Understanding the Basics
You may know that therapy isn’t one-size-fits-all. In fact, there are dozens of different theories and approaches to therapy, which means that the process will look a bit different depending on the style your therapist is using. Today I want to introduce you to my absolute favorite psychological theory: Acceptance and Commitment therapy, aka ACT!
As a licensed clinical psychologist and owner of Humankind Psychological Services, I have witnessed many people struggle with anxiety, depression, substance abuse, and other mental health issues that can affect the quality of their lives. Like most mental health providers, I don’t just use the same theory and approach for everyone. I integrate different theories together and tailor my approach to suit the individual client. However, at the heart of everything I do, I am rooted in ACT.
The reason I love ACT so much is that when I was in graduate school and I learned a bunch of different approaches to treatment, ACT was the first approach that really clicked for me. As someone who has struggled with lifelong anxiety, I found myself applying ACT to my own life experience and it was really working!
Most approaches to therapy focus on getting rid of symptoms. ACT is different because instead of trying to get rid of your symptoms, it focuses on changing your relationship to your symptoms so that you can still live a meaningful, fulfilling life even if your symptoms never go away. After all, struggles and pain are natural parts of being a human.
ACT is based on the idea that humans are natural problem-solvers. The strategies we use to solve problems in the world around us are often quite effective. For example, if you dislike broccoli, you can “solve” the problem of broccoli by simply avoiding consuming it. You have full control over whether you put a piece of broccoli in your mouth or not. Using this avoidance method, you can go through your entire life without ever having to eat broccoli.
However, when we apply those same problem-solving strategies to our inner world, they backfire. If instead of disliking broccoli, you dislike sadness, you can’t just avoid feeling sadness. You don’t get to choose what emotions arise in your body, and sadness is an inevitable life experience. So if you try to avoid that feeling, you’re going to have to avoid a lot of different situations in your life that may create sadness.
So instead of trying to avoid sadness (or any other unwanted inner thought, feeling, memory or sensation), ACT can help you build what’s called psychological flexibility. Psychological flexibility is our ability to contact the present moment, notice what’s going on right here and now, and make decisions based on the current situation and your personal values. In other words, you aren’t making assumptions or jumping to conclusions based on what’s happened in the past or what you worry about happening in the future. You aren’t letting your emotions dictate your behaviors. You are thinking clearly and acting in ways that you can look back on later and feel proud of.
To help you build this psychological flexibility, ACT uses six core processes, and I’m going to talk briefly about each of them today.
Acceptance, which highlights the importance of accepting the things we cannot control to reduce our suffering. Oftentimes, we find ourselves ruminating or obsessing over things we have no control over, such as other people's actions or words, future events, replaying embarrassing moments from the past (we can’t go back in time and change the past!), or trying to avoid unpleasant emotions. These uncontrollable factors can cause us significant distress and impact our mental well-being. By acknowledging and accepting the parts of our daily lives that we can’t control, we can reduce our suffering and improve our quality of life. Accepting something doesn’t mean you like it or want it to be there; it simply means you have no control over it, so you’re not going to waste your energy fighting it.
Cognitive Defusion, which doesn’t change the THOUGHTS that enter your mind, but it changes the way you RELATE to your thoughts. Basically, you hold your thoughts more loosely, instead of treating them like facts or truth with a capital T. Just because I have the thought of “I’m a loser and nobody likes me” doesn't mean it’s true. When I am fused to this thought, I don’t register it as simply a thought or idea in my brain. I assume that thought is true, just because it’s there. I buy into it automatically without questioning it. When I defuse from that thought, I can notice it and say, “my brain is telling me a story that nobody likes me, but just because my brain is saying it doesn’t mean it’s necessarily the truth.” By recognizing that our thoughts are just words in our brains– sometimes helpful and sometimes unhelpful– we can stop taking every single thought so seriously!
Being present: in other words, mindfulness! This process is about maintaining ongoing, nonjudgmental contact with the inner and outer world, so you’re staying curious and aware of what’s happening in each new moment, both in your own mind and body and in the world around you. When you’re stuck in judgments and ideas about the past and future, you go into situations expecting them to be exactly like they’ve always been. If you felt anxious at the last dinner party you attended, you might go into the next dinner party expecting yourself to feel anxious, which then becomes a self-fulfilling prophecy. If you can instead stay present, you might notice moments of anxiety, moments of calmness, moments of enjoyment, and everything in between. If you stay present instead of making assumptions about how it will be, you give yourself a chance to have new experiences that are different from your expectations.
Self as context is basically the observing self. When you’re stuck in what’s called the conceptualized self, you get caught up in the labels you’ve attached to yourself and your experiences and there’s no room for anything to be different. If your whole life you’ve been told that you’re a “bad dancer” you might be so attached to that conceptualization of yourself that it affects your behavior, you avoid dancing, you feel embarrassed when you’re on the dance floor, you basically feed this attachment to something you think defines you. When you have self-as-context you take a more curious observer perspective. It’s not about whether you’re a bad dancer or a good dancer. You’re just a person, and that label only has to define you if you choose for it to define you.
Defining valued directions: your values are like the roads on a roadmap for your life. They point you in the direction that feels most true and meaningful for YOU. Nobody else can tell you what your values are- only you get to decide what matters for YOU. Some ways to think about your values would be, what type of person do I want to be? What makes me feel proud of myself? What kind of person do I want to be remembered as when I die? When you act in alignment with your values, you tend to feel like life has purpose and meaning. When you act out of alignment from your values, you tend to feel stuck or empty. For example, if I value authenticity, then I’m going to be happier with myself when I’m being genuine and real and I’m going to feel worse about myself if I’m lying or being fake and phony.
Finally, we have Committed Action, which is what it sounds like. When we’re suffering and stuck, we often are not striving toward goals or behaviors that match up with our values and the life we want to live. When we’re engaging in committed action, we are creating habits and patterns of behavior that serve those values we just talked about. An example of committed action would be if I tend to get anxious speaking up in group settings, but kindness is one of my values, then instead of letting my anxiety control me and keep me quiet in a group situation where I see a friend being disrespected, I commit to speaking up and standing up for my friend, because that action is within my control and makes me feel more aligned with my value of kindness. Instead of letting my anxiety take me away from what matters to me, I commit to doing the hard thing anyway. This is of course easier said than done, but with practice, we get better and better at committing to the actions and behaviors that make us proud!
The six processes of ACT are interconnected, and there's no particular order to work through them. They all work together to help you build psychological flexibility.
ACT is a powerful therapy that can be effective in treating a wide range of issues, including chronic pain, depression, anxiety, OCD, substance abuse, binge-eating, body image, burnout, relationship problems, insomnia, perfectionism, and more.
If you're interested in learning more about ACT, you can check out my YouTube channel for a full breakdown of the theory (without fancy clinical jargon!) and for more insightful and informative videos on various topics related to mental health and personal growth. ACT is a complex theory that cannot be fully explained in a short blog post, so be sure to check out my videos for a deeper dive!
I'm also thrilled to let you know that I'm launching a new Instagram paid subscription service soon. This is where I'll share more personal content with you, things that I don’t usually talk about on social media because they are more vulnerable topics, but will hopefully help you feel less alone in your own struggles and mental health journey. Plus, you'll have opportunities to ask me any burning mental health questions you may have.
Just follow me on Instagram (@mindfuldrpaula) for updates on the launch and how to sign up.
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Mindfully,
Dr. Paula