Acceptance and Commitment Therapy (ACT) is a type of psychological therapy that helps you accept the difficulties that come with life.

There is a growing amount of research evidence that shows ACT to be an effective therapy for anxiety, depression, addictions and relationship difficulties.

ACT is newer form of cognitive-behavioural therapy, often referred to as a “third wave” cognitive-behavioural therapy (behaviourism being the first wave and cognitive therapy the second). Other third wave therapies include Dialectical Behavioural Therapy (DBT) and Compassion Focused Therapy (CFT). What these newer cognitive-behavioural therapies have in common is that they are mindfulness-based therapies.

ACT promotes a mindful awareness of our thoughts and feelings, allowing us to let go of unhelpful thoughts and accept difficult feelings. In ACT this is called psychological flexibility, getting unstuck from our thoughts and being open to our feelings. This psychological flexibility then frees us up to act in ways that are more consistent with our values, the way we would like to be. ACT recognises that struggling with difficult feelings and ruminating on unhelpful thoughts is the root of psychological distress (anxiety, depression, addictions, relationship difficulties etc), that take us away from how we really want to be. ACT therefore addresses this avoidance by fostering a commitment to actions based on our values.

Therapy using the ACT approach focuses on six areas: mindfulness, acceptance, defusion, the conceptualised self, values and committed action.

Mindfulness

Mindfulness is about being present in the here and now. Flexible attention in the now means choosing to pay attention to experiences that are helpful or meaningful – and if they are not, then choosing to move on to other useful events in the now, rather than being caught up in negative judgement or rumination. Anxiety is often focussed on a dreaded future event. Depression is often related to ruminating on the past. Learning to be present through mindfulness is therefore a very helpful intervention for both anxiety and depression.

Acceptance

Experiential avoidance is the process by which we run from or attempt to control our painful thoughts, feelings, or experiences. Whether it be a situation you cannot control, or an emotion that overwhelms, accepting it can allow you to move forward. In ACT, acceptance is choosing to feel with openness and curiosity, so that you can live the kind of life you want to live despite your uncomfortable feelings, as opposed to living a constricted life that focusses only avoiding discomfort.

Defusion

Cognitive fusion means buying into what your thoughts tell you (taking them literally, word for word) and letting what they say control what you do. When we fuse with a thought, we lose sight that it is just a thought. Defusion is when we notice that we are thinking, without getting caught up in it. This allows us to be aware whether these thoughts serve us or not, and to choose whether we give power to our thoughts.

The conceptualised self

In ACT the conceptualized self is the story you tell yourself about who you are and who others are in relation to you. We all have these stories, and held lightly, they can even be helpful. However, when we hold tightly to our story, it becomes difficult to be honests with ourselves or to make room for other thoughts, feelings or behaviours that don’t fit the story but might be helpful. ACT aims to help a person connect with an alternative perspective-taking self. This sense of self allows us to see that we are more than the stories we tell ourselves. It allows us to see that we belong not because we are special, but because we are human.

Values

Values are chosen qualities of being and doing, such as being a caring parent, a dependable friend, a supportive partner, or being loyal, honest and courageous. Living in accordance with our values never finishes; it is a lifelong journey. Your values are your own. ACT helps you to become more fully aware what they are, so that they can guide you in your way forward.

Action

ACT is a bahavioural therapy that builds your commitment to taking action in accordance with your values. Committed action is a process of competently and continuously building good habits in small steps.

ACT therapy starts with teaching these six processes and noticing how they apply to the difficulties you wish to work on in therapy. What then follows are therapeutic conversations where the therapist coaches you how to apply these six processes in your daily living.

Further Reading

A Liberated Mind: the essential guide to ACT (2019) by Steven C. Hayes