What Is Acceptance & Commitment Therapy?

Acceptance and commitment therapy (ACT) is one of the therapies we use at Footprints to Recovery. It’s a psychotherapy developed by Steven Hayes, PhD. in the 1980s to promote positive behavior change. ACT draws on aspects of cognitive behavioral therapy and clinical behavior analysis but has a significant mindfulness component.

In ACT therapy, you’re encouraged to accept difficult thoughts and feelings instead of trying to avoid them, change them, or push them away. The ACT principles teach you to just notice these occurrences as thoughts, separate from yourself. ACT also helps you identify your core values and incorporate them into all aspects of life. The goals of ACT are to decrease psychological suffering, encourage “psychological flexibility,” and move toward a meaningful life.

How Does Acceptance and Commitment Therapy (ACT) Work?

Acceptance and commitment therapy holds the view that the basis of a lot of your problems can be tied to FEAR. This stands for:

Fusion – You are so tied to your thoughts that you can’t separate yourself from them. Cognitive fusion can feel rigid and like you’re being governed by your thoughts. You might see thoughts as facts without any evidence to support them and have other maladaptive thinking patterns. An example of cognitive fusion is, “I relapsed, which means I am no good, and I will never get sober.”
Evaluation – You might find yourself evaluating your experience. This typically involves labeling thoughts and feelings as “good” or “bad.” For example, you may label thoughts around urges to drink or use drugs as “bad.”
Avoidance – Trying to push negative thoughts or feelings away or numb them is avoidance. An example of avoidance would be drinking or using drugs when difficult feelings arise.
Reason-giving – This is the reason or justification you give for why you can’t change your behavior. An example could be, “I can’t stop drinking because my life is too hard to cope with sober.”

A part of acceptance and commitment therapy is identifying these tendencies. Your therapist may use cards or worksheets to help you recognize when you’re engaging in FEAR.

The second part of acceptance and commitment therapy is helping you learn healthier alternatives to deal with thoughts and feelings and identify values and goals to guide your life. ACT does this through six core principles:

#1 Acceptance

You’ll learn to accept your feelings and emotions without judgement. This process involves some mindfulness training. Your therapist will teach you how to just notice thoughts and feelings as they arise instead of getting “hooked” by them and creating a story around them. You won’t judge a thought or feeling as good or bad, you’ll only acknowledge that it’s a thought or feeling you’re having. If uncomfortable emotions arise, you’ll allow yourself to feel them instead of trying to push them away or numb.

#2 Cognitive Defusion

Cognitive defusion is a way of creating space between yourself and your thoughts. Your therapist will teach you specific techniques to do so. A handful of examples:

Giving a physical shape, texture, or size to a thought.
Thanking your mind for producing this interesting thought.
Labeling a thought: “I am having a thought right now that I am a bad person.”
Repeating a thought out loud until it becomes just a sound.

These types of exercises can decrease your attachment to your thoughts and make them feel less powerful.

#3 Being Present

Being present is a key component of ACT. By being present in your current experience, you can slow down the hamster wheel of unhelpful ruminations that keep you stuck in the past or worrying about the future. Your therapist will teach you mindfulness exercises to help you do this, such as getting in touch with all of your senses or describing your internal experience in a non-judgmental way.

#4 Self as Context

Self as context is a way to be present in the now. It’s the idea of “observing self.” You’ll learn that you are not your thoughts, feelings, or experiences. You’re the core where they are produced. ACT will teach you to be aware of thoughts and private experiences without getting attached or invested in them.

#5 Values

Acceptance and commitment therapy helps you identify your core values and use these to guide central parts of your life like spirituality, family, and career. Your therapist will help you decipher if your values are coming from your true self or based on “should’s,” past influences, or outside expectations.

#6 Committed Action

You’ll determine specific goals you’d like to achieve and the psychological roadblocks that are getting in the way. These goals will be in line with the values you’ve identified. You’ll use the other ACT processes to help you work toward these goals, such as acceptance and cognitive defusion.

Acceptance and commitment therapy can be used across several therapy sessions or as a brief therapy over six 30-minute sessions, known as FACT: Focused Acceptance & Commitment Therapy.

Who Benefits From Acceptance and Commitment Therapy (ACT)?

Acceptance and commitment therapy can be helpful for anyone struggling with life’s challenges. Studies on ACT have shown it can be especially effective for certain populations. For instance, many addiction treatment centers use acceptance and commitment therapy because of its effectiveness with substance use and mental health disorders. Several studies have shown that ACT can help reduce drug and alcohol use in people with addiction. These outcomes were seen when using ACT alone or in combination with other therapies. Acceptance and commitment therapy can also help people with chronic pain. This can be useful in addiction treatment for people recovering from painkiller dependencies.

ACT is also effective in decreasing mental health disorder symptoms. A small study on people with moderate to high anxiety disorder or depression symptoms found 8 weeks of ACT significantly decreased anxiety and depression symptoms as compared to the control group. Another study suggests that reduced cognitive fusion as a result of ACT helps decrease distress and depression in people with mental illness.

People with eating disorders like bulimia benefit from ACT as well. Acceptance and commitment therapy helps them sit with uncomfortable thoughts and feelings that trigger binge-purge behaviors. Similar to how ACT works with substance abuse, people with bulimia can learn to accept difficult thoughts, not judge them, and know that they can survive these thoughts and feelings without numbing.

Looking for Help?

If you’re struggling with addiction and mental health disorders, call us for a free, confidential consultation. We use types of therapies like ACT that are evidence-based and help you develop healthier coping skills for long-term recovery.

References

Medically Reviewed by Sierra Gabrys, M.Ed., LCPC, NCC, CCM

What Is Acceptance and Commitment Therapy (ACT)?