ACT

ACT is a therapeutic approach which incorporates elements of mindfulness, acceptance and behavioural change to encourage the development of psychological flexibility. This has been associated with enhanced quality of life and wellness.

ACT is an evidence-based approach that has been referred to as a third-wave behavioural therapy. It emphasizes aspects of mindfulness (i.e., being in the present moment), acceptance strategies, values-based work and committed action to allow individuals to live a more meaningful life. 

ACT Graphic Design Marlene

This therapeutic approach invites individuals to accept difficult thoughts, feelings, and situations. When learning ACT, people make room for difficult thoughts and feelings through present moment awareness and learned skills of acceptance, awareness, and defusion (i.e., making space from thoughts and feelings).

The tenets for change within this approach are based on the idea that painful thoughts and feelings are experienced by everyone and we are unable to change their occurrence. What can cause individuals to get stuck is hooking into difficult thoughts and feelings and having strong, unhelpful reactions to them. Therefore, when engaging in this treatment approach, individuals discover how they can accept painful thoughts and feelings as a natural part of life. They also learn to cope with difficult thoughts and feelings, instead of fighting against them.  Individuals also learn to defuse challenging thoughts by understanding how to shift one’s attention to things that are meaningful and are aligned with the person they want to be. In doing so, one develops a stance of psychological flexibility towards their thoughts and experiences. This can allow for a greater sense of well-being. 

ACT also focuses on the idea that every behaviour has a purpose and a function. Therefore, during therapy in ACT, the purpose of one’s behaviour is explored. It is important to understand that our actions – even when they are not helpful – are carried out for understandable reasons.

In working with ACT, individuals gain a deeper understanding of their values and move towards things in life that are meaningful for them. In doing so, they will also recognize elements of their life that are keeping them stuck. They will learn to embrace these challenging thoughts and feelings as well. 

At FTPS, we use ACT when working with many individuals. Some therapists integrate ACT into their approaches while others will use it as a stand-alone approach for a variety of issues, including anxiety, depression, trauma, life transitions and self-exploration.

Frequently Asked Questions

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 enhanced psychological flexibility. ACT therapy services also involve values-based methods to enhance people’s understanding of what matters to them. A core concept in ACT therapy techniques is about developing psychological flexibility. 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. It has been found that ACT therapy services can enhance individuals’ quality of life and overall well-being. It is an excellent approach for individuals experiencing a wide range of psychological issues.

Dr. Steven Hayes is the founder of Acceptance and Commitment Therapy. At the University of Nevada, he is a Nevada Foundation in the Professor of Psychology in the Behaviour Analysis Program. He developed what is called Relational Frame Theory and its extension to Acceptance and Commitment Therapy. 

Relational Frame Theory (RFT) is the theoretical framework that underlies act therapy techniques. This theory can sometimes seem quite complex. 

RFT is based on the idea that we relate one concept to another when we learn and use language. Connections can be made between events that are not inherently related to each other. For example, human beings will 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 continues to associate hearing the bell with wanting food. 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 “breakfast” or “lunch” 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 therapy services. 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 helps 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.

Therapists may take a primary ACT approach or will incorporate ACT therapy techniques into the work they are doing. At FTPS, we use ACT therapy services for a variety of issues, either as a stand alone treatment or as part of other evidence-based care for these types of presentations:

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

What is ACT therapy for OCD? When integrating ACT therapy for OCD, therapists will often focus on the importance of values-based work for Exposure and Response Prevention. When planning to do Exposure and Response Prevention (ERP) work, it is important to begin by mapping out a hierarchy of the things you want to stop avoiding or be able to approach without relying on compulsions and rituals to feel less distress. Acceptance and Commitment Therapy speaks to the importance of allowing yourself to have difficult thoughts and feelings while continuing to do what matters to you. In keeping with this idea, ERP work can focus on engaging with activities, items or people that might be triggering but are important to you. This can be much more motivating than engaging in ERP work just for the sake of doing Exposure and Response Prevention. When we are motivated to begin to do things that matter to us, experiencing distress might feel less difficult because we know we are becoming the person we want to be. This is one of the ways in Acceptance and Commitment Therapy can be useful in the treatment of ACT therapy for OCD.

Randomized control trials are considered a gold standard form of research in demonstrating the effectiveness of a treatment (medication or therapy). Importantly, several randomized control trials have demonstrated that Acceptance and Commitment Therapy is an effective treatment for many different conditions. A recent paper by Gloster and colleagues (2020) reviewed meta-analyses that have been gathered on Acceptance and Commitment Therapy. A meta-analysis is a type of statistical method that puts together data from multiple studies to understand the common results and what the overall trends are. These researchers found that ACT was effective for anxiety, depression, substance use, pain as well as transdiagnostic groups. Overall, there is very good evidence that ACT therapy for anxiety as well as other presenting issues is very effective.

ACT therapy techniques are evidence-based. A lot of excellent research has been done to demonstrate that it is effective for both adults and adolescents.
As described, therapists practising ACT therapy services 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 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. This includes times when the emotions and thoughts we feel are pleasant or unpleasant. We want to strive to become aware of these emotions and thoughts without taking a judgemental stance towards them. This process is also referred to as mindfulness. 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 therapy for anxiety as well as other presenting issues,  we want people to learn to embrace their ideal self and acknowledge what that might look like. We can do this by reflecting on situations and being asked “what our ideal self would have done”. This allows us to be mindful of who we want to be in a variety of contexts. 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 means that we make space from difficult thoughts. This allows people 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. This can also be useful in ACT therapy for OCD when we make space from difficult intrusive thoughts.

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 want to 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 setting meaningful goals connected to our values. It is also about ensuring that the goals we set are related to behaviour change that is measurable and observable. Problem solving can be integrated in this work to ensure that goals are being met in small steps that are meaningful to the individual.