One of the first questions I often hear from patients at some point within the first couple sessions is: What is Acceptance and Commitment Therapy? During the initial visit, a patient and therapist are working to assess what brings a patient into therapy and beginning to formulate treatment options. Many patients have been familiarized with Cognitive Behavioral Therapy, but may not have learned much about Acceptance and Commitment Therapy. This is where it can be helpful to establish some basic terminology and core concepts, so that the patient and clinician can begin to create a treatment plan that makes sense to all parties involved. I begin to talk about treatment options with patients as soon as possible, typically within the first and second sessions.
Acceptance and Commitment Therapy is also referred to as ACT. It is pronounced as the full word (act) rather than spelled out per letter (A-C-T). It is a newer wave of Cognitive Behavioral Therapy formulated utilizing concepts such as Relational Frame Theory (RFT), which explores the workings of language as intervention. This therapeutic intervention helps to cultivate psychological flexibility, which is practiced utilizing combinations of the 6 core components or processes of ACT. These 6 core processes include experiential acceptance, cognitive defusion, present moment contact, values, committed action and self as context. In this blog post, we will define these processes and consider what they may look like in action.
Acceptance work provides opportunity to lean in or open up to experience (thoughts, emotions, events, sensations, etc.), particularly those experiences in which people find difficult. The aim of acceptance work is not to condone or agree with difficult aspects of experience. Acceptance doesn’t necessarily mean that you are okay with or even want any certain aspect of the struggle or pain. Acceptance work is all about allowing space for pain and struggle when it arises. This can enable people to stop spending their resources on fighting or avoiding their experience, and instead shift their time and energy toward living life (with the totality of experience). For a step by step radical acceptance guide, please wander on over to this blog post here.
Defusion can help people to take a step back from experience, particularly thought. Through utilizing defusion strategies, we are able to move into the role of an observer of thoughts. This is very helpful when feeling consumed by or stuck in thought. These practices help to identify thoughts as thoughts (simply words or images in the mind), which is very different from automatically identifying a thought as a fact. This may look like trying a thought watching activity, such as leaves on a steam. If you’d like to try it, please check out this YouTube video by Therapy in a Nutshell.
Many people may refer to present moment contact as “mindfulness.” When we are practicing present moment contact, we are able to notice our experience and live in the now. This is different than focusing on the past and/or future without awareness. Present moment contact practices may include sitting with current thoughts, emotions and sensations through activities such as grounding, meditation or otherwise noticing that your mind is focused on the past or future while reorienting to the present moment.
Clarification of values is the process of uncovering what is most important to you. Values help to create meaning and build a life worth living. Russ Harris, an ACT teacher, utilizes the concept of a values compass to help people navigate life and make values-based choices. This may look like reflecting on values that come through during open-ended questioning and/or a formal look at values via worksheets.
Committed Action is a crucial component in the process of utilizing the values compass concept. This is where effective action comes in as a way to build a life guided by values. A values-based life is a more personally meaningful life. Committed action may look like courage; doing what you feel is best for you despite that action being more difficult than other actions in the short-term.
Self as Context work allows people to observe themselves and their experience. This helps to provide a different understanding of the self, which includes all aspects of experience in any given context. Context will change from one moment to another. This may entail considering how you feel and think today in comparison to how you felt and thought yesterday, or years ago. This also means that how you feel and think now may also change tomorrow, or next year, or in 5 years, and so on.
Acceptance and Commitment Therapy (ACT) is a rapidly growing therapeutic treatment option rooted in cognitive behavioral science. Through working with the 6 core processes (experiential acceptance, cognitive defusion, present moment contact, values, committed action and self as context), this modality can help people to cultivate psychological flexibility in order to navigate all sorts of experiences and build more personally-meaningful lives.
Harris, R. 2009. ACT Made Simple: An Easy-To-Read-Primer on Acceptance and Commitment Therapy. New Harbinger Publications, Inc.
Hayes, S. ND. The Six Core Processes of ACT. Association for Contextual Behavioral Science.