What is ACT therapy?
What is Acceptance and Commitment Therapy?
Written by: Phil Landry, LPC
When I tell new clients that I rely heavily on a therapeutic approach known as Acceptance and Commitment Therapy, aka ACT, I am often met with a blank stare.
As popular as ACT is among therapists, it has not yet infiltrated the consciousness of the general public, even the members of the general public who are open to seeking out a therapist. The purpose of this essay is to do my part to educate people about ACT, and to help people start to utilize its principles to live more meaning-filled lives.
Let me tell introduce you to a made-up person named Jeremy. He will be our model client for learning about the ACT approach in a psychotherapy context.
(NOTE: I have never worked with anyone named Jeremy, and this made-up person will be an amalgamation of imaginary and actual experiences I have had as a therapist). Jeremy presents with complaints about being chronically bored at work and feeling like there is nothing he can do about it. He cares about his job and does not want to do anything else, but he is at his wit’s end and has reached out to me for help.
ACT can be summarized as an approach that helps people develop psychological flexibility.
Psychological flexibility is defined as the ability to engage in behavior, moment-to-moment, that is intentional and helps them build a life reflective of what is important to them.
To help clients develop psychological flexibility, ACT targets 6 different psychological/cognitive/emotional/behavioral processes: values, committed action, contact with the present moment, defusion, acceptance, and self-as-context.
A visual representation of these 6 processes is known as the “hexaflex,” which is a combination of a hexagon that encompasses each of the 6 processes, and flexibility which relates to the goal of promoting psychological flexibility in clients.
For the rest of this piece, I am going to use the example of working with Jeremy to not only define each of these core processes, but also to demonstrate how they might be used to improve psychological flexibility in your life. Also, please note that there are many different ways to use ACT in psychotherapy. Teaching about the hexaflex is just one way, and it is reflective of my personal style rather than a uniform approach used by all therapists who use ACT techniques.
Let’s start where I start with most clients:
Values and Committed action
From an ACT perspective, values are intangible, abstract concepts that are chosen as the focus for a person’s life because they are important to them (think: love, compassion, security, family, industriousness, etc.). Committed actions are the concrete expression, through observable behavior, of the abstract value.
Jeremy is clearly upset that his behavior is keeping him away from a life of meaning and purpose, though he might be focusing too much on his feelings and thoughts and too little on his behavior to be able to see this yet. I ask him to tell me broadly about what is important to him, and he talks about wanting to have a home, a long-term partner, to have enough money to take care of himself and give back to his community and be a good friend. I help him convert these wishes into the values of security, generosity, and connection. Notice how we have not talked much about his job yet! Going big picture can be helpful for defining values before narrowing down to one specific area of life.
Now that I know what is important to Jeremy and what kind of life he wants to live, we can get into the other core processes that can help him improve values-congruence in his life by exploring the internal barriers to values-congruent, committed actions at work.
Pretty much everyone is at least somewhat familiar with the next core process due to the explosion of awareness of the benefits of mindfulness:
Contact with the present moment
Something I notice as I listen to Jeremy is that his foot taps and he uses more rigid, black-and-white words like “never” and “always” when he describes the chronic stress and anxiety he experiences. I pause him and ask if he noticed these two changes in his behavior. He looks at me quizzically and asks me to repeat the question. I do, and he says “maybe.” I then ask him if he feels more aware of me sitting across from him than he did when he was describing his experience with stress and anxiety. He says he does, and I say good, you just took a step towards increasing your ability to have contact with the present moment!
A simple definition of contact with the present moment would be the ability to use attention, the intangible skill that we have in narrowing or broadening our focus on different types of information, purposefully, to notice things like thoughts, sensory information (think taste, touch, smell, etc.), sensations arising from underneath the skin (this is called interoception and involves everything from noticing our heartbeat, the feeling of air moving in and out of the lungs, etc.), mental images, and emotions.
Remember that the purpose of ACT is to help people to live more intentional lives by increasing their ability to engage in behavior, moment to moment, that allows them to move toward a life reflective of their values. It makes sense that we would need to be able to use our attention effectively to 1. notice when we are not engaging in behavior that is reflective of our values and 2. shift our attention to information available in the present moment that will help us take steps towards a values-based life.
Now that Jeremy has become aware of how disconnected he is from the present moment and has had a taste of what it is like to make contact with it, I can help him use his attention more effectively.
That brings us to our next two psychological processes from the hexaflex:
Defusion and Acceptance
Defusion is easier to explain by starting with defining fusion. Fusion, from the ACT perspective, is the process by which a person relates to their thoughts as true and accurate about the world. You might be thinking, “Isn’t that a good thing?” and you would be right - if we cannot trust the information our mind is giving us through thoughts, then how are we supposed to be able to move through the world? The problem is that an overreliance on fusion can lead a person to engage in unworkable (i.e., values-incongruent) behavior when they are reacting to their interpretation of the world rather than the world itself. In addition, many people fuse with rigid beliefs and rules about behavior or how they should think or feel, in a way that negatively impacts psychological flexibility. As you might have guessed, defusion is the process of relating to thoughts as information, rather than truth.
Let’s return to Jeremy to see how I might help him deepen his insight into the role that fusion/defusion plays in keeping him stuck, and how I will help him to develop more skill in fusing and defusing on purpose in the pursuit of his values. From the interaction I described with him earlier, I took note of his use of rigid, absolutist words like “always” and “never” in his speaking. These are excellent targets for defusion skills. I ask him to share with me about the kind of thoughts that he has at work when he starts to feel bored. He tells me that he tends to have thoughts like “I will never get out of this dead-end job,” “I am miserable, and I will always be miserable,” and the juiciest one of all, “Nothing I do ever makes a difference.” That last one really jumps out at me, because if he fuses with that thought on a regular basis, then no wonder he feels stuck! I get him to notice that when these thoughts come into his awareness, he seems to fixate on them rather than turning his mind towards a more helpful thought process that can help him to find a workable solution to his problems. He hesitantly acknowledges that that makes sense, and when I encourage him to test the reality of the thought “nothing I ever do makes a difference,” by asking him what his experience has shown him about his ability to make a difference, he acknowledges that his behavior has helped in the past. I make sure to point out that it seems like his mind is not being very helpful in these instances, and it might be important for him to develop some skepticism of his thoughts so he can learn when fusing with them is workable versus unworkable.
Before going further, I need to explain what acceptance skills are. From an ACT perspective, acceptance skills involved taking an open and curious attitude towards internal experiences. This includes everything from feelings, body sensations, thoughts, and behavioral urges. Many people find themselves locked in patterns of behavior that are not reflective of their values because they have become unwilling to use acceptance skills to make contact with the internal experiences that arise when engaged in values-congruent behavior.
Returning to Jeremy, I ask him to tell me something he has done before at work that helped him to not be bored. He says that when he takes breaks to go talk to his coworkers, he experiences a reprieve from the boredom. He promptly starts to tell me about how awkward he feels around his coworkers and that he starts to feel anxious and have thoughts like “they do not like you” or “they wish you would leave them alone” while experiencing urges to walk away when talking with them. This is very interesting to me because this tells me that I can help him to use acceptance skills to be open to experiencing the physiological sensations of anxiety, thoughts related to anxiety, and the urge to run away if they help him to be congruent with his value of connection. I ask him if he would be willing to do things that trigger the sensations associated with anxiety and he agrees that if it helps him to develop more meaning in his life then he would be willing.
The final core process of ACT can be one of the most challenging to understand:
Self-as-context
It helps to compare it to its opposite, self-as-content.
Self-as-content is what occurs when a person identifies their sense of “I” with the thoughts in their mind, the feelings they are having, their urges, or memories.
Self-as-context is what occurs when a person identifies themselves with the “observing self,” the part of us that is always present that witnesses our internal and external reality without being identified with it.
This is a subtle distinction. One of the best metaphors and a favorite tool used by ACT therapists! I have learned to help my clients make this distinction in that if we imagine that the human mind is like a chessboard with pieces, self-as-content occurs when a person identifies with the pieces, and self-as-context occurs when the person identifies with the board. This process is very, very important because it is the foundation for a person’s ability to define themselves as they choose rather than defining themselves on their past behavior. It is a requirement to be able to say I choose who I am and to make changes reflective of values rather than their personal history and beliefs about themselves they are fused with.
Let’s bring it all together and see how learning about the ACT approach in therapy has helped Jeremy to improve his satisfaction with work.
Through therapy, I have taught Jeremy about the 6 core processes of the hexaflex: values, committed action, contact with the present moment, defusion, acceptance, and self-as-context. He has learned that his difficulty at work is linked to fusion with thoughts like “nothing I do makes a difference” and “they wish you would go away,” along with his loss of contact with the present moment which would help him see that his behavior is making a difference and that his coworkers like him. He has a newfound openness, through acceptance skills, to the discomfort of anxiety that arises when engaging in committed actions reflective of his values. He has loosened his reliance on self-as-content (his previous view of himself) and instead focuses on experiencing his life through the skill of self-as-context, which has opened him up to see flexible, workable behavior at work. He can see ways to help himself create more meaning at work, and with his newfound sense of determination and clarity, is working, day to day, to improve his work situation.
If you think this style of therapy might be helpful for you, I encourage you to submit a contact form at https://www.mymoderntherapy.com/contact-us to connect with a therapist at Modern Therapy that utilizes Acceptance and Commitment Therapy in their approach.