Acceptance Commitment Therapy (ACT) – What is it, Techniques, Exercises and More

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In recent years, acceptance and commitment therapy has received much attention from clinical psychologists and academicians. It is an action-oriented approach to treating mental health issues rooted in traditional cognitive behavior therapy and other methods. 

Acceptance and commitment therapy teaches clients to face their struggles and emotions and move forward with their circumstances. This is the acceptance part of the therapy. Clients also commit to making changes to their behavior and tracking their progress on a date today basis. Several psychologists and psychotherapists use this method to treat depression, anxiety, and substance use disorders. 

In this article, let us take a quick look at acceptance and commitment therapy and what it entails for you as a client. 

What is Acceptance Commitment Therapy (ACT)?

Acceptance and commitment theory is an evidence-based treatment for many psychological conditions. It was developed in the 1980s by Steven C. Hayes, a psychologist and professor. He was inspired by his journey with panic attacks, which he tended to avoid and escape from. 

In due course, he vowed not to run away from panic attacks and instead accept his distress and work on them. The basis of ACT lies in his initial experiences and the insight that humans tend to avoid negative emotions and distress. 

By accepting what is unpleasant and distressing and committing to specific behavioral changes, Hayes noted that we could make a transformational shift toward recovery. Since then, it has been used to treat various conditions such as stress, anxiety, depression, eating disorders, and chronic pain. 

Acceptance and commitment therapy techniques

Acceptance and commitment therapy follows a well-structured technique that revolves around your therapist listening to your problems and helping you understand how to listen to yourself talk. 

Here are the basic steps:

  • The therapist teaches you to recognize specific vocabulary regarding your psychological limitations, trauma, relationship issues, etc.
  • Train you to recognize which problem requires immediate action and if you can accept the situation as it is. 
  • The therapist works with you to identify behavioral changes that are realistically possible for you to commit to. 
  • During subsequent sessions, your therapist will monitor your progress and identify where you find difficulties in accepting distress and committing to making changes. 

The process helps you develop emotional and psychological flexibility and enables you to change your thinking process in ways conducive to better mental health. 

Acceptance and commitment therapy exercises

Exercises that lead to transformative change in acceptance and commitment therapy can be categorized under the six core processes. These include the following: 

  1. Acceptance – Exercises in this domain focus on helping you identify dysfunctional thoughts and emotions and accept them unconditionally. This may happen during a therapy session or as part of journaling.
  2. Cognitive defusion – In this process, you learn to separate yourself from your thoughts and emotions and observe them without judgment. There is an element of mindfulness involved in this exercise. 
  3. Being present – Building on the concepts of mindfulness, this stage helps you to be in the present without focusing on the past or the future. You learn to accept your situation without judging it or reacting negatively. 
  4. Self as context – This stage involves exercises that help you to situate your experiences and circumstances according to your unique environment. It helps to put your negative thoughts and emotions in context. 
  5. Values – During this stage, you learn to choose personal values that matter the most to you to make effective changes that lead to self-improvement. After all, you will only be motivated to make changes if your efforts are aligned with your values. 
  6. Committed action – This is ACT’s primary focus and helps you take action on identified behaviors, thoughts, and feelings. Your therapist will customize tasks that you can complete after the session. You aim to commit to making those changes that lead to a transformational shift. 

Problems with acceptance and commitment therapy

Although acceptance and commitment therapy (ACT) is proposed as a newer and different form of treatment for mental health issues, it is essentially a form of cognitive behavior therapy. Hofmann and Asmundson compared and contrasted CBT with ACT and suggested that they both follow similar theoretical models. They further noted that the criticisms of CBT by ACT proponents do not hold much weight. 

Despite the objections, many studies support ACT’s efficacy, especially in short-duration therapeutic models. If you don’t have time to invest in a full-fledged CBT treatment, ACT can be an accessible model that incorporates mindfulness elements. However, it is essential to find a therapist who is certified and trained in ACT. 

Acceptance and commitment therapy for depression

Twohig and Levin (2017) reviewed the core features of ACT’s theoretical model of psychopathology and conducted a systematic review of randomized controlled trials (RCTs) for depression and anxiety. 

After analyzing 36 RCTs, the authors found that ACT enhances psychological flexibility leading to improvement in the symptoms of depression and anxiety. They also found that the efficacy was similar to CBT. In short, if you cannot find a traditional therapist or clinical psychologist and are looking to address your depressive symptoms, ACT might be a good option. 

Acceptance and commitment therapy for OCD

Bluett et al. (2014) examined existing literature on acceptance and commitment therapy’s efficacy in treating OCD. Their findings were primarily positive and comparable with CBT. 

However, it is essential to note that OCD is a severe psychiatric illness that requires close monitoring of symptoms and signs. If ACT does not help you, traditional forms of treatment, such as Exposure and Response Prevention (ERP), might be better options. 

Acceptance and commitment therapy for trauma

McLean and Follette (2016) wrote that ACT, at its core, tried to understand the human condition, which can be traumatic at times. They proposed that ACT provides the tools to heal trauma in a non-pathologizing approach. This means that instead of considering trauma as a clinical condition, ACT helps you accept what occurred previously and commit to improving your current situation. 

However, post-traumatic stress disorder (PTSD) and certain traumatogenic personality disorders, such as borderline personality disorder, require more intensive treatments than ACT. 

Concluding thoughts about acceptance and commitment therapy (ACT)

In short, ACT is an effective therapeutic model to help you understand your thoughts and feelings and take responsibility for your situation. Further, it also enables you to commit to changing your behavior so that you eventually start to feel better. 

Although ACT provides a convincing approach to treating anxiety, depression, and other psychological conditions, it may not be suitable for more serious psychiatric disorders. 

Before deciding which treatment model is ideal for your situation, you must undergo a comprehensive psychological evaluation so that the clinical psychologist or the psychiatrist can make the right intervention-related decision. 

Jaiyant Cavale, Clinical Psychologist
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