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Acceptance and Commitment Therapy Explained
Acceptance and Commitment Therapy or ACT is a 'third wave' mindfulness based behavioural therapy which sits alongside Dialectical Behavioural Therapy (DBT), Mindfulness Based Cognitive Therapy (MBCT) and Mindfulness Based Stress Reduction (MBSR). ACT was created by Steven Hayes et al, (1986) as an alternative to these other traditional therapies.
In contrast to traditional western therapies that see psychological suffering as abnormal, ACT therapy takes a different stance by working with the view that the human mind is often destructive and often leads to psychological suffering.
Symptom reduction is not the goal of ACT (but is usually a byproduct) based on evidence that trying to 'get rid of symptoms' only exacerbates them further and can create clinical disorders in the first place (Harris, 2006).
The more energy and time we spend trying to get rid of thoughts the longer we suffer, therefore in ACT we redirect this towards taking effective action aligned with our values. The major emphasis of ACT is on value. These values may include:
forgiveness
acceptance
compassion
living in the present moment and the transcendent self (Harris, 2006).
Changing our relationship with private painful experiences (such as thoughts, feelings, images and memories) in a way that reduces their impact and influence (on) over our lives. Seeing these experiences as harmless and transient even if they are uncomfortable.
The overarching goal of ACT is to create a rich and meaningful life while accepting the pain that inevitable comes with existence. We attempt to create this life but acknowledging that we will encounter difficulties along the way.
Related: Learn how to manage stress
What are the main components of ACT Therapy?
Developing acceptance of unwanted private experiences which are out of our control.
Learning psychological skills to manage difficult thoughts and emotions.
Explore values and use them to guide our actions to live a life that is important to us.
To focus our attention on what is important and engage fully in whatever we do.
The Hexaflex model in ACT
The hexaflex model is an outline of all six core processes that are required to support a move towards psychological flexibility. Steven Hayes, who co-created ACT, defines psychological flexibility as 'making contact with experience in the present moment fully and without defence'.
In the hexaflex model each domain comes with a range of activities and exercises to complete. These are briefly outline below but each are expanded in a future lesson.
Contacting the present moment
Defusion
Acceptance
Self as context
Values
Committed action
Acceptance and commitment therapy core skill: Contacting the present moment
Contacting the present moment means flexibly paying attention to our hear-and-now experience. Always being open and curious to our experience. This also give us the opportunity to gather information to decide whether to change or persist in our current behaviour. Sometimes we will need to redirect our focus as desired.
Consciously paying attention to the physical world around us or the psychological world within us, connecting and fully engaging with our experience.
Exercise: Dropping the anchor
What is ‘Dropping Anchor’ and How Does It Help?
Dropping anchor is a very useful skill. You can use this technique for handling difficult thoughts, feelings, emotions, memories, urges and sensations. Other ways dropping the anchor can offer support is by enabling us to:
Switch off auto-pilot and engage in life;
Ground and steady ourselves in difficult situations;
Disrupt rumination, obsessing and worrying;
Focus our attention on the task or activity at hand;
Develop more self-control,and;
Act as a ‘circuit-breaker’ for impulsive, compulsive, aggressive, addictive or other problematic behaviours.
What is involved?
Dropping anchor involves playing around with a simple formula: ACE
A: Acknowledge your thoughts and feelings
C: Come back into your body
E: Engage in what you’re doing
A: Acknowledge your thoughts and feelings
Silently and kindly acknowledge whatever is ‘showing up’ inside you: thoughts, feelings, emotions, memories, sensation, urges. Take the stance of a curious scientist, observing what’s going on in your inner world.
And while continuing to acknowledge your thoughts and feelings, also:
C: Come back into your body
Come back into and connect with your physical body. Find your own way of doing this. You could try some or all of the following method or develop your own:
• Slowly pushing your feet hard into the floor
• Slowly straightening up your back and spine; if sitting, sitting upright and forward in your chair
• Slowly pressing your fingertips together
• Slowly stretching your arms or neck, shrugging your shoulders
• Slowly breathing
Remember, you are not trying to turn away from, escape, avoid or distract yourself from what is happening in your inner world. The aim is to remain aware of your thoughts and feelings, continue to acknowledge their presence and, at the same time, come back into and connect with your body. In other words, you are expanding your focus: aware of your thoughts and feelings, and also aware of your body while actively moving it.
And while acknowledging your thoughts and feelings, and connecting with your body, also:
E: Engage in what you’re doing
Get a sense of where you are and refocus your attention on the activity you are doing.
(Taken directly from Russ Harris script for dropping the anchor exercise)
Related: Learn how to be more mindful in five simple steps
Acceptance and commitment therapy core skill: Defusion
The aim of defusion is to reduce the problematic power of cognition over behaviour while moving towards being psychologically present and engaged in experience. Defusion is a technique that allows us to get some distance or take the emotional heat from thoughts, feelings, memories or sensations (all our internal experiences). Overall, defusion aims to enable mindful value-based living.
The main aims of defusion include
Decrease attachment to our inner experience
Reduce believability of our thoughts
Decrease the influence of thoughts on our behaviour and experiences
Increase our availability to be present and take effective action
Facilitate psychological action
To change our relationship to our thoughts (the three 'N's of defusion - see below)
Defusion helps us to consider important questions like
Do my thoughts dictate how my day is going to be?
Is holding this thought helpful/belief/assumption for me?
Does it cause me more suffering and keep me from being effective?
Three 'N's of defusion
Notice - Notice what your mind is doing
Name - Name the thinking process; for example, naming can be 'thinking', 'worrying', 'self-judgement'. 'black and white thinking'.
Neutralise - Neutralise the thought by asking yourself if you need to act on it; also question whether to let the thought advise you or determine your behaviour: will acting on this thought help or hinder me progress toward what is important in my life?
Exercise: Hands as thoughts and feelings
Imagine in front of you is everything that matters: the people, places, activities you love (partner, family, walking, connection in nature).
And all the real life problems and challenges you need to deal with.
And all the tasks you have to do to make your life work, such as your job, studying, and supporting your family.
Now pretend your hands are your thoughts and feelings. Hold them in front of your face as though you are trying to conceal your visage. This action represents difficult thoughts and feelings blocking your sight.
Notice 3 things
1) How much are you missing out on? How disconnected and disengaged are you from the people and things that matter? ('Very disconnected - missing out on spending time with people, going out to social events'.)
2) How difficult is it to keep your attention focused on daily tasks, challenges, or the problems you need to solve? ('I can't give all my attention to things that are important to me.')
3) How difficult is it to take action, to do the things that make your life work? ('I find it such a struggle when my mind is lost in negative and difficult thoughts!')
Now slowly separate/unhook/detach/defuse from your thoughts and feelings. Do this by slowly lifting your hands away from your face.
What’s your view of the room like now? How much easier is it to engage and connect? How much easier it is to keep your attention focused on daily tasks, challenges, and the problems you need to solve? How much easier is it to take action?
Notice these things (i.e. hands) haven’t disappeared. If you can use them, do so. Thoughts and feelings often give us important information we can make good use of.
But if not, just let them sit there.
(Russ Harris exercise, 2014)
Acceptance and commitment therapy core skill
Acceptance
Acceptance is opening up and giving room to our inner experiences (thoughts, memories, images, feelings, emotions, impulses, and sensations), whether painful or pleasurable. Typically, people try to shut out or repress difficult thoughts and feelings. While this approach is understandable, it doesn't deal with the problem.
In contrast, acceptance invites you to allow your thoughts and feelings, regardless of how unsettling, to enter your conscious mind. Once there, the thoughts and feelings are observed objectively and no judgment is advanced.
Accepting negative emotions
A common misunderstanding is that you have to like or be on good terms with difficult thoughts and feelings. Acceptance makes no such demand. So, when you are experiencing negative emotions, let them in and accept that they are not only completely normal but part of your mental environment.
By doing so, by accepting and not pushing away, we avoid the unpleasant tug-of-war of negative emotions over things that cannot be changed. An oft-reported positive outcome of the acceptance approach is a reduction in stress.
Acceptance also doesn't mean liking it or not having negative thoughts, it simply offers a reduction in our stress when getting stuck in the tug of war over things that can't be changed.
Acceptance naturally leads to symptom reduction as we remove the layer of distress. Acknowledging and making room for your fatigue, pain, numbness, or the general sadness you feel towards your limitations can help you lead a more meaningful life.
As Shinzen Young simply equated - Pain X Resistance = Suffering
How to move towards Acceptance?
Allow it to be there with you
Sit with it
Drop the anchor exercise
Make peace with it
Offer yourself compassion, hold it lightly
Breath into it
The Four As of Acceptance
Acknowledge
Allow
Accommodate
Appreciate
Russ Harris uses a good example of the Four As of acceptance in his metaphor Uncle Tim or The unwanted party guest.
Acceptance and commitment therapy core skill
Self as Context
The self as context is described as the part of you that notices thoughts, emotions, memories. This is a safe place to open up and make room for difficulties, while observing thoughts and feelings. The overall aim is to enhance defusion and move towards acceptance.
Exercise: The Continuous You (Steven Hayes)
X= any thought, emotion
1) Notice X
2) There is X and then there is part of you noticing X
3) If you can notice X, than you can't be X
4) X is part of you, but there is more to you than X
5) X changes but part of you doesn't
Acceptance and commitment therapy core skill
Values
Values are our deepest desires of how we want to live and behave in the world. This includes how you treat yourself, others and the world.
Values are fully utilised when used as a guide for motivation, inspiration and guidance. Values can help give us sense of meaning and purpose in our lives by turning goals into action.
These values can be broken down into three areas
Chosen life directions
What you stand for
Desired personal qualities
Values are
Based on the present
Don't need to be justified
Often neglected as a priority
Should be your values and not others
Values ingrained within the self and others
Exercise: Choosing your values
Click on the document below which outlines a range of values and what they mean. Follow the exercise, mark your values and write them down in a notebook. (Values Checklist.pdf)
Exercise: Bullseye
Once you have completed the above exercise, use the bullseye exercise to explore and identify the areas of your life that you feel are aligned or misaligned with your values. (Bullseye worksheet.docx)
Acceptance and commitment therapy core skill
Committed Action
Committed action is taking effective action that is guided and motivated by our values. Committed action can be broken into two components:
Physical action
Psychological action
Psychological flexibility must always be at the centre of committed action to enable a flexible approach towards change.
What skills do we need to move towards committed action?
Basic problem solving allows us to work towards goal setting (committed action)
Identify problem
Brainstorm solutions
Pros and cons of each solution
Generate an action plan
Implement action plan
Observe and reflect on the outcome - modify if required
Exercise: Choice point
Complete the exercise below to explore and identify towards moves and away moves from your values. (Choice Point.docx)
Exercise: SMART goal setting
Pick a area from the bullseye exercise
Choose the values you would like to include in the goal
Set SMART goal
S - Specific (make it specific rather than generic)
M - Motivated by values
A - Achievable
R - Realistic (do you have the resources to complete this goal)
T - Time framed (give yourself a time frame to complete the goal)
Acceptance and commitment therapy final thoughts
From this article, you should have a clear understanding of how Acceptance and Commitment Therapy (ACT) can offer support with a range of psychological difficulties.
Furthermore, you will have gained insight into the core skills and exercises of ACT that clients take as part of the intervention.
After following the above if you still feel you need further support, don’t hesitate to reach out to a qualified professional.
References
Main article image - A Visual Model of ACT created by Anna Scetinina.