An Introduction to ACT

Today, we have a guest post from our PMVC member Dr. Jennifer Barbera. In this post, Dr. Barbera gives us an introduction to ACT – Acceptance and Commitment Therapy.

We would like to thank Dr. Barbera for contributing to the Psychotherapy Matters community.


Going beyond negative thinking and mindfulness towards helping people build emotional resilience and valued living.

Do you know anyone who has not felt distressed, anxious or stressed in some way?

You might be hard-pressed to think of someone. This is because it is difficult to live a rich and valued life without encountering hardship, upset, or emotional suffering at some point.

It is widely known that most people experience disruptions in their mood and some form of anxiety from time-to-time. Many people, from all walks of life, including therapists, attend therapy as they look to navigate life’s challenges.

People also vary in how they respond to adversity and stressful life circumstances.

Positive Psychology arose because valuable information comes from people who overcome adversity. Overcoming adversity and growing from one’s experiences is known as ‘resilience’ (Horner, 2016).

What is ACT:

Acceptance and Commitment Therapy, otherwise known as ACT, was inspired by positive psychology. ACT draws together a rich base of knowledge that can be used to help alleviate human suffering. ACT also focuses on assisting people in pursuing what matters most to them, despite what problems show up in their lives.

ACT is a mindfulness-based behavioural therapy that focuses on how people respond to adversity. ACT is an empirically validated psychotherapy approach (ATjak et al., 2015) that aims to assist people to build resilience and enhance their capacity to cope with challenging life circumstances.

ACT places a particular focus on how people respond to uncomfortable or distressing feelings. In particular, as recognized by other approaches such as DBT (dialectical behaviour therapy), many people fight or struggle against their emotional pain. Fighting VS accepting one’s painful emotions and experiences has a significant impact on the intensity of one’s suffering.

The specific way that a person copes with adverse experiences also has a direct impact on the extent to which they are likely to struggle with various mental health concerns (Horner, 2016). These concerns include depression, anxiety, PTSD, and substance and alcohol use.

In simple terms, ACT aims to address the many concerns that people can have through 3 key processes:

1) Teach people how to accept their emotions and be present

2) Help people choose a valued direction

3) Increase people’s capacity to take action

ACT and its core principles arose out of a recognition that:

Anxiety, low mood and painful feelings are common human experiences. These experiences may not be best accounted for by medical models that pathologize many universal forms of human suffering (Harris, 2006).

Human beings have a propensity for increased emotional suffering, compared to other animals. We are more vulnerable to emotional suffering in large part because we think, judge, evaluate, criticize and ruminate on our difficulties. This universal human tendency to think using language has a very significant impact on the extent to which humans suffer.

The content of our negative or unhelpful thinking is not necessarily the problem. It is the relationship that we have with our negative thoughts that leads to increased suffering. In other words, it is not so much what our mind tells us as the extent to how fused we are with our thinking mind that becomes problematic.

When we can observe and notice what our mind tells us, we will find that negative thoughts have much less emotional impact. Looking ‘at’ our thinking instead of ‘from’ our thinking allows us to hold our mind’s narrative more lightly. Increasing our ability to tap into our observing self through mindfulness is a valuable way to help alleviate human suffering and is a key component of ACT.

In addition to mindfulness, there are other specific characteristics across people that can either help or hinder a person’s ability to cope with adverse life events. These particular characteristics can be identified, developed, and enhanced to help improve well-being and resilience. 

Psychological Flexibility:

These specific characteristics are collectively known as ‘psychological flexibility’ (Luoma, Hayes & Walser, 2007). Just like people can develop muscles and muscle tone through exercise, through practice, people can develop and enhance characteristics that build emotional and psychological resilience.

Increasing psychological flexibility skills helps to reduce vulnerability to mental health issues. These include anxiety, depression, low self-esteem, alcohol or substance use disorders and other mental health concerns.

Psychological flexibility refers to a person’s characteristics in the following six core areas:

1) Acceptance VS experiential avoidance & resistance

Many people react to painful emotions by trying to fight, control, deny or avoid their suffering. This common human tendency to fight or attempt to push away pain plays a key role in human suffering. This is because emotional pain is part of being human, and so there is not a viable long-term way to avoid pain entirely (Luoma et al., 2007).

In fact, resisting or trying to control emotional pain often backfires for people as they enter a “self-amplifying loop, which creates additional suffering” (Luoma et al., 2007, p. 23). In essence, when one starts to suffer and responds by judging, fighting, denying or overtly trying to control their painful emotions, the emotions tend to increase in intensity, especially over the long-run.

In recognition of the amplifying effect of emotional resistance, ACT aims to teach people the importance of openness through acceptance-based strategies. Acceptance does not mean agreeing, liking or giving in to one’s feelings. Acceptance refers to the concept of ‘making space’ and allowing what already is in that moment. This way, valuable energy is not wasted on trying to change what already is.

2) Mindfulness VS dominance of the conceptualized past and future

Mindfulness refers to the extent to which a person focuses on the present moment, versus focusing on things that have already occurred or have not occurred yet. Mindfulness also is about being able to notice and observe thoughts and feelings without judgement.

The fact that humans can reflect on the past and ponder the future is a precious resource. At the same time, these abilities can create new problems (Harris, 2006). This is because being excessively focused on the past or future or losing contact with the present increases suffering. A primary goal of mindfulness is developing an ability to stay anchored in present moment awareness. ACT uses various exercises and experiential moment-to-moment in-session awareness to help train mindfulness skills. Through practice, people are more easily able to tap into their observing self and thereby reduce judgement and rumination on past events and future scenarios.

3) Cognitive de-fusion VS cognitive fusion:

Cognitive fusion refers to how much a person is entangled or blended with the content of their thinking. In contrast, cognitive de-fusion refers to the extent to which a person can observe and notice their thoughts as they have them.

People who are fused with their thinking, and thus lower in cognitive de-fusion, are not as aware in the moment that they are having the thoughts that they are having. They just automatically think and perceive things as if their thought is actual reality or the only viewpoint.

In contrast, by noticing one’s thoughts, a person can separate from the thought. The thought then has less emotional impact. In essence, by noticing each thought as it occurs, a person can tap into an observing part of themselves and is no longer fused with only their thinking mind. Aside from increased mindfulness of thoughts, ACT also teaches other ways of defusing from one’s thoughts and beliefs through cognitive de-fusion strategies.

4) Self as context VS attachment to the conceptualized self

The concept of the conceptualized self refers to self-referencing perspectives and beliefs a person has. Aside from automatic thoughts, people have an underlying view and corresponding narrative about themselves. A self-narrative relates to how people might answer the question, “who are you?”

The extent to which one’s narrative is flexible and self-supporting varies widely across people. When people become attached to a conceptualized self (e.g., ‘I am not good at relationships’), a lack of flexibility can make it more difficult for a person to make desired changes in their life.

ACT aims to help people differentiate between a stable enduring sense of self and more fleeting thoughts, feelings, sensations and memories. If one is lower in self-as-context skills, thoughts, feelings, sensations and memories can become more easily attached to one’s view of self. ACT also strives to help people become more aware of the timeless, interconnected sense of self so that it becomes easier to distinguish this sense of self from any particular context (Luoma et al., 2007).

5) Defining valued directions VS lack of value clarity

Values are the qualities that underlie living in a meaningful, purposeful way. Values represent what is important to someone. Values differ from goals, in that values are a life-long striving that drives the direction of behaviour, while goals are achievements that can be worked towards and then completed (Luoma et al., 2007).

Rather than only focus on goals, ACT aims to help people uncover their primary values in life. Being in greater touch with one’s values can help provide a meaningful direction to one’s life. A meaningful direction in life is thought to be to an antidote to dissatisfaction, confusion and depression.

ACT aims to help people identify and clarify their most important values. ACT also incorporates ways to help people to stay in touch with their values in a day to day process, which leads to more purposeful and satisfying living. As a way of assisting people in clarifying values, ACT often encourages people to reflect on questions such as what they want their life to stand for and what kind of person they want to be.

6) Committed action VS avoidance & inaction.

Another fundamental component of psychological flexibility is the extent to which a person persists with meaningful action in the face of difficulty, as opposed to becoming avoidant or inactive. Avoidance and inactivity tend to increase depression and anxiety over the long run.

This is concerning because, when faced with difficult emotions and adversity, people commonly shut down and become inactive. People also tend to pull back from important relationships and leisure activities. Particularly with depression and anxiety, people often start to withdraw from their life and avoid people, situations and activities.

To try and help counterbalance these concerns, ACT places a particular focus on helping people to choose differently. ACT teaches people ways to take valued action, even in the face of adversity or emotional difficulty. Enhancing the range of psychological flexibility skills is thought to help people more easily choose valued actions, despite what difficult feelings and negative, or self-defeating thoughts, or narratives, show up.

To learn more about ACT, visit the Association for Contextual Behavioural Science at https://contextualscience.org/act.


Dr. Barbera C. Psych can be reached at:

Psychotherapy Matters through Dr. Barbera’s Profile.

Website: https://www.findinnercalm.ca

Her website is focused not only on connecting people with accessible psychological services in Ontario, but also helping people learn about information that will help them understand themselves, develop self-compassion, and heal with or without the help of a psychologist or therapist.

For a continually expanding source of psychology information visit the self-help, resources and blog pages of her website:

Self-help: https://findinnercalm.ca/self-help

Resources: https://findinnercalm.ca/psychology-resources

Blog: https://findinnercalm.ca/psychology-blog


References:

A-Tjak, J.G; Davis, ML; Morina, N; Powers, MB; Smith, JA; Emmelkamp, PM (2015). “A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.” Psychotherapy and Psychosomatics. 84 (1): 6-30.

Harris, Russ (August 2006). “Embracing your demons: an overview of Acceptance and Commitment Therapy.” Psychotherapy in Australia. 12(4): 2-8. https://unitementalhealth.files.wordpress.com/2017/07/act1.pdf

Horner, G. (2016). Resilience. Journal of Pediatric Health Care. 31(3): 384-390. https://www.jpedhc.org/article/S0891-5245(16)30254-1/pdf

Luoma, J.B., Hayes, S.C., & Walser., Robyn, D. Learning ACT. An Acceptance & Commitment Therapy Skills-Training Manual for Therapists. New Harbinger Publications, Inc. (2007).

Dr. Jennifer Barbera Psychologist
Dr. Jennifer Barbera Psychologist

Dr. Jennifer Barbera C. Psych is a clinical and counselling psychologist that works in a private practice in Hamilton, Ontario. She has over 23 years of counselling experience in various community organizations, hospital, university and private practice settings. Dr. Jennifer Barbera C. Psych has extensive experience and training in assisting people to recover from depression, anxiety and trauma using a combination of approaches such as CBT, ACT, DBT, IFS and EMDR. She has a particular interest in treating complex trauma and dissociative symptoms.

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