Acceptance and Commitment Therapy (ACT)

Thanks to traditional cognitive behavioral therapies, which has now been around for almost 50 years, it is no longer revolutionary for mental health professionals and patients to believe that learning to think differently is an important part of treatment. A third generation of cognitive behavior therapists, referred to as a “third wave” of cognitive behavioral therapists, are exploring variations on traditional CBT.

One of the most prominent of these so called third wave therapies is called Acceptance and Commitment Therapy (ACT) (www.contextualpsychology.org). Unlike traditional CT, Acceptance and Commitment Therapy (ACT) does not emphasize challenging, changing or replacing distorted thoughts. Rather than the traditional CT emphasis on changing the content of what we think, ACT asks its patients to explore whether there may be other ways to react differently to how we think. While this emphasis on changing the context and reactions to our thinking may to some degree also be true for traditional CT, ACT places far more emphasis on letting our internal thoughts be what they are. Instead ACT challenges us to accept our internal life for what it actually is, while encouraging us to commit to changing what we can in the actions of our daily lives. Traditional CBT’s primary emphasis is on examining how realistic or accurate our thoughts may or may not be. ACT is primarily interested in understanding the function of thoughts and actions, i.e., exploring how our thoughts or our reaction to thoughts work for or against us. ACT looks for where all this energy, otherwise spent on controlling our thoughts and feelings, may be more productively spent in our day to day, minute to minute actions and lives. What are our deepest values in life, how can we begin to use this moment to take action towards those values. Value assessments are used to explore our commitments in life. Experiment and experience is used to distinguish what we can from what we cannot change and to acknowledge what are deepest values and commitments actually are.

ACT and other third generation CBT’s are still very interested in some of the main traditions of CBT, that is; the importance of changing behavior, empirically based therapy and even the importance of dealing with thoughts. All CBT’s including ACT, share an interest in the effects of thoughts on a person’s life, however ACT is somewhat more “eastern” in its approach to our internal life.

If you would like to see the father of cognitive therapy , Aaron Beck MD, discussing this eastern point of view with the Dali Lama, click here:

Can trying too hard to change or control our thinking and feelings actually backfire? ACT strategies are therefore often explorations of letting go of our internal experiences. They propose that it is a compulsive and inflexible attempt to control our thoughts and feelings that can seriously worsen the effects of anxiety and depression. ACT attempts to diminish, “experiential avoidance” (emotional avoidance), the compulsive habit of coping with emotions by rigidly avoiding or controlling them. ACT therapists are exploring whether or not less controlling strategies might be a better way to deal with the emotional control paradox, e.g., does trying to rigidly control our thoughts and feelings put us further out of control? Acceptance and Commitment Therapy doesn’t rely only on logical or “declarative” modes of thinking but through experiential strategies explores holistic or “procedural” and learning. Declarative (propositional) knowledge depends on reasoning and putting what you know into descriptions and words, procedural knowledge is the knowledge your body has. Declarative knowledge is describing how to ride a bike, procedural knowledge is actually what your body needs to know to actually balance the bike, turn, hit bumps, etc. ACT attempts to break down our compulsive insistence relying only on logic, certainty, and language. Less logical tools used to address thoughts might include; mindfulness, metaphors, paradox, verbal repetition and deconstruction.

Mindfulness exercises are used by ACT and several other types of third generation CBT’s. Mindfulness exercises are a fundamental part of learning to react to our thoughts differently. They are used as a compliment to therapy not a replacement for therapy. Mindfulness exercises are used as a way to experience thoughts in a different context. In Acceptance and Commitment Therapy, mindfulness and other experiential exercises are used to see our old thoughts and ourselves from a new context, and therefore give ourselves the opportunity to act in new ways around old thoughts. Since we often get tangled up in a series of reactions to our thoughts, arguing with them, trying to be positive, trying to distract ourselves and getting anxious and frustrated about our inability to stop them, mindfulness offers an alternative way of experiencing thoughts. Mindfulness and other ACT exercises help us to see our thoughts for what they actually are, not what they say they are. ACT tries to help us experience the difference between our descriptions and evaluations of things and the thing itself. Mindfulness can also be seen as an exercise to improve our ability to make subtle discriminations, e.g., between ourselves and the content of our thoughts, between our evaluations of events (situations, sensations, etc) and the events themselves.

In addition mindfulness and other ACT exercises are a way to practice living in the present. Even traditional CBT proposes that anxiety comes out of thoughts about the future, while depression is often maintained by thoughts focused on the past. In Acceptance and Commitment Therapy, mindfulness and other exercises are used to break the habit of living in the past or future and to commit to living in the moment. Mindfulness is a way to practice living in this moment, an opportunity to learn to accept the moment as it actually is. However, our urge to fix our feelings and thoughts is overwhelmingly powerful; so many people expect mindfulness to be a way to get rid of our negative feelings and thoughts. Mindfulness and being in the present is not necessarily tranquility. It is hard work to just practice just letting each moment be what it happens to be, rather than what we expect or demand it to be. Mindfulness lets us stand back and see our minds tendency to keep doing this but it gives us an alternative, an “observer” context to see ourselves and our world from. For more on the history of “observer” viewpoints in philosophy and psychotherapy click our “New Articles” in our navigation menu and also visit: www.Deikman.com/awareness.html.

While no form of therapy has accumulated as much scientific proof as traditional cognitive therapy, third wave therapies are continuing the tradition of building therapy based on scientific research (Empirically Supported Therapy). Over the past 10 years third wave therapies have begun to accumulate an impressive amount of research showing effective results for a variety of difficulties.

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