Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) is an action-oriented approach to psychotherapy that stems from traditional behavior therapy and cognitive behavioral therapy. Clients learn to stop avoiding, denying, and struggling with their inner emotions and, instead, accept that these deeper feelings are appropriate responses to certain situations that should not prevent them from moving forward in their lives. With this understanding, clients begin to accept their hardships and commit to making necessary changes in their behavior, regardless of what is going on in their lives and how they feel about it.

Acceptance and commitment therapy was developed in the 1980s by psychologist Steven C. Hayes, a professor at the University of Nevada. The ideas that coalesced into Acceptance and commitment therapy emerged from Hayes’s own experience, particularly his history of panic attacks. Eventually, he vowed that he would no longer run from himself—he would accept himself and his experiences.

“We as a culture seem to be dedicated to the idea that ‘negative’ human emotions need to be fixed, managed, or changed—not experienced as part of a whole life. We are treating our own lives as problems to be solved as if we can sort through our experiences for the ones we like and throw out the rest,” Hayes writes in a Psychology Today post. “Acceptance, mindfulness, and values are key psychological tools needed for that transformative shift.”

When It’s Used

Acceptance and commitment therapy can help treat many mental and physical conditions. These include:

  • Anxiety disorders
  • Depression
  • Obsessive-compulsive disorder
  • Psychosis
  • Eating disorders
  • Substance use disorders
  • Workplace stress
  • Chronic pain

What to Expect

Working with a therapist, you will learn to listen to your own self-talk or the way you talk to yourself specifically about traumatic events, problematic relationships, physical limitations, or other challenges. You can then decide if a problem requires immediate action and change or if it can, or must, be accepted for what it is while you learn to make behavioral changes that can modify the situation. You may look at what hasn’t worked for you in the past, and the therapist can help you stop repeating thought patterns and behaviors that can cause you more problems in the long run. Once you have faced and accepted your current challenges, you can make a commitment to stop fighting your past and your emotions and, instead, start practicing more confident and optimistic behavior, based on your personal values and goals.

Acceptance and commitment therapy aims to develop and expand psychological flexibility. Psychological flexibility encompasses emotional openness and the ability to adapt your thoughts and behaviors to better align with your values and goals.

The six core processes that promote psychological flexibility are:

1. Acceptance
Acceptance involves acknowledging and embracing the full range of your thoughts and emotions rather than trying to avoid, deny, or alter them.

2. Cognitive Defusion
Cognitive defusion involves distancing yourself from and changing the way you react to distressing thoughts and feelings, which will mitigate their harmful effects. Techniques for cognitive defusion include observing a thought without judgment, singing the thought, and labeling the automatic response that you have.

3. Being Present
Being present involves being mindful in the present moment and observing your thoughts and feelings without judging them or trying to change them; experiencing events clearly and directly can help promote behavior change.

4. Self as Context
Self as context is an idea that expands the notion of self and identity; it purports that people are more than their thoughts, feelings, and experiences.

5. Values
Values encompass choosing personal values in different domains and striving to live according to those principles. This stands in contrast to actions driven by the desire to avoid distress or adhere to other people’s expectations, for example.

6. Committed Action
Committed action involves taking concrete steps to incorporate changes that will align with your values and lead to positive change. This may involve goal setting, exposure to difficult thoughts or experiences, and skill development.

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