Acceptance And Commitment Therapy

Unlike other therapy models, the focus of acceptance and commitment therapy (ACT) is not on eliminating maladaptive thoughts, feelings, and behaviors. Instead, the goal is to develop the client’s psychological flexibility to adapt their behavior based on its usefulness. The psychological flexibility model consists of six core components, including the following:

Defusion

The component of defusion teaches individuals to look at their thoughts with dispassionate curiosity. For example, they may repeat the name of a place they fear until they no longer feel the same level of fear. Defusion can help clients become observers of their thoughts to recognize that not every thought is necessarily a fact. 

Acceptance

Practicing acceptance can mean willingly experiencing emotions without trying to change how often you feel them or how sensitive you are to them. Instead of labeling emotions with words like “good” or “negative,” acceptance may help clients view them through a non-judgmental lens. 

Self-as-context

The self-as concept allows a person to examine their own thoughts and behavior from an impartial viewpoint and recognize that one negative thought isn’t indicative of their overall character. 

Flexible attention to the present moment

Paying attention to the present moment can help individuals respond flexibly to what’s going on around them instead of focusing on the past or present. This component also encourages individuals to focus on their surroundings instead of their internal thoughts or feelings.

Values

Values are ongoing patterns of action that are established as reinforcers. Setting values can provide direction for what actions you want to take to achieve the life you desire. 

Committed action

Committed actions are the steps you take to live out your established values. Clients are often encouraged to outline what specific actions they can take and follow through with their plans. Everything that occurs during acceptance and commitment therapy is based on these six core components. 

During acceptance and commitment therapy (ACT), sessions are often an hour long, and a treatment plan may last between eight and 16 weeks. Treatment often begins by assessing the goals of the client. Your therapist may clarify what it would take to achieve a more valued life. They may also try to learn what actions you have taken in the past to achieve your goals and how well those actions worked in the short and long term. 

ACT often includes psychoeducation, which may be presented as stories and experiential exercises. Psychoeducation is done to help you better understand that much of your psychological experience is uncontrollable but still acceptable. This technique may also help clients be in more control over their thoughts and not believe that their thoughts control them.  

Metaphors are often used to help clients better understand their emotions and how to respond to them. Dozens of metaphors have been created to address each of the core components of ACT. Below are a few you may learn about during your therapy sessions.

Riptide and quicksand

If you’re trapped in a riptide or quicksand, struggling could exhaust you and cause further harm. If you relax, however, you can save energy and be carried to shore or float to the surface. Acceptance is often the quickest and safest way out.

Passengers on a bus

You drive the bus of your life, and the passengers include your thoughts, feelings, and memories. Some of those experiences may try to bully you and tell you which direction to go. However, if you ask them to sit down and be quiet, you may regain control over the bus. 

The path up the mountain

Like a switchback trail, a journey of progress is often not a direct route. Looking at your overall journey instead of worrying about where you are at each moment, you may better understand and appreciate how far you’ve come. 

Setting values

The final phase of ACT involves identifying what values matter to you and setting goals to propel your life toward those values. You may work with your therapist to determine what committed actions you can take to align your life with your values and incite meaning.  

ACT may be used to treat mental health conditions, including but not limited to the following: 

• Anxiety
• Depression
• Obsessive-compulsive disorder (OCD)⁴
• Substance use disorders⁵
• Eating disorders
• Psychosis

This modality may also be helpful for individuals living with other challenges, such as chronic pain, smoking, epilepsy, tinnitus, and workplace stress. Australian Family Physician notes that the treatment broadly applies to several life difficulties, including those that don’t fit into specific diagnostic categories. It may benefit people of all ages and backgrounds who are experiencing stressful life events such as divorce, loss of a loved one, or parenting challenges. 

Acceptance and commitment therapy is considered part of the third wave of cognitive-behavior therapy, emphasizing topics like mindfulness, acceptance, and meta-cognition. Therefore, the treatment may be helpful for people who have not seen progress when trying more traditional types of cognitive-behavioral therapy. In addition, people interested in working to accept, instead of eliminating, unhelpful thoughts may be interested in ACT.

Acceptance and commitment therapy goals differ from other therapy models because they don’t address a specific disorder or symptom. Instead, clients are encouraged to develop flexibility in each of the six core components. Often, the therapist works with them to: 

1. View thoughts as thoughts, not the literal truth of every situation
2. Accept unwanted feelings that accompany difficult actions, especially if they line up with their values
3. Maintain perspective on their thoughts and feelings so they don’t cause urges to partake in maladaptive behaviors
4. Purposefully remain in the present moment
5. Clarify their fundamental hopes and values
6. Commit to taking action that is in line with their values 

Another goal of ACT is to guide clients to consider the workability of their actions. Workability provides awareness about whether behaviors and actions solve mental health challenges and cultivate a life in line with their values. As clients develop greater cognitive flexibility within the core components, they may identify unworkable behaviors without judgment. 

While specific symptoms are not addressed during ACT, a reduction in symptoms often occurs as a byproduct of therapy. 

Because ACT is a relatively new treatment, much of the research surrounding it involves its efficacy as a therapy model. In a review of more than 100 studies examining the impact of ACT, researchers confirmed that ACT has been proven to be an efficacious treatment. It shows positive effects for various conditions, including depression, anxiety, substance use disorders, and pain. Researchers have found it is more beneficial than placebo treatment and more effective than many active intervention modalities outside of cognitive-behavioral therapy.

A recent study investigated the role ACT can play in the mental health of college students. University students may struggle with their mental health and study skills as they adapt to the demands of higher education. After participating in acceptance and commitment therapy, researchers found that the students had improved well-being, increased psychological flexibility, lower stress levels, and better time management.