Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) is a unique form of psychotherapy that focuses on helping clients accept their thoughts and emotions without judgment, while committing to values-based actions that lead to a more fulfilling life. It is a highly client-centered approach that emphasizes the importance of individual goals, values, and experiences.

ACT  has been developed in response to the limitations of traditional cognitive-behavioral therapies (CBT) that focus on the control of thoughts and emotions. ACT is an empirically supported approach that emphasizes psychological flexibility and values-based behavior as a means to promote psychological well-being and adaptive functioning.

ACT is based on the idea that emotional distress and psychological suffering are a natural part of the human experience, and that attempts to avoid or eliminate such experiences can actually increase suffering. Rather than trying to change thoughts and emotions, ACT focuses on developing psychological flexibility and resilience, so clients can live rich, meaningful lives, even in the face of challenges and difficulties.

ACT is suitable for individuals who experience difficulties managing their emotions or their cognitive processes, particularly in relation to negative thoughts or unwanted emotions. This approach has been applied to a wide range of mental health disorders, including depression, anxiety, substance abuse, eating disorders, and chronic pain.

Structure of therapy



The structure of ACT therapy can vary depending on the needs and goals of each individual client. However, the therapy is usually structured around six core processes of psychological flexibility, which are also known as the hexaflex: acceptance, cognitive defusion, present-moment awareness, self-as-context, values, and committed action.

During therapy, clients learn to develop these processes by engaging in experiential exercises, such as mindfulness practices, values clarification exercises, and exposure-based activities. ACT therapists also use metaphors and other techniques to help clients understand the nature of their thoughts and emotions, and how they can work with them rather than against them.

The Hexaflex

The hexaflex is a visual representation of the six core processes of psychological flexibility in ACT. Each of these processes is interrelated and mutually reinforcing, and together they form the basis of ACT therapy. The six processes are:

1. Acceptance: The willingness to experience difficult thoughts and emotions without judgment or avoidance.
2. Cognitive defusion: The ability to observe thoughts as they are, rather than as literal truths.
3. Present-moment awareness: The ability to be fully present in the moment, without judgment or distraction.
4. Self-as-context: The recognition that thoughts and emotions
5. Values: The identification of what is truly important to the individual.
6. Committed action: Taking action towards one's values, even in the face of difficult or uncomfortable thoughts and feelings.

Psychological flexibility and values-based behavior

Psychological flexibility is a key concept in ACT, which refers to the ability to be present in the moment and to take action in accordance with one's values, even in the presence of unwanted thoughts or emotions. It involves accepting difficult thoughts and feelings, while still pursuing valued goals and actions. In contrast, psychological inflexibility involves attempting to control, avoid, or suppress unwanted thoughts or feelings, which can lead to psychological distress and dysfunction.

Values-based behavior refers to actions that are consistent with one's personal values, which are beliefs or principles that are important to an individual. ACT emphasizes the importance of identifying and pursuing one's values, as a way to enhance psychological flexibility and increase overall well-being.

Experiential Avoidance vs Experiential Acceptance

Experiential avoidance is a key concept in ACT, which refers to the tendency to avoid or suppress difficult thoughts, feelings, or experiences, rather than accepting and processing them in a healthy way Experiential avoidance can lead to a range of psychological problems, including anxiety, depression, and substance abuse.

Experiential acceptance, on the other hand, involves a willingness to experience difficult thoughts and emotions, without trying to control or avoid them. This does not mean that one must like or approve of these thoughts or emotions, but rather that one is willing to acknowledge and accept them as part of the human experience. This may involve developing mindfulness practices, exposure-based activities, and values clarification exercises, as well as exploring the client's cognitive processes and helping them to develop greater awareness and acceptance of their thoughts.

ACT emphasizes the importance of experiential acceptance as a means to promote psychological flexibility and well-being. By accepting and processing difficult experiences, individuals can learn to develop greater resilience and adaptability, and to move towards valued goals and actions, even in the presence of challenging thoughts or emotions. This approach can be particularly helpful for individuals who struggle with anxiety or depression, as it provides them with tools to manage difficult emotions and develop a more positive relationship with their inner experiences.

 What happens in a session?

In an ACT session, the therapist works collaboratively with the client to identify the client's values and goals, and to develop strategies for moving towards those goals, even in the presence of difficult thoughts and emotions. The therapist also encourages the client to identify the ways in which they may be stuck in unhelpful patterns of thinking or behaving, and to develop alternative strategies for coping with difficult thoughts and emotions. This may involve exploring the client's cognitive processes and helping them to develop greater awareness and acceptance of their thoughts, while learning to disengage from unhelpful patterns of thinking.

Conclusion

Overall, ACT offers a client-centered and effective approach to promoting psychological flexibility and values-based behavior, which can be applied to a wide range of mental health disorders. By helping individuals to develop greater acceptance and adaptability in the face of difficult experiences, ACT can provide a pathway towards greater psychological well-being and resilience.

Further reading

Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behavior Modification, 31(6), 772-799.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44(1), 1-25.

Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist, 40(7), 976-1002.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The process and practice of mindful change. New York: Guilford Press.

Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152-1168.

Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865-878.

Ruiz, F. J. (2010). A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10(1), 125-162.

Twohig, M. P., & Levin, M. E. (2019). Acceptance and commitment therapy. The Wiley Handbook of Cognitive Behavioral Therapy, 331-353.