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Many of our psychologists use ACT when working with teens and adults online throughout the United States in North Carolina, Georgia, Texas, Colorado, Florida, and several other states under PSYPACT.
“The more we try to avoid the basic reality that all human life involves pain, the more we are likely to struggle with that pain when it arises, thereby creating even more suffering.”
What’s included in this Acceptance & Commitment Therapy article?
What is ACT?
How is ACT Different from CBT?
What Makes ACT Unique?
Dr. Russ Harris talks about how the human mind has evolved for in a way that creates psychological suffering to help us survive.
(pronounced to rhyme with “fact”)
ACT is a powerful, evidence-based psychological intervention that uses acceptance and mindfulness strategies. Using acceptance & commitment therapy, together with commitment and behavior change, increases psychological flexibility.
ACT is a more recent type of cognitive-behavioral therapy (CBT). CBT has been linked to measurable improvements in brain functioning. Like DBT, ACT is part of the “third-wave” of CBT modalities.
The main goal of ACT is to increase psychological flexibility so we can do more of what matters to us.
Both ACT and CBT are behaviorally-based therapies. That means they target changing your behavior and addressing the relationship between your thoughts, emotions, and behavior. ACT is generally considered different from CBT in a few important ways.
Acceptance & Commitment Therapy
is more focused on changing behavior, goal-setting, and taking action (in the name!) than CBT.
always integrates awareness and mindfulness and values work to facilitate action.
views how to handle and address thoughts differently than CBT (see below).
ACT has six core processes (described below), yet the basic formula for Acceptance & Commitment Therapy is simple:
1) A = Accept your thoughts and feelings and be present
2) C = Connect with your values
3) T = Take effective action
The premise of ACT is radical, no doubt. Yet it works! And it’s backed by a tremendous body of research including almost 1,000 randomized controlled trials (RCTs), the highest standard of clinical research at this time.
“The impediment to action advances action. What stands in the way becomes the way.”
Pain isn’t the problem. Emotions aren’t the problem. Emotions give us powerful information about what is working and what isn’t. Fear is energy that can be harnessed and used for your benefit.
But the most common thing you will hear people say is, “I wish I could stop being anxious” or “I wish I could get rid of my anxiety.” Well, besides the fact that if you truly lost all of your anxiety, you would likely not be able to cross the street and would likely never be able to plan what you’d have for dinner, there is another downside to that agenda.
Pain vs. Suffering
Pain is not the problem. It is a part of life. For instance, love comes with loss. Sadness highlights the things that give us joy. The only way to avoid grief entirely is not to love and not have relationships. Pain is the price of admission to a rich and meaningful life.
We suffer because of all the things we do to avoid and escape pain. That struggle creates suffering. Ironically, our attempts to chase happiness as the be-all and end-all, based on the belief that anything less than happiness is a failure, actually keep us unhappy. Mind. Blown.
What are the Core Processes of Acceptance & Commitment Therapy?
Acceptance
Defusion
Getting Present
Flexible Perspective-Taking for Self & Others
Values Clarification
Goal-Setting and Values-Based Committed Action
Extra Component: Self-Compassion
Acceptance is the active awareness and acknowledgment of our internal experiences (e.g., thoughts, emotions, urges, sensations, and memories) as they occur. When we take action or make decisions in line with our values even when it’s hard, this is called willingness.
It is the alternative to our human default mode of experiential avoidance of anything that causes us pain or discomfort. Unlike many other models of therapy that focus on getting rid of or controlling these experiences, ACT focuses on “making room” for them.
With acceptance, we drop the rope, so to speak, and the struggle. ACT considers more recent neuroscience research that suppressing thoughts and emotions actually increases their intensity and negative impact. So, avoiding (“Don’t think about it”), denying it (“It’s not that big of a deal”), or compartmentalizing it (“You just need to suck this up and deal”) not only don’t work but also make it worse for us in the long run.
Defusion is the process of changing the way you interact with or relate to your thoughts by changing the context or function, instead of the content. There is a shift from getting “hooked” by our thoughts, judgments, and our “stories” towards noticing, observing, and distancing ourselves from the context.
Without going into the more complex neurolinguistics and behavioral theory of relational frame theory upon which ACT is based, the premise is that we have a history with language.
It has enabled us to be the top of the food chain despite our not being the strongest or fastest. Language allows us to connect words to objects and experiences. We can’t create, develop, research, or build without language.
Yet language is so powerful that, you forget what you’ve learned through language vs. IRL experience.
If you read this word, lemon, you can visualize a yellow fruit. That can be handy except when it’s not. If you try to break that connection, visualize it as pink fruit. You will notice the difficulty. If I tell you it’s sour, though, you may also decide that you don’t like lemons without ever tasting one.
Yet you can lessen the strength of the word-image association with some everyday automatic, annoying thoughts.
** Don’t use these techniques with shame- or trauma-related thoughts. These are intended for thoughts that don’t cut deep.
Let’s take another thought – “I am a failure.” If you say that sentence aloud right now, if you’re like most people, you’ll feel an uncomfortable sensation immediately. In my network of language, that word may instantly connect to painful images and memories. Rewind back to when I missed the winning shot or lost that friend. That phrase has merely 4 words in it. Yet, it is so powerful because of its learned associations.
Now, the thought “I’m a failure” goes way beyond four words. It’s potentially hundreds of memories that now trigger memories, and on it on it goes.
Defusion helps us observe a thought without buying it and getting tangled in it.
One basic way to defuse a thought is to distance yourself from it with observational language. So, the thought “I’m a failure” becomes the “I’m noticing the thought that I’m a failure” or “My brain is telling me I’m a failure” or “Here’s the old “I’m a failure” story.”
Another way to defuse a thought, if it feels appropriate and aligned, is to play around with some type of visualization taking the feared thing and transforming its nature or context like Henry Winkler with his rival in Waterboy or Ron Weasley with the boggart using the Ridikulus charm in Prisoner of Azkaban (not like Harry, definitely not like Harry).
Yet another way to defuse a thought would be that I could repeat it over and over again until it becomes meaningless or type it – FAILURE, FAILURE, FAILURE, FAILURE, FAILURE, FAILURE. or translate it into French (échec) or Chinese (失敗).th
Defusion does not aim to make light of or demean painful thoughts. It takes the power out of these associations and helps you see words as just letters and sounds.
(**If you have experienced trauma, there are different skills to use here.)
From a cognitive neuroscience perspective, we are also shifting the mind from the default mode network of rumination and mind-wandering to the task-positive network that allows flexible focus and task completion.
Present Moment Awareness is a central component of ACT and is the process of consciously paying attention to and engaging and connecting with what is happening in the moment.
Without awareness, intentional change can’t happen.
Awareness is essential for emotion regulation. From a neuroscience perspective, when you are aware of the physical sensations of the stress response, you can then initiate actions that will activate the parasympathetic nervous system (PNS) (or “rest and digest, feed and breed” system) which moderates and downregulates the stress response by inhibiting the sympathetic nervous system (SNS) (or “fight or flight”) and HPA axis.
From a cognitive neuroscience perspective, we are also shifting the mind from the default mode network of rumination and mind-wandering to the task-positive network that allows flexible focus and task completion.
LET ME REPEAT FOR THOSE IN THE BACK ROW – you don’t have to meditate for an hour or even 10 minutes to be mindful. is it ok to do a 10- or 20-minute mindfulness meditation? Absolutely! But the point is that you don’t “have to” do that.
Based on recent meta-analyses (a large study of studies), only a very small portion of the effects of mindfulness are due to the length of the meditation sessions.
Some ACT coaches and therapists do include this in their approach. If my clients are interested in this as an advanced practice, I do too. However, it’s not required. In my practice, typically, I focus on shorter, more practical exercises that you can use in your daily life to rewire your brain to activate the observing system of the brain, which will be discussed next. Although I personally practice a more robust mindfulness practice, there are benefits to more strategic approaches, and my emphasis is on doing what is most workable and sustainable for you.
FLEXIBLE PERSPECTIVE TAKING OR SELF-AS-CONTEXT
Perspective-taking is the process of understanding the difference between that part of you that experiences and observes things in the physical world (self-as-context for experience) and the part of us that has thoughts, feelings, judgments, memories, fantasies, and sensations about you and your experience (self-as-content for experience).
When we get caught up in stories like “I’m not a good parent” or “I’m not the kind of person they promote here,” they can start to substitute for real-world experience. I start to act “as if” I’m not a good parent or good at work.
It’s like putting on a virtual reality headset and forgetting you have it on. You are playing out stories about the future without any experience. You see yourself in terms of a story, not real life.
This skill is learning:
1) when you’ve got the VR headset on, especially in a certain context or relationship and knowing how to take it off and connect with the real world
2) when other people have their VR headset on, and are not seeing you as you are, but as they are and knowing how to change your behavior accordingly
He asked me to play football. I immediately shrugged, and in my head and pretty quickly aloud, I said, “I can’t play football.” One of the hazards of parenting as a psychologist is that your children become way smarter than you. He said, “Mom like you literally can’t play football? You have arms and legs, and you’re an athlete. Come on.”
That’s how quickly it happens. I substituted my belief for the experience. I’ve played touch football many times and have enjoyed it, but it’s not among my favorite sports to do (although I love to watch college football!), and I rarely do it.
When a client wants to do something, and it aligns with their values, and they tell me, “I can’t do it because of X.” If they want to, our discussion would be around something like, “Would you be willing to try it and collect some data on how it goes?” It’s showing yourself in real life, not telling yourself.
(Son applies Acceptance & Commitment Therapy skills better than psychologist mom)
Me: “I can’t play football”
Teen Son: “Mom, like you, literally can’t play football? You have arms and legs, and you’re an athlete. Come on.”
(Son applies Acceptance & Commitment Therapy skills better than psychologist mom)
VALUES
Simply put, values are what is important to you.
Values have been defined as “desired qualities of ongoing actions” (Russ Harris, 2009), which means how you want to be in the world. What kind of human, parent, partner, co-worker, supervisor, friend, etc., do you want to be right now?
Values are the compass for the committed action of ACT.
Yet, determining what is and isn’t a value is often unclear. Please check out my blog article on the importance of values and values-based living.
Identifying and following your values is part of living by your “inner scorecard,” as Warren Buffett has called it.
GOAL-SETTING AND COMMITTED ACTION or (DO WHAT IT TAKES)
Goal setting and committed action are those processes that involve planning and committed action towards your personal values.
In ACT, the goal is not insight or understanding or “getting rid” of emotions.
Humans LOVE to “understand” and crave certainty, but it can be a trap.
In the end, understanding isn’t action in the real world. Certainty doesn’t matter if it doesn’t stand for workable action.
We also love to have goals to get rid of things.
In ACT, there’s a great saying: if a dead person can do it better than you, then it’s probably not a worthy or realistic goal for a human. And human beings can’t get rid of anxiety near as well as dead people. And if we got rid of all of our anxiety, we’d be dead because we wouldn’t be afraid of speeding cars or snakes.
The goal is a rich and fulfilling life, which we achieve through action—specifically, acting in line with our values day-to-day. Sometimes, we discuss this from the perspective of the “Choice Point” model or the Matrix or Life Map models (Bailey, Ciarrochi, and Harris 2013).
Prioritize the most important ones in the moment. Name the actions that move you closer towards your values (TOWARDS MOVES) and what move you away (AWAY MOVES)?
What is one thing you can do right now or if you want to go further with planning, tomorrow, next week, next month, etc. to move towards your values?
Yet goals must be values-driven. If we let the goals lead us, then, as Russ Harris says, “no matter what you have, it’s never enough.”
SELF-COMPASSION
Self-compassion is not one of the six original skills in ACT. However, it’s incorporated by most ACT practitioners, especially those who work with shame and trauma.
Self-compassion means being present with your STUF (sensation, thoughts, urges, and feelings) with curiosity and non-judgment, treating yourself with genuine kindness, and viewing yourself as connected to humanity, not isolated from it.
Self-compassion is different from self-esteem, which we do not want more of. Why? High self-esteem is not consistent with a performance mindset, and it relies on what others think of us, not is
Self-compassion is the hardest skill to master in my experience in life and work, and it packs the biggest punch.
Dr. Jan Newman, the founder of Momentum Psychology, used ACT to transition from her job making multiple six figures as an attorney to become a clinical psychologist and eventually a university professor, peer-reviewed researcher, and eventually entrepreneur. She sought and received extensive training in ACT and trained with recognized experts in ACT including developer Dr. Steve Hayes as well as trainers Dr. Russ Harris and Dr. Jason Luoma. It is the primary modality Dr. Newman uses with most of her clients, and what she is sought out for.
Most of our therapists are also trained in ACT and use it when appropriate.
Research (and there’s a lot of it including 912 randomized controlled trials (RCTs))
My experience with clients and our own lives
Alignment with my values of helping others live a rich and fulfilling life
Way of life vs just a treatment or coaching “model,”
Effectiveness with behaviors that are very common in high-performing individuals such as perfectionism and imposter syndrome and #doingtoomuch.
Most of us also have seen how effective ACT is firsthand in our work. We have seen the effectiveness of this treatment through my involvement in active research studies as well as our experience with actual clients. Many of our therapists track a variety of variables through regular monitoring through a program called PsychSurveys.
Clients really enjoy seeing their progress over time and even when there are setbacks, they can usually identify a stressor that has made things more difficult. We’re tracking outcomes regularly, and, together, we can see the improvement based on the data.
ACT is not just a model of therapy or coaching; it’s a framework for living. It is something that I use in my daily life. There’s a saying among therapists and coaches who use ACT – “once you go with ACT, you can never go back.”
When our founder was a baby lawyer at an Am-Law 100 law firm, she first read Russ Harris’ book the Happiness Trap. It helped her leave BIGLAW – honestly more than other CBT therapy and coaching did. It was a game-changer.
Leaving a multi-six-figure job, she moved halfway across the country with a toddler and pregnant to pursue a dream that transformed her life. She maintains that she couldn’t have done it without ACT (or her husband or mentor, Landy Anderton (former federal prosecutor turned clinical psychologist). She decided then that she would do everything that she could to learn the intervention inside and out for therapy and for coaching so that she could help others.
ACT emphasizes compassion, self-compassion, nonjudgement, acceptance, and values-based action. It also allows us to teach our clients the “formula,” if you will, for life. ACT is a sustainable and replicable model. Once you learn it, you can use it. Our goal is to teach you how to be your own best therapist and coach. We believe that it is more effective to teach a person to fish rather than give him/her/them a fish.
Having said all of this, ACT is not for everyone. For instance, for some clients, DBT or RO-DBT, is more appropriate.
ACT is also an integrative therapy, and can be combined with exposure-based techniques, which are among the most widely studied and effective methods in clinical psychology.
Very.
In a 2020 metanalyses, researchers analyzed 20 meta-analyses of ACT with 12,477 participants and 100 controlled effect sizes.
Results showed that ACT is efficacious for all conditions examined, including:
anxiety,
depression,
substance use,
trauma,
pain, and
transdiagnostic groups (individuals with more than one diagnosis)
Results also showed that ACT was generally superior to:
inactive controls (e.g. waitlist, placebo),
treatment as usual, and
most active interventions.
For more information on ACT, please check out the public resources on ACT for the Association of Contextual Behavioral Science.
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