Everything You Want to Know About Acceptance and Commitment Therapy

ACT Therapy Basics

Many people often wonder, what is acceptance and commitment therapy? Acceptance and Commitment Therapy is a psychotherapy approach which involves aspects of mindfulness, acceptance and behavioural change to encourage the development of psychological flexibility. It has been found that engaging in ACT enhances individuals’ quality of life and overall well-being. 

We speak a lot about the idea of psychological flexibility in acceptance and commitment therapy. This is a core concept that is part of ACT counselling and ACT for anxiety. This will be explained in greater detail below. When we develop enhanced psychological flexibility, we are more able to manage difficult psychological events that may happen to us. Therefore, strengthening this important psychological muscle can be very helpful in different ways. 

Relational Frame Theory (RFT) is the theoretical framework that underlies acceptance and commitment therapy principles. This theory can sometimes seem quite complex. We will try to explain it simply and demonstrate how it relates to acceptance and commitment therapy. 

RFT is based on the idea that we relate one concept to another when we learn and use language. Connections can also be made between events that are not inherently related to each other. For example, human beings will be able to make connections between neutral events that follow important events. A classic example of this is when someone hears a bell after getting some food and then continuing to associate hearing the bell with wanting to get food. An association has now been made between two events.

The overall idea is that human communication is possible because relational links are created between events and/or stimuli. And these are not necessarily words and events that have any connection, other than the meaning that language has given them. For example, we can understand that the word “dinner” or “supper” is associated with eating a meal. 

In an article by Steven Hayes, he speaks to how RFT can result in certain processes that are directly targeted in ACT counselling. For example, RFT suggests an increased likelihood of processes we call cognitive fusion (i.e., not being able to create distance from difficult thoughts), experiential avoidance (i.e., avoiding things that can cause us distress), and the suppression of difficult thoughts and feelings.

Acceptance and Commitment Therapy strives to help individuals achieve the ability to engage in cognitive defusion (i.e., making space from difficult thoughts), experiential acceptance (i.e., being able to accept things that are difficult), acknowledging and embracing values and understanding the impermanence of our thoughts. ACT therapy for anxiety as well as other mental health issues are all based on the research and science of RFT.

There are many benefits of ACT and we will review those throughout this blog! Looking for ACT therapy near me? Read on and learn more about it and how we offer this at Forward Thinking Psychological Services®!

Principles of Acceptance and Commitment Therapy

The idea of psychological inflexibility is said to arise from a few basic processes. The Association for Contextual Behavioural Science has referred to these as the following: emotional inflexibility, cognitive inflexibility, attentional inflexibility, difficulty in perspective taking, dearth of chosen values and challenges with embracing values-based actions. In Acceptance and Commitment Therapy, we work towards changing these processes to become more flexible.

ACT counselling does not necessarily do this in a structured way. Rather, your therapist will work with you to gain skills and awareness that allow for enhanced flexibility and present moment awareness in a number of different areas. In gaining these skills, you are more able to create perspective on situations around you and act according to your values and what is important to you. These are fundamental ways in which Acceptance and Commitment Therapy for anxiety and other mental health issues can help an individual to better manage difficult thoughts and feelings. 

Psychological flexibility, in ACT, has been described by Twohig and Levin (2017) as “…the ability to stay in contact with inner experiences, allow them to be there when useful, see thoughts as just thoughts, have a strong sense of life direction, and pursue things that are meaningful.” (p. 754). We speak about the idea a lot in general ACT counselling and ACT for anxiety. 

What this means is that individuals can learn to be mindful and accepting of difficult thoughts and feelings and still engage in meaningful activities and life goals. You might wonder, why would this be important?

A measure called the Acceptance and Action Questionnaire (AAQ 2) was designed to measure features of psychological flexibility and experiential avoidance. Several studies have found that when an individual scores low on this measure they often experience:

• Increased anxiety
• Increased depression
• Decreased work performance
• Declines in overall wellness
• Worry

This demonstrated the many benefits of ACT and why it might be a therapy intervention you want to consider trying out. 

How Acceptance and Commitment Therapy Works

As described, therapists practising ACT counselling work from what is called the Relational Frame Theory. Within this theory, there are 6 main concepts that therapists consider and work on with individuals:

1. Present Moment Awareness: this involves becoming more aware of emotions and thoughts that arise in the present moment. This allows for people to learn greater awareness of their thoughts and feelings and become more mindful of the current moment. Mindfulness allows individuals an opportunity to make different choices than they might have otherwise made.

2. Self as Context: individuals sometimes define themselves by their thoughts and feelings. In ACT counselling, we want people to learn to embrace their ideal self and acknowledge what that might look like. It is important to learn that we are not simply the content of our thoughts, we are also the context in which our thoughts occur.

3. Defusion: when we defuse from difficult thoughts and feelings, we are able to unhook from them. This allows people to then be able to gain distance and perspective from their thoughts. This enables individuals to make different choices and act in ways that matter to them and are not driven by anxious thoughts or other unhelpful thinking styles. When engaging in ACT therapy for anxiety, this can be a very useful strategy to make space from anxious thoughts that are hard to let go of.

4. Acceptance/Allowing: this involves working towards acceptance of difficult thoughts and feelings. Although we might not want to experience these, we often still do. We also want to still be able to live a fulfilling life, despite unpleasant thoughts and feelings. This can involve showing compassion towards oneself, allowing for curiosity towards different experiences and making space for challenging thoughts, feelings and body sensations.

5. Values: values can be thought of as representing the directions of a compass. We never arrive at the destination of “west” but we can keep moving in that direction and visit goals along the way. We never stop wanting to be a “kind partner” or a “good parent”. We do meet goals that are aligned with our values (e.g., helping our child with their homework).  Values are important discussion points within Acceptance and Commitment Therapy as we want to think about the type of person an individual wants to be and what is meaningful to them.

6. Committed Action: this can involve goal setting and ensuring that the goals we set are related to behaviour change that is measurable and observable. Problem solving can occur to ensure that goals are being met in small steps that are meaningful to the individual.

Benefits of Acceptance and Commitment Therapy

Therapists may take a primary Acceptance and Commitment Therapy approach or they may incorporate it into the work they are doing. At FTPS, we use ACT Counselling for a variety of issues, either as a stand alone treatment or as part of other evidence-based care. You might wonder, but what are the benefits of ACT and what types of mental health issues is it helpful for? It has been found to be effective when treating a variety of different presentations:

• Anxiety
• Depression
• Obsessive Compulsive Disorder
• Body Focused Repetitive Behaviours
• Perfectionism 

Is Acceptance and Commitment Therapy a form of CBT?

Acceptance and Commitment Therapy has been referred to as a “third wave psychotherapy”, along with other therapies, including Dialetical Behaviour Therapy (DBT) and Mindfulness-Based Cognitive Therapy (MBCT). These types of therapeutic approaches are based on fundamental behaviour therapy principles, however, they add other ingredients into the mix. 

If one were to contrast Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy, a fundamental difference is the approach that each takes to how an individual should handle uncomfortable thoughts. In traditional CBT, unhelpful thoughts are challenged and one learns to gather evidence for and against negative thoughts in order to produce an alternative or balanced thought. However, in an ACT approach, one learns that difficult thoughts cannot always be challenged. Nor is that seen as the point. Instead, we must learn to take them along with us and still engage in things that are important to us. 

Both CBT for anxiety and ACT for anxiety have been found to be effective treatments for helping an individual decrease the barriers that anxiety causes them in their lives. 

How Do I Find Out More about ACT at Forward Thinking Psychological Services®?

At FTPS, we offer ACT for adolescents and adults. Our services are provided by clinicians who have training and experience in this approach. Our adolescent services are delivered by our clinicians on our team who provide specialized adolescent therapy, given their training and background. 

If you are interested in learning more about our ACT services, please reach out to us at info@ftpsych.ca 

Contact us today! We would love to hear from you and help you move forward on the path to wellness.