Would you like to live a more rich, full, meaningful life? Would you like to live a life in accordance with your values? Would you like to learn how to become more mindful in your life and psychologically flexible? Then you might be interested in trying Acceptance and Commitment Therapy — also known as ACT.

What is ACT?

ACT is considered part of a “third wave” of behavioural therapies, alongside Dialectical Behavioural Therapy (DBT), Mindfulness-Based Cognitive Therapy (MBCT), and Mindfulness-Based Stress Reduction (MBSR). It is under the umbrella of Cognitive Behavioural Therapy (CBT) but it largely differs from CBT. The goal of ACT is to create a rich, full, and meaningful life guided by values whilst learning to accept the inevitable suffering that comes in life. Rather than a focus on trying to control or eliminate difficult thoughts and feelings, ACT aims to assist one to be able to allow, accept, and make room for difficult thoughts and feelings.

The aim of ACT is not to eliminate symptoms but to change the relationship one has with their suffering, which often leads to a by-product of symptom reduction. ACT may seem counterintuitive upon first glance. You might find it strange that your therapist is telling you that the aim of therapy is not to get rid of your anxiety or depression, but it’s for good reason.

The more we tend to fight with or try to get rid of unwanted thoughts and feelings, the more we struggle with them. This process is called experiential avoidance in ACT. Often, typical coping strategies eliminate unwanted thoughts and feelings in the short-term, but rarely are they effective in the long-term and they can even be self-destructive. For example, using alcohol to calm oneself down might be helpful in the moment, but it’s unlikely to improve the person’s situation in the long-term. Instead of getting rid of difficult thoughts and feelings, ACT aims to reduce the influence that unwanted thoughts and feelings have over our behaviours.

Six core processes of ACT

There are six core processes of ACT which make up a model called the Hexaflex. Each process has its own exercises, tools, skills, and metaphors.

Cognitive defusion (watch your thinking)

Defusion means learning how to “step back” and separate from our thoughts, memories, and images. It’s a way of creating space between us and our thoughts so that we can mindfully choose how we want to respond to them.

Acceptance (open up)

Acceptance means making room for painful emotions, sensations, and feelings. It involves opening up and allowing the emotions to be rather than fighting, resisting, running from, or getting overwhelmed by them.

Self-as-context (pure awareness)

Self-as-context is the aspect of yourself that is aware of what we are thinking, feeling, sensing, or doing in any moment. It is the “you” that is aware of all of the thoughts and experiences that you have.

Values (know what matters)

Values are what you want your life to be about and what you want your life to stand for. In ACT, being clear about your values is an essential step to creating a life that is meaningful.

Contacting the present moment (be here now)

Being psychologically present. It’s the opposite of acting on “automatic pilot.”

Committed action (do what it takes)

Taking effective action guided by your values. Doing the things that matter to you to create a more rich, full, and meaningful life.

What to expect from an ACT session

Similar to other therapies, the therapeutic relationship in ACT is prioritized. ACT takes the stance that therapists and clients are fellow travelers on the same human journey. ACT tends to be experiential — your therapist may guide you through exercises to help you grasp the concepts and apply them to your life. A typical session might involve a mindfulness exercise, the use of metaphors, paradoxes, exercises to help you identify your values, and tools to use outside of sessions.

What ACT is used to treat

ACT is considered an evidence-based treatment, with the strongest evidence for anxiety, depression, and chronic pain, and growing evidence in substance use, OCD, and other transdiagnostic concerns (A-Tjak et al., 2015; Gloster et al., 2020). It is also widely used as a framework for everyday concerns — perfectionism, self-criticism, life transitions, and the work of clarifying what you want a life to be about.

Further reading

  • The Happiness Trap — Russ Harris
  • ACT Made Simple — Russ Harris
  • The Worry Trap — Chad LeJeune

If you’d like to try ACT, book a free 20-minute consult with our practice.

References

A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36. https://doi.org/10.1159/000365764

Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009

Harris, R. (2009). ACT Made Simple. New Harbinger.

Harris, R. (2011). Embracing your demons: an overview of acceptance and commitment therapy.

Hayes, S. (2021). State of the ACT evidence.