Acceptance and Commitment Therapy, known as “ACT” (pronounced as the word act), is an empirically supported, cognitive behavioral intervention that is designed to help individuals increase their psychological flexibility. Instead of aiming to push away, ignore, resist, or eliminate distressing thoughts or emotions, ACT focuses on changing the relationship one has with their thoughts. Rather than challenging or disputing negative thoughts, ACT teaches individuals to accept them while committing to behaviors aligned with their values.
Developed in the 1980s by psychologist Steven C. Hayes, ACT has over 3000 published studies and has gained significant stature as an evidence-based practice that can be utilized across a wide range of psychological conditions (see appendix A for a description of conditions and links to the research).
The basis of ACT is grounded in Relational Frame Theory (RFT), a behavioral theory that explains how the language we choose to use with ourselves and others, as well as our cognitive reasoning, contribute to our overall emotional and psychological health.
ACT is also a type of Exposure Therapy. What this means is that in some sessions we may directly explore some of the painful thoughts, feelings, memories, sensations and urges you experience in your daily life so that you can practice using the new tools you are learning in a safe and supportive environment. Because of this therapy may be very challenging at times. However, we will work together to ensure you feel safe, grounded, and supported.
ACT starts from the premise that we may feel stuck, but we are not broken.
The reality is, we often find ourselves trying to move away from our pain, only to create more suffering inside of us. There is an old adage from the renowned psychologist Carl Jung that says, “what you resist not only persists, but will grow in size.” What he means by this is that the more you resist, or push down, the painful things in life, rather than learning how to be with them and manage them, the more you bring them to you, often with even greater intensity.
Have you ever found yourself trying to avoid or dismiss a difficult thought or feeling, only to find that you brain just won’t let it go? This is often a common human reaction to pain, uncertainty, and anxiety.
You are playing in the ocean, and everyone is having a great time, but there is this big, ugly beach ball that is floating around and distracting you. At first, you just try to ignore it but, it keeps bumping into you. You become irritated so you push it under the water to get rid of it, but each time you try to walk away it just pops back up. So, you push it down again, and again until you realize that you are spending all of your time and energy keeping this ball under water and you are too distracted and exhausted to do anything else.
What would happen if you were to just let go and allow it to float on its own? Sure, it may come back to you from time to time, but if you let it be, it will drift off again. Detached from it, you notice that your relationship to it has changed. You may find that you are not so annoyed or distracted by it and you can begin to re-engage with the life around you.
Our beachball may be made up of anxiety, depression, anger, stress, rumination, intrusive thoughts, toxic relationships, toxic work environments, etc. We may respond by trying to push it away through isolation, ignoring feelings of overwhelm or burnout, avoidance. We may also use other maladaptive coping strategies like food, substances, social media, or video games to distract us so that we can avoid feeling the discomfort of our life experiences. These strategies may work for a while… until they don’t. And then they can create long-term negative consequences for us.
For example, an individual who experiences fear and anxiety around the thought that everybody is always judging them may try to control the resulting feelings of inadequacy by avoiding being around people. Although on the surface this looks like a good strategy to get rid of those difficult thoughts and feelings in the moment, it leads to the even more painful feeling of social isolation in the long term, reinforces the thought that “I am not good enough” or “I am not of value to anyone.”
All together, these processes help us to develop “psychological flexibility,” which is the ability to be in the present moment, non-judgmentally, with awareness and openness, and to take action that is guided by our values.
The effectiveness of ACT has been widely researched and has a strong base of empirical evidence supporting its use across a wide range of psychological conditions. Below are several key areas where ACT has demonstrated efficacy.
ACT has been shown to be effective in treating depression. A comprehensive meta-analysis conducted by A-Tjak et al. (2015) reviewed 39 randomized controlled trials (RCTs) and concluded that ACT demonstrated moderate-to-large effect sizes in reducing depressive symptoms, comparable to other well-established therapies like Cognitive Behavioral Therapy (CBT).
Another study by Zettle and Hayes (1986) was one of the earliest to compare ACT to CBT in the treatment of depression. Results showed both therapies were effective, but ACT showed more lasting benefits in terms of psychological flexibility and overall well-being.
ACT is also effective for treating anxiety disorders, including Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD). A randomized controlled trial conducted by Arch et al. (2012) compared ACT to CBT for individuals with anxiety disorders. The study found that both treatments were equally effective at reducing anxiety, but ACT showed a unique advantage in enhancing psychological flexibility, a core aspect of mental health.
A systematic review by Swain et al. (2013) further supports ACT’s effectiveness in treating anxiety disorders. This review found that ACT produced significant reductions in anxiety symptoms across multiple RCTs.
ACT has shown to be effective in helping individuals cope with chronic pain. A meta-analysis by Veehof et al. (2011) reviewed 22 studies on ACT for chronic pain, finding moderate improvements in pain-related outcomes, including reduced pain interference, depression, and anxiety. ACT’s approach of acceptance, rather than attempting to control pain, was linked to better outcomes than traditional pain management strategies.
The study highlights ACT’s potential to improve quality of life for individuals suffering from chronic pain by reducing the impact of pain on daily functioning, rather than focusing on pain reduction alone.
ACT has been successfully applied to substance use disorders. In a study by Luoma et al. (2012), individuals in recovery from substance use who received ACT showed higher rates of sustained abstinence compared to those in a traditional treatment group. ACT’s focus on values and acceptance helped participants achieve more meaningful, lasting changes in behavior.
This evidence supports ACT as an effective intervention in helping individuals overcome addictive behaviors by addressing underlying psychological distress and promoting values-based living.
ACT has also shown promise in helping individuals with psychotic disorders. A randomized controlled trial by Bach and Hayes (2002) applied ACT to individuals experiencing psychotic symptoms and found that those receiving ACT had fewer hospitalizations compared to a control group. ACT helped reduce the distress and believability of psychotic experiences, allowing individuals to engage more fully in their lives.
ACT’s effectiveness can be largely attributed to its focus on increasing psychological flexibility, which refers to the ability to stay present in the moment and adapt behaviors based on personal values, even in the face of difficult thoughts and emotions. Research by Hayes et al. (2013) highlights the role of psychological flexibility as a key mechanism of change in ACT, mediating the positive outcomes seen in various clinical populations.
Leigh is a psychotherapist who specializes in working with clients who experience a wide range of symptoms associated with anxiety, depression, and trauma. She utilizes mindfulness-based and evidence-based treatments in her practice, including ACT, MBSR, DBT, CBT, and SFBT.
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