What is Acceptance & Commitment Therapy (ACT)?
“Endless suffering - all from not allowing the mind to do its job.”
- Marcus Aurelius
While many people are familiar with cognitive-behavioral therapy (CBT), much fewer know about its third-wave counterpart, acceptance and commitment therapy (ACT). Whereas CBT primarily focuses on identifying cognitive distortions (i.e., catastrophizing, all-or-nothing thinking, etc.) and challenging them through cognitive restructuring, ACT takes an acceptance-based approach towards managing one’s thoughts, alongside reorienting oneself to value-driven behavior.
Similar to CBT, ACT is an evidence-based behavioral approach to psychotherapy. However, rather than attempting to change the content of one’s thoughts through cognitive disputation and subsequent restructuring, ACT emphasizes psychological flexibility. This refers to the ability to remain engaged in the present moment and mindfully defuse from sticky thoughts, even in the presence of difficult experiences. The key difference between the two revolves around the inherent goal of the practice. The aim of ACT is not to eliminate anxiety; rather, to change our relationship with it.
Instead of disputing the validity of thoughts, as one would do in traditional CBT, ACT encourages acceptance of the mind’s natural activity. For example, let’s take a closer look at the potential thoughts of someone with a fear of public speaking. They might have automatic thoughts such as, “I’m definitely going to sound stupid,” “Everyone will laugh at me,” or “Why would anyone want to hear what I have to say anyways? They all think I’m crazy.” This individual’s thoughts are fraught with cognitive distortions such as catastrophizing, all-or-nothing thinking, fortune telling, mind reading, and onwards.
A traditional CBT approach might involve challenging these thoughts and generating more balanced alternatives. This could involve creating a thought log, whereby one quantifies their emotional reactivity, labels their thoughts as distorted, and subsequently looks at the evidence for and against their thoughts before coming to a more rational conclusion and re-rating their emotional experience. In contrast, ACT helps one to simply notice their thoughts, like clouds floating by, without arguing with them. This is done through acknowledging their presence, making space for them, and choosing to behave in line with one’s personal values nonetheless (i.e., “I may sound crazy, and people might judge me, but sharing my ideas is important to me, so I’m going to do it anyways.”).
Important to this intervention is understanding what one’s values are in the first place. This is often done through an activity called a values card sort, whereby an individual ranks their top 5 values through the process of elimination. In doing so, one can better understand why certain behaviors make them feel good (i.e., value-aligned) and why other behaviors lead to negative emotionality (i.e., value-inconsistent).
These shifts from control to acceptance, from avoidance of feared outcomes to engagement in one’s values, are among the core principles of ACT. In these ways, an ACT practitioner invites their patients to stop arguing with their internal experiences and instead focus on what truly matters to them. Doing so helps individuals to live a life guided by self-defined meaning and values, rather than a life guided by fear.
Through blending mindfulness techniques, such as cognitive de-fusion, with behavior change strategies, such as behavioral activation, ACT fosters lasting change in people’s lives. Whether one is navigating anxiety, depression, OCD, or simply feeling stuck in their lives, ACT offers a powerful framework for moving forward. This is not done by eliminating discomfort; rather, by learning to carry it with you on the path to a more meaningful life.