What Is Acceptance and Commitment Therapy (ACT)?

“God, give me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”

You’ve probably heard this “serenity prayer” even if you’ve never been to an AA meeting – the context in which it gained popularity – just from hearing it in books, tv shows, or movies. Though not exactly the same sentiment as this prayer, Acceptance and Commitment Therapy, ACT, similarly encourages clients toward endurance and acceptance rather than a constant drive toward “solutions.”

Q: What’s the difference between this and other kinds of therapies?

A: The easiest way to answer this question might be to look at this quick exchange that could happen between a client and an ACT-practicing therapist, according to a Social Work Today article by Claudia Dewane, LCSW, DEd:

Client: “I want to change, BUT I am too anxious.”

Social worker: “You want to change, AND you are anxious about it.”

Many other kinds of therapy, such as Cognitive Behavioral Therapy, for instance, would take the client’s statement here as a jumping off point to begin reducing anxiety so the client can get to the change s/he wants. But with ACT, the therapist does not accept the premise that the client needs to feel less anxious in order to change.

This position that ACT practitioners take is called “psychological flexibility.” It’s the idea that human beings’ rational skills might be great at helping them solve practical problems, but are not as great at helping them overcome psychological pain. Therefore, when people attempt to use rationality to overcome unwanted feelings, the struggle just makes their lives harder. ACT trainer Russell Harris uses the metaphor of quicksand to help clients understand this idea – the more they struggle, the worse it gets.

Experts in psychological theories would describe ACT as part of a “wave” of theories, along with DBT, which was described in this post, that have a bit of existentialism behind them. But don’t worry if your memory of philosophy has gotten a bit dusty since college – this just means that ACT is part of a group of theories that believes that suffering and pain are a normal part of life, and therefore people should not try to avoid or suppress them.

Q: If ACT doesn’t try to “solve” clients’ emotional/psychological problems, then what exactly does it do?

A: ACT has 6 “core processes”, as practitioners call them. Although there might be some slight variation in how different experts would describe them, the basic ideas are:

1. Acceptance: As discussed above, this process involves feeling your feelings, even if they’re bad, rather than avoiding them.
2. Cognitive Defusion: As the APA explains, “The result of defusion is usually a decrease in believability of, or attachment to, private events rather than an immediate change in their frequency.” Labeling is one possible technique to help with this, e.g. thinking to yourself, “I am having the thought that no one loves me” to help yourself see the thought as separate from reality.
3. Being Present: This is the practice of facing events as they happen, using thoughts to describe what’s going on instead of judging what’s going on, rather than withdrawing from the present moment.
4. The Observing Self: Mindfulness is the key to this process. The term “the observing self” refers to the idea that there is your regular thinking self, which immediately feels all of your emotions, but then there is also an “observing self” that you can cultivate that can look at those thoughts from more of a detached distance.
5. Values: This process is one of the most unique parts of ACT because it allows clients to shape their future behavior around their own personal values, whatever those are. The APA explains this well: “ACT uses a variety of exercises to help a client choose life directions in various domains (e.g., family, career, spirituality) while undermining verbal processes that might lead to choices based on avoidance, social compliance, or fusion (e.g., ‘I should value X’ or ‘A good person would value Y’ or ‘My mother wants me to value Z’).”
6. Committed Action: This is the process that’s most like other forms of behavior therapy. It involves taking your identified values and putting them into action even if doing so goes against the grain of popular culture or your family’s/friends’ values. It often involves the kind of “homework” that other forms of therapy, like CBT or DBT, might involve.

Q: How do I know if I would benefit from ACT?

A: This answer is good news: Unlike the theory, we looked at in the last post in this series, DBT, ACT has been shown to work well with a wide variety of mental health conditions. The APA (American Psychological Association) lists depression, anxiety, stress, substance abuse, and psychotic symptoms as problems with which clients have been helped through ACT, and even notes that the method has helped alleviate burn-out in therapists themselves.

For further lists of types of mental health problems that ACT has been shown to treat effectively, see this overview page from goodtherapy.org or Claudia Dewane’s article.

Q: What would happen in a typical session if I was being treated with ACT?

A: As mentioned above, cultivating mindfulness would be one major goal involved in any ACT session, the objective being to help clients stay present in any moment, even emotionally difficult moments, rather than letting an emotional “autopilot” turn on.

Writing for Psychology Today, Deborah Serani, Psy.D., mentions that therapists might work with clients on acceptance strategies such as these during ACT:

1. Letting feelings or thoughts happen without the impulse to act on them.
2. Observe your weaknesses but take note of your strengths.
3. Give yourself permission to not be good at everything.

Serani says that “Acceptance and Commitment Therapy is not a long term treatment,” but Russell Harris says it can be used “both as brief therapy or long term therapy,” so it would be best to talk with a specific therapist about how they prefer to practice ACT. Harris also notes, though, that it can be used both with individuals or with couples/groups. Because of the emphasis on the client’s values, ACT is capable of being highly individualized.

If you want to talk about whether ACT or another kind of therapy may be right for you, you can call us at (305) 501-0133 or click here to schedule a free 20-minute Clarity Consult .