Most people, especially those who work within psychology, mental health and well-being, have heard of Cognitive Behavioural Therapy (CBT). CBT is a form of therapy that encourages the client to change the way they think about situations, and therefore change the way they behave in reaction to them. Acceptance and Commitment Therapy (ACT) is a branch of CBT which is growing in popularity alongside other behavioural therapies such as mindfulness based CBT. I have seen first-hand with the patients I work with how ACT can change the way patients think, and seen them recover from their mental health disorders to the point of discharge. So, like my post on mindfulness, this is an educational blog post in order to inform you about ACT as a type of therapy that everyone should be aware of and everyone can adapt into their lives in order to fully engage with every moment of every day.
As mentioned briefly above, ACT is a type of therapy that is a branch of CBT. ACT was designed to overcome the weaknesses of CBT. The main difference between the two of them is where CBT encourages the client to overcome negativity and difficulty in their thoughts, feelings and experiences by changing the way they think, ACT looks to accept the negativity and difficulties and help the individual to learn to cope with them.
ACT looks at the clients personality, character traits, values and behaviours to help them to reduce the avoidant coping styles (such as repression, self harm, and simply ignoring what is happening) and instead addresses the situation, and also addresses the patients commitment to making changes.
At the simplest level, ACT works off two main types of strategies; acceptance and defusion.
Acceptance -> ACT therapists believe that accepting things can help individuals move on. Individuals should accept uncontrollable situations, personality traits, and overwhelming emotions. Therefore ACT believes that individuals should accept reality and work with what you have.
Some acceptance strategies include:
- Letting thoughts and feelings happen without the impulse to act on them (this acceptance strategy is used a lot with patients who tend to self harm in response to their thoughts)
- Observing your weaknesses, but also your strengths
- Giving yourself permission to not be good at everything – no one can be perfect.
- Acknowledging difficulty in life without avoiding or escaping it – accepting that everyones life has it’s ups and downs.
Defusion -> ACT therapists refer to realising thoughts and feelings for what they are really like as defusion. It is the act of cognitively defusing a psychologically heightened experience.
Some defusion strategies include:
- Observing what you are feeling – the physical sensations
- How are you talking to yourself as these feelings are experienced?
- What interpretations are you making? Are they based in reality?
- Counter your negative self talk with realistic self talk
- Now re-evaluate the experience
As you may be able to figure out, ACT uses mindfulness techniques. It is about being aware of the here and now, the sensations that you are feeling, and how these relate to what your thoughts are telling you. It helps patients with illnesses such as severe depressive disorder, and psychosis/psychotic symptoms to connect to reality and to challenge what their thoughts are telling them.
For example; a patient with depressive disorder may not believe that they are ‘good enough’, despite having a good group of family and friends, having good grades from school, and a good job. Everything in reality says they are good but their mind does not, so ACT helps them to acknowledge their reality and to re-evaluate their thoughts based on this. It can also help them to accept that they may not be good in certain aspects of their life, but they don’t have to be good at everything to be good enough.
So that is the simplest explanation of ACT, however when you look into it in more detail ACT works off several different aspects of a person’s sense of self in order to reinforce these ideas and to increase something that is called psychological flexibility.
Psychological flexibility is the act of contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behaviour in the service of chosen values (Hayes, S., unknown date).
What a mouthful, right?
Basically, psychological flexibility is the ability to be able to adapt to situations, and change behaviour in order to do so, based on your own personal set of values which makes you an individual. ACT works off the following framework (Hayes, S et al., 2013) which may seem complicated now, but don’t worry, I’ll go through it point by point.
This first figure is called psychological inflexibility. This is what patients may appear to have at the beginning of therapy, and therefore require ACT. This is what ACT is aiming to change.
This second figure is called psychological flexibility. This is what both the client and the ACT therapist is aiming to achieve, together.
To help the explanation of these figures it is important to know that each corner of the hexagon on the first figure relates directly to the same corner of the hexagon on the second figure. We will start with cognitive fusion/defusion, and work our way around the hexagons clockwise.
- Cognitive fusion is an aspect that an individual with psychological inflexibility would have.This is where individuals would take their thoughts literally, without noticing the process of actually thinking them. Their thoughts occur in their head, and they don’t think about how they came to think it, just that because they think it, it must be true
ACT therapists would use defusion to help counter-act cognitive fusion and help the client gain psychological flexibility. Defusion, as explained earlier, is where contact with the ongoing process of thinking is increased, rather than just noticing the end product of thoughts. The individual would learn to be aware that they are in the process of thinking, so be aware of how they come to have the thoughts they do.
- Experiential avoidance contributes to a client having psychological inflexibility. This is the attempt to alter the form, frequency or intensity of private experiences. These experiences can be thoughts, feelings, and bodily sensations. It is a form of avoidance learning. It means avoiding what the private experiences really are, what they mean, and how they really effect you, even when doing this is ineffective.
To have psychological flexibility the client needs to learn how to accept the private experiences. They need to adopt an open, receptive and flexible posture in terms of moment-to-moment experiences. This can be done by using some of the acceptance strategies explained earlier.
- Psychological inflexibility involves the individual losing flexible contact with the present. So what becomes central is being elsewhere, wherever the difficult events are not occurring. This links directly to experiential avoidance.
In order to tackle this, clients need to have contact with the present moment. This relates to mindfulness, in which clients need to have their attention brought to the present moment in a focussed and flexible manner. This reduces the risk of an individual avoiding their difficult events, and facing them instead.
- Individuals with psychological inflexibility tend to have an attachment to a conceptualised self. This is where the individual becomes attached to an idea about who they are as a person. This is based on the negative thoughts and situations they have successfully avoided, and the evaluative stories about who they are. In order to gain psychological flexibility the client must have a sense of their self as a perspective in which to view their life from. The clients will be able to see their inner experiences as distinct from their consciousness (so, the negative experiences do not have to be what represent them as a person, but at the same time they are not totally avoided or repressed), and the experiences are not seen as a threat to their sense of self but as something to accept and cope with and live with.
- If a client has psychological inflexibility then they tend to struggle with their values. This is a very important aspect of ACT. Individuals with psychologically inflexibility are usually unable to identify their values (what is important to them in life), or the values they have in life are not those of their own choice but have been (sometimes without realising) chosen for them by those closest to them (parents, partners, bosses) or they have chosen their values through social compliance (what the individual thinks that society as a whole finds important), or they are choices based on avoidance.
Increasing the ability to persist or change their behaviour based on their values is an important aspect of psychological flexibility. Therefore the individual usually needs support in identifying their values. Values help the other processes of ACT (those previously discussed) as having values in life gives meaning to the importance of psychological flexibility and increases the chances of the individual being committed to therapy.
- This leads on to the final point of each hexagon. ACT encourages the development of effective action linked to chosen values to decrease the chances of inactivity, impulsivity or avoidance persistence. Individuals who embark on ACT need to be committed to the change they are about to make in their life, and also committed to everything that they find important in their life. To help this ACT therapists involve work linked to short, medium and long term behaviour goals so individuals can see how their behaviour is affecting the way they live their life.
The overall aim of ACT is to improve the way an individual views their life, and to give them healthy coping strategies when life gives them a bit of shit. It is not about changing what is unchangeable, or avoiding what you don’t want to face. It’s about accepting who you are as a person, based on your personality and values in life, and how you can use this in order to accept difficulties, focus on the present and commit to the important things in life.
Below is another version of the psychological flexibility hexagon which clearly highlights the aims of ACT and what it means to be psychologically flexible.
If you have any further questions about ACT, or need any extra explanation (I understand that this blog post is very wordy!) then feel free to comment or contact me and I will try my best to help 🙂
Guarna, J. (2009). Comparing ACT and CBT. Retrieved from https://contextualscience.org/comparing_act_and_cbt
Hayes, S. ACT. Retrieved from https://contextualscience.org/act
Hayes, S. et al., (2013) Acceptance and Commitment Therapy and Contextual Behavioural Science: Examining the progress of a Distinctive Model of behavioural and Cognitive Therapy. Behavioural therapy, 144(2), 180-198.
Serani, D. (2011, Feb 22). Acceptance and Commitment Therapy. Retrieved from https://www.psychologytoday.com/blog/two-takes-depression/201102/acceptance-and-commitment-therapy/