Written by Jiovann Carrasco, LPC-S
Acceptance and Commitment Therapy is a third wave behavioral therapy (along with DBT and MBCT) that uses mindfulness skills to develop psychological flexibility and helps clarify and direct values-guided behavior. ACT, pronounced “act,” (not by it’s initials A-C-T) is a directive and experiential form of therapy based on Relational Frame Theory (RFT), its underlying scientific theory of human language and cognition. This theory emerges from the philosophy of Functional Contextualism, as opposed to mechanistic models, which aim to repair, change, or fix “problems.” Instead ACT does not see clients as damaged or flawed, and do not define unwanted experiences as “symptoms” or “problems,” but resolves to define the function and context of behavior (ACT defines behavior to encompass both private and public activity, ie. actions, thoughts, memories, emotions, sensations) in order to determine its “workability,” for the purposes of creating rich and meaningful lives.
The aim of ACT is to experience the fullness and vitality in life, which includes a wide spectrum of human experience, including the pain that inevitably goes with it. Acceptance (not the same as approval) of how things are, without evaluation or attempts to change it, is a skill that is developed through mindfulness exercises in and out of session. ACT does not attempt to directly change or stop unwanted thoughts or feelings (as in CBT), but to develop a new mindful relationship with those experiences that can free a person up to be open to take action that is consistent with their chosen values. Thus, values clarification is a key component to ACT.
Six Core Processes
Psychological flexibility is the main goal of ACT and is created through six core processes:
1. Contact with the Present Moment
6. Committed Action
These six process are not separate, but overlapping and interconnected. All six of these processes are introduced and developed experientially over the course of treatment. Psychological flexibility can be defined simply as “the ability to be present, open up, and do what matters.”
Being present means being in direct contact with the present moment, rather than drifting off into automatic pilot, and getting in touch with the observing self, the part that is aware of, but separate from the thinking self. Mindfulness techniques are taught to experience the observing self firsthand, whether they bring awareness to each of the five senses, thoughts, or emotions.
Opening up is the ability to detach from thoughts (defusion) and accepting, or making space for and dropping the struggle with painful feelings, urges, sensations, etc. Acceptance is the ability to allow what is to be as it is instead of fighting or avoiding it. If someone is thinking, “I’m a terrible person,” they might be instructed to say, “I am having the thought that I’m a terrible person.” This effectively separates the person from the cognition, thereby stripping it of its negative charge. When someone is experiencing painful emotions, like anxiety for example, they might be instructed to open up, breath into, or make space for the physical experience of anxiety and allow it to remain there, just as it is, without attempting to eliminate it, which has a paradoxical effect of making it much worse.
Do What Matters
And finally doing what matters is all about values clarification, knowing what matters to you personally, and taking effective action guided by those values. Various exercises are employed to help identify chosen values, which act like a compass from which to direct intentional and effective behavior. People who are fused with their thoughts and tend to struggle with or avoid painful emotions, often struggle with choosing purposeful and values-guided action. Through mindful liberation from such struggle they find acting congruently with their values quite natural and fulfilling.