Written by Dr. Farhan Shahzad and Sarah Davies-Robertson
Acceptance and Commitment Therapy is also known as ACT and is an approach to counselling that was originally developed in the early 1980s by Steven C. Hayes. It rose to prominence in the early 2000s when Hayes collaborated with Kelly G. Wilson and Kirk Strosahl.
ACT seeks to help clients transform their relationship with difficult thoughts and emotions through the acceptance of these and emotions. ACT sees these thoughts and emotions as being a normal part of life for much of the time, and, rather than avoiding them, clients should show compassion and allow the thoughts to pass freely. It is avoidance of these thoughts and feelings that is the problem, not the thoughts and feelings themself. Clients present to counselling with issues because they are avoiding the difficult thoughts and emotions, and by suppressing difficult thoughts and emotions, they only make them worse.
Have you ever tried not to think of a pink elephant? What do you see? A pink elephant!
ACT is based on this premise. The more we try to NOT think of something, the more powerful it can become in our minds. ACT practitioners do not seek to eliminate or change a client’s thoughts or emotions, but instead seek to help the client view these thoughts and emotions for what they are – pieces of language and transient psychological events, not external “truths”.
“Unlike more traditional cognitive-behavioural therapy (CBT) approaches, ACT does not seek to change the form or frequency of people’s unwanted thoughts and emotions. Rather, the principal goal of ACT is to cultivate psychological flexibility, which refers to the ability to contact the present moment, and based on what the situation affords, to change or persist with behaviour in accordance with one’s personal values. To put it another way, ACT focuses on helping people to live more rewarding lives even in the presence of undesirable thoughts, emotions, and sensations.”-(Flaxman, Blackledge & Bond, 2011, p. vii).
ACT practitioners encourage clients to approach problematic thoughts and beliefs and to be psychologically flexible, mindful and open. They use a range of mindfulness and acceptance-based strategies that also borrow from both cognitive and behavioural therapy approaches, and focus on a two-pronged approach: 1) helping clients develop acceptance of any unwanted thoughts and emotions and 2) committing to taking action towards living a valued life.
The basic principles of ACT
There are a number of causes of psychological distress, as suggested by the ACT model. Cognitive fusion is a term used in ACT that refers to when an individual allows their thought processes to have an excessive influence over their behaviour. The individual becomes so caught up that they become disconnected from the present moment.
During a state of cognitive fusion, a thought can seem like it is a fact and that you must obey it. Some people feel that they need to get rid of these thoughts or emotions straight away and that they command their immediate attention. Cognitive fusion is problematic because it prevents the individual living in the here and now and experiencing the present moment.
The term, experiential avoidance is used to refer to the process of engaging in strategies of avoidance and, while these strategies are effective in the short-term, they restrict an individual’s choices and usually lead to reinforcement of these problematic thoughts in the long-term. The more a person focuses on avoiding their thoughts and feelings, the more restricted their life becomes. Similarly, when a person focuses on avoiding these negative thoughts, they remove their focus from enjoying the present moment. The more energy being used on getting rid of these negative thoughts, the less energy they have for focusing on personal inner experiences and the world around them. The more energy spent on being fused, the less they have for being psychologically present. When individuals are psychologically fused, they focus too much on the past (ruminating) or the future (worrying). The goal of ACT is therefore to help clients improve their psychological flexibility so that they can be psychologically present and enjoy the moment.
The Six Core Therapeutic Processes According to ACT
The six core psychological processes that help people increase their flexibility are known as the ACT Helaflex and include the following:
v Cognitive Defusion.
v Acceptance
v Contact with the present moment
v Values
v Committed Action
v Self as Concept
Cognitive Defusion
Cognitive Defusion is also simply known as defusion and is the process of learning to detach ourselves from our thought processes. We simply observe them for what they are- transient private events that stream through our consciousness and are ever-changing. When an individual is defused from their thought processes, they are no longer controlled by them and do not get caught up in trying to change or control them.
Acceptance
This is the process of opening oneself up and also allowing room for unpleasant feelings, sensations and urges. This means the individual does not struggle with these unpleasant private events, but, instead, begins to accept them as a normal part of life. By releasing oneself from battling these unhelpful thoughts, the individual goes on to free themselves to enjoy the present moment.
Contact with the present moment
In this process, the individual becomes “psychologically present” and brings their full attention to the here and now. Because we have the ability to think about the past and the future, this can sometimes make it difficult to stay present in the current moment. Staying present in the moment is imperative to enjoying life.
Values
Therapists help clients identify their values, for instance, what is important to them. This is a central component of ACT and it assists the client to highlights things that are important and meaningful to them. It focuses on helping a client live out a truly authentic life.
Committed action
Once the client has identified what is important to them (i.e. through identifying their values), they can then make steps towards living out these values, even in the face of unpleasant thoughts and emotions. Behavioural interventions such as goal setting, exposure, behavioural activation and skills training are used to help the clients take positive steps.
Self-as-context
This is also known as pure awareness or the observing self, and creates a distinction between the observing self and the thinking self. The thinking self refers to the self that generates thoughts, beliefs, memories and judgements, whereas the observing self is the self that is aware of what we think, feel, sense and do. When we are aware of the observing self, we are able to step back and be mindful, thus separating ourselves from the thoughts, beliefs and memories that we have.
Each of these processes contribute to psychological flexibility.
The aim of ACT is to increase our psychological flexibility by using the above processes. The greater our ability to be full conscious and mindful, the better we are at tackling life’s problems and challenges. By embracing life, we become filled with vitality, which is a sense of being fully alive and embracing the present moment.
The six core components of the Helaflex are split into three types of functions. Both acceptance and defusion focus on separating thoughts and feelings, seeing them for what they are- just thoughts and feelings, and allowing them to come and go on their own accord. Values and committed action involve facilitating growth and directing the individual towards living out their authentic goals. While, self-as-context, and contacting the present moment are focused on making contact with the verbal and non-verbal aspects of the here and now. The psychological flexibility can be summed up as “be present, open up, and do what matters” and the ACT acronym is very useful for helping clients do this.
v A- Accept your thoughts and feelings
v C- Choose a valued direction
v T- Take action
Essentially, we must encourage clients to accept what is out of our personal control and take action to make positive changes that align with the client’s values. “ACT is not about trying to reduce, avoid, eliminate, or control these thoughts and feelings. It’s about reducing their impact and influence over behaviour in order to facilitate valued living” (Harris, 2009, p. 61).
ACT in a Nutshell
The ACT in a nutshell exercise is a metaphor used to demonstrate the psychological processes underlying a client’s suffering and how ACT works. The therapist’s role here is to understand the psychological fusion that affects the client’s ability to be present and in the moment. When using any of the hexaflexercise techniques or metaphors, it is important to take the time to master them and also practise reading them allowed. Sharing these techniques often requires a slow, soothing voice. Recording and listening back can be very helpful here.
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