Straight Up Guide to Acceptance and Commitment Therapy
These guides were born out of Noah and Christine’s frustration with overly complicated and jargon-filled articles, newsletters, books, and therapy websites. Our mission is to create clear and practical guides in order to learn, grow from challenges, and lead more meaningful and impactful lives.
Acceptance and Commitment Therapy, or ACT, is a relatively new form of CBT that posits psychological flexibility as the key to mental health. ACT is part of what’s known as the “third wave” of CBT along with Dialectical Behavior Therapy (DBT) and Mindfulness-Based Stress Reduction (MBSR), and it incorporates a more Eastern/Buddhistic outlook on psychological pain and suffering. ACT views pain as an inescapable part of life, and believes that any attempts to control or avoid pain only make it worse. However, ACT believes that we can still lead meaningful lives in spite of pain and suffering. Acceptance means not trying to control events, people, or internal states. Commitment means taking actions toward people or things you value, regardless of how you may feel at the moment.
ACT views the mind as essentially an “associating machine.” From a conditioning point of view, this means that any thought, word, or feeling can be paired with anything else. Everyone has learned about Pavlov’s dogs and how they became conditioned to salivate when a bell was rung even where there was no food present. ACT takes this even further and explains how human language can allow anything to be paired with anything within one’s mind. For instance, let’s say you say the word “cookie” every time you give you child a cookie, and can now generate a hunger response by simply saying “cookie” – this is traditional conditioning. However, you could further tell the child that an oreo is a type of cookie, and once the child know that, you say then say the word “oreo” and generate a hunger response as well. What’s the big deal about this? The word “oreo” and an actual cookie were never paired in real life – they were paired in the brain only! ACT calls this relational framing, and it’s both a power and a curse for human beings. The good news is that rules for behavior can easily be formed that protect us from danger – we are very teachable. The bad news is that once these rules are formed, they are very difficult to change, even when they no longer serve us. It is incredibly easy for us to be stuck, or “fused” with ideas, beliefs, and language that no longer move us toward our goals. One way to think about this is that we are great learners, but no so great at unlearning. The old phrase “You can’t teach an old dog new tricks” could be restated in ACT-ese as “It’s really hard for a dog to learn to do an old trick in a new way.”
While ACT may seem complicated under the hood, it is much simpler when applied in practice. ACT relies on mindfulness and experiential exercises to increase psychological flexibility. In traditional CBT, thoughts are analyzed for signs of cognitive “distortions,” which are basically lapses in logic and reasoning. Written thought records and Socratic reasoning are used to challenge the validity of one’s thoughts. ACT does not find these to be particularly helpful, as people tend to know that the thoughts aren’t logical but believe them anyway. ACT implies that focusing on modifying thoughts in session could even be contributing to the problem as focusing on thoughts could actually be reinforcing them. ACT instead relies on mindfulness and other techniques to “defuse” from your thoughts, meaning to recognize them for what they are, namely fleeting mental states. ACT tries to change your relationship to your thoughts rather than the thoughts themselves.
ACT divides itself into six key processes, which they refer to as the “hexaflex.” Let’s briefly go over them here:
1) Acceptance – This means that we stop fighting and trying to control negative emotions and experiences, and instead be aware of them and even embrace them.
2) Defusion – This means identifying rules and associations that we are stuck in, and finding ways to detach from them when they are no longer working for us.
3) Being Present – In order to change our relationship to our thoughts, we need to learn to pay attention to them and to be more mindful and present in our lives. The goal is present moment awareness.
4) Self as Context – The hardest of the six to explain, it can best be understood as embracing a more eastern/Buddhistic view of the self as more continuous and having a more fluid sense of identity.
5) Values – The only reason to choose short-term pain over avoidance would be in the service of goals and values that transcend the present moment. Therefore we need to identify the people and principles in our life that give our lives meaning beyond how we feel at any particular time.
6) Committed action – These are behaviors that will move you toward the people and things in your life that are of value to you. ACT teaches that these actions can be undertaken even when we don’t feel like doing them.
It is very much a behavioral therapy that emphasizes action over insight. ACT sessions tend to focus on whatever the patient is currently avoiding, whether it be a feeling, thought, or action. One way to conceptualize ACT would be the phrase “Don’t fight it, feel it,” even when it’s painful, and continue to move toward what interests and is of value to you. This will keep you from getting stuck, and instead moving toward goals that give your life purpose and meaning.
Christine Izquierdo and Noah Laracy are the co-founders of Straight Up Treatment, an anxiety disorder specialty treatment center. Straight Up Treatment utilizes a variety of cognitive-behavioral approaches to treat anxiety-based conditions such as Obsessive-Compulsive Disorder, Social and Performance Anxiety, Panic Disorder, Depression, and Generalized Anxiety.
You can learn more about them here.
You can read more guides here.