Acceptance and Commitment Therapy or ACT (pronounced “act”) is a therapeutic theory that works with individuals to decrease suffering and emotional pain and improve your ability to approach life problems through mindfulness and acceptance. ACT is based on relational frame theory (RFT), and was developed from a school of research that focused on human language and cognition or thinking. RFT suggests that the rational skills used by the human mind with the attempt to solve problems, are not only ineffective in helping people overcome psychological pain and emotions but in fact increase the amount of emotional pain and suffering.

The use of ACT has been researched and supported by evidence for the treatment of substance abuse, psychosis, anxiety, depression, chronic pain, and eating disorders, meaning that it works on a wide variety of problems. ACT therapy was developed with the goal of teaching people that although psychological pain is normal, we can learn ways to live healthier, fuller lives by shifting the way we think about pain.

How does ACT, Acceptance and Commitment Therapy work?

At the very foundation of ACT is an emphasis on values, forgiveness, acceptance, compassion and living in the present moment. When working with a therapist using ACT, exploration of current emotional or chronic pain and ways of attempting to manage the pain is explored with the ultimate goal of moving towards an acceptance that life is difficult. ACT argues that life is hard and that pain is normal and inevitably will accompany some situations. Rather than attempting to avoid pain and difficulty through distracting or challenging of thoughts, ACT works towards truly acknowledging and accepting of the pain. For example, as we age it is natural to experience physical pain, body aches and muscle soreness, and any “magic pill” that slows down the aging process and the subsequent pain is unnatural. Similarly, with heartbreak, loss and grief, pain is normal and to be expected. ACT focuses on first accepting that life is difficult and rather than attempting to directly change or stop unwanted and uncomfortable thoughts and feelings, people must be encouraged to develop and new and compassionate relationship with those difficult experiences.

Following the acceptance of difficulty and the development of a compassionate way of being with pain, ACT looks towards developing a value system as values-congruent living is the desired outcome of working with ACT. Through exploring values with an ACT therapist, a client is guided in answering questions that include “What do I want to be doing with my life?” and “What do I stand for?” The purpose of developing this value system is that ACT assumes that the quality of life is dependent on a mindful action that is driven by the personal value system. Values act as leading principles that guide and motivate an individual on a daily and ongoing basis and provides the opportunity for individuals to act in a manner that is more consistent with what is most important to them. Through these more mindful actions, an individual can commit to a new behavior, regardless of the presence of symptoms, and ultimately live a more meaningful life.

Acceptance therapy for anxiety

ACT, which has been shown to be useful in treating anxiety, is about both acceptance and change. While the emphasis is not in symptom reduction, through acceptance of anxious thoughts, an individual can be guided towards change. The emphasis in ACT is not about changing or eliminating the symptoms, instead, it is about changing the relationship with the symptoms. The paradox is that through accepting and acknowledging or “leaning towards” the anxiety, a person, in fact, experiences less anxiety and suffering and the result is symptom reduction.

This can be thought of through the metaphor of quicksand. If you are ever to fall into a pool of quicksand, the last thing you want to do is fight and struggle, as the more you fight, the deeper you sink and the faster you are sucked under. In quicksand, struggling is the worst thing that you can do. To effectively escape quicksand and survive the struggle, you must first stop struggling and relax. As you lie back and spread out your arms, you are able to float on the surface and avoid being sucked in. This concept can be applied to anxiety disorders, as anxious or negative thoughts are in essence quicksand. As you feel lost, confused or fearful, the more your mind fights against the anxiety and attempts to end it, the deeper you sink in to your mind and the same feelings you are trying to escape.

After you stop fighting your emotions and relax, then what? The quicksand metaphor only goes so far as to prevent being sucked under, but it seems to stop once you are laying on the top of the quicksand and escape is still necessary. This is where ACT introduces the idea of language in creating our suffering. Our language creates suffering as it allows us to rank and rate our experiences as good or bad, black and white, happy or unhappy. By being present in the moment and stopping ourselves from falling victim to this rating system, we are able to escape the downward spiral. ACT allows an individual to create a detached relationship with their thoughts and feelings, and through a mindfulness practice allows for the alleviation of anxiety, or any other emotional experience. When a person is having thoughts such as “I’m a terrible person”, “life is so miserable” or “I’ll never be happy”, mindfulness and ACT transitions those thoughts to “I’m having the thought that I am a terrible person/life is so miserable/I’ll never be happy”. It is in this detachment, that you are able to roll right off of the patch of quicksand and stand again on stable ground.

The concepts of this behavioral therapy are relatively new and foreign to most people, and there is a paradox that on the surface is difficult to grasp given our normal ways of thinking. However, through guidance, practice, and support with a therapist who has a high level of acceptance and commitment therapy training at APEX Recovery, our clients can find freedom from suffering and live a more fulfilling life through mindfulness and acceptance.