‘third wave’ of behaviour therapies, along with Dialectical Behaviour Therapy, Mindfulness-Based Cognitive Therapy, and several others. These therapies comprise a movement in psychology that regard mindfulness and acceptance as important additions to change-oriented treatment strategies.

ACT was the first of the ‘third wave’ therapies, and has the largest body of empirical data to support its effectiveness. And it is very effective. For example, one published study showed hospital re-admission rates for psychotic patients were cut by 50% with only 4 hours of ACT (primarily using values-guided behavioural interventions, and cognitive defusion techniques to reduce believability in delusions & hallucinations). To download this paper, by Bach and Hayes, click here

What is Relational Frame Theory?

ACT is based on a theory of human language and cognition known as Relational Frame Theory (RFT). You can be an excellent ACT therapist without knowing RFT, in the same way that you can be an excellent driver without knowing how your car engine works. However, a working knowledge of RFT can certainly enrich your practise, and give you a greater understanding of how ACT works and why it  is so effective.