9 min read

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Vanessa Kensing

12 Things You Didn't Know About Acceptance And Commitment Therapy (ACT)

Learn more (on a jargon-free, human level!) about Acceptance and Commitment Therapy (ACT) from Vanessa Kensing, private practice psychotherapist in NYC.
12 Things You Didn't Know About Acceptance And Commitment Therapy (ACT)

Welcome to our new series, "Things You Didn't Know," all about different types of therapy, directly from the experience of private practice therapists in NYC who use these techniques every day to help countless people heal. Today, we hear from NYC therapist Vanessa Kensing about Acceptance and Commitment Therapy (ACT).

What is Acceptance and Commitment Therapy (ACT)?

Acceptance and Commitment Therapy (ACT) is one of the so-called “third wave” of behavioral psychotherapy approaches. The “third wave” approaches can be thought of as updated versions of Cognitive Behavioral Therapy (CBT), usually with more of a focus on mindfulness and present-moment processing. ACT is characterized by compassionate exploration and acceptance of what can and cannot be controlled, and a commitment to action and change that allows the individual to live a values-based life in spite of emotional challenges.

Interestingly, acceptance is not the goal of ACT per se; rather it is through the framework of acceptance, cultivated through mindfulness, that individuals discover their inherent ability to manage the relationships between their thoughts, emotions, and behaviors.

Where did Acceptance and Commitment Therapy come from? What philosophies inform ACT?

Acceptance and Commitment Therapy was developed by Steven C. Hayes in 1986 as a response to how the field of psychology was conceptualizing the experience of suffering and pain. At that time, it was mainstream belief that suffering and pain should be avoided or minimized. However, Hayes saw suffering as both inevitable and essential to human existence. Using Relational Frame Theory – a theory that suggests that our ability to relate is the foundation of language and cognition – Hayes created a form of psychotherapy that explores ways to alter our relationship to suffering and pain - specifically helping us move from avoidance to accepting and even embracing discomfort and pain.

As mentioned above, ACT is considered to be a part of the “third wave of cognitive behavioral therapy” along with other therapies you may be familiar with such as Dialectical Behavior Therapy (DBT) and Mindfulness-Based Cognitive Therapy (MBCT).

Unlike CBT, which focuses on directly changing, challenging or stopping distorted thoughts and feelings, ACT focuses on developing a new and compassionate relationship with those painful thoughts or feelings. This is achieved through mindfulness and values-based exploration. To summarize, ACT is informed by Relational Frame Theory, cognitive-behavioral theories, mindfulness practices, and values-based theories. For a more thorough look at the philosophies underpinning ACT please read this additional resource.

How hands-on is an ACT therapist?

While each therapist has their own individual style, in general, an ACT-informed therapist takes an active role in guiding the client through an exploration of their values, as well as building skills associated with mindfulness. ACT is a collaborative therapy model - therefore the therapist and client are both actively engaged in helping the client build the framework of acceptance.

What is Acceptance and Commitment Therapy like?

  • An individual may come into therapy feeling dissatisfied with their life, but at the same time state that they “shouldn’t be dissatisfied,” because they have “a lot of things that make them lucky or privileged.”

    An ACT-informed therapist would aid this individual into to exploring their values through a values exercise (see page 8 and 9 from this handout for an example) – this would help the individual explore and examine in what ways they were living within their value system and in what ways they may want/chose to change. This would allow the client to find acceptance in their dissatisfaction and begin to make shifts and/or changes that would allow them to find more alignment between the things they value and the way they spend their time. Similarly, this would aid them in getting “unstuck” from the back-and-forth cognitive tug of war of “I’m dissatisfied - but I shouldn’t be.” The work would involve helping the individual “make room” for the difficult feelings and accept them as they are (without necessarily trying to evaluate, dispute, or “resolve” them). It is a paradox seen often in ACT that once an individual truly accepts their feelings (even those that are contradictory), they are then able to take values-guided action.
  • A client may come into treatment expressing difficulty with anxious ruminations. No matter what they do to try to change their thoughts, they keep coming back to their anxiety and dread. The client feels “stuck” in a cycle of anxious dread.

    An ACT-informed therapist could provide psycho-education around the concept of thought diffusion. This technique encourages individuals to be the observer of their cognitive and emotional experience, rather than “fusing” with that experience so they become inseparable from it. Various ACT interventions (many of them involving mindfulness) can help an individual create enough emotional and cognitive distance to “unhook” from their rumination. The client can then observe their rumination by saying something like “Oh, I am doing that thing I do, focusing only on what could go wrong” – this observation creates the distance needed to unhook from the rumination so they can then ask themselves, “Can I do something that will make me feel better instead?” Once this greater distance from thoughts and feelings is established, ACT can help the client choose actions based on their values.
  • A client may come into therapy saying that their life would be so much better if the other people in their life (e.g. spouse, boss, parent) would change.

    While it may be true that the client’s life would be enhanced by their spouse spending more time with them, or their boss being more validating, an ACT-informed therapist would aid the client in an exploration of what can and cannot be changed within these interpersonal dynamics. In doing so, the client could discontinue repeating failed attempts of getting their needs met, and instead focus on what they can actively do to improve their own lives. This may involve the individual mindfully grieving the things that they expected from other people but did not get.

What conditions does Acceptance and Commitment Therapy work for? Why do you think that is?

ACT is helpful for obstacles like mood disorders (such as anxiety or depression), substance abuse issues, and trauma. In each case, the individual can be “stuck” in the way they are relating... the individual to their mental health, the individual with their drug or behavior of choice, and the individual with their trauma experience. ACT allows each individual to disengage in thoughts, feelings and behaviors that don’t serve their long term well being through compassion and commitment.

How long does Acceptance and Commitment Therapy last?

While most people can learn the concepts and techniques associated with ACT in a matter of months, change does take time! Integrating new ways of thinking and relating to one’s self is a long process which is impacted by developmental experiences, trauma, support systems, etc.

Despite the length it may take to achieve lasting change, one will be motivated by the small successes along the way. ACT is a flexible enough framework that it can be adapted to both short-term and long-term applications.

Are there certain personality types that would work especially well with ACT?

Like many other therapies, if you are open to self exploration, and open to new ways of thinking about the world around you, then ACT would be a good fit. It does challenge the problem-solving paradigm through the use of acceptance, so a willingness to engage differently with one’s thoughts, feelings, and behaviors is helpful - but even if you don’t feel that willingness, ACT can help you develop that willingness!

Are there certain personality types that may not enjoy Acceptance and Commitment Therapy?

As a perfectionist (in recovery 🙂) myself, ACT can be challenging at times. I want to control everything even if I rationally know that is impossible. Letting go of control can feel like failure; however, ACT has helped me reframe those emotional reactions from failure to empowerment.

ACT is, however, contraindicated for those individuals who are in situations where acceptance would be dangerous. For example, for those in abusive relationships, or behavioral problems where the individual is placing their physical health and safety at risk, ACT may not be the most appropriate approach.

How do you know if Acceptance and Commitment Therapy is working? How do you know if it’s not?

ACT is working when you notice your relationship to your thoughts and feelings is changing, when you use techniques to stay or come back to the present moment (thus stepping out of the various forms of “auto-pilot” that can underlie numerous mental health disorders), and when you recognize yourself living in a way that is consistent with your value system.

ACT usually works very well, if delivered well and with adherence to the theoretical model! However, some signs that ACT isn’t working could be development of more rigid and fused relationships with thoughts and emotions (rather than more flexible, pliable ones) and feelings of hopelessness. If you experience this, you should speak with your therapist about your concerns and your therapist should be open to considering alternate approaches.

How should a therapy-goer prepare for Acceptance and Commitment Therapy?

Though this can also happen in session, you can begin to explore your values - what is important to you and how has this come to be? Similarly, you may want to explore mindfulness exercises such as meditation, deep breathing, and visualization to get a feel for what is to come.

Most importantly, you should put time into finding a therapist that is the right fit for you. Therapy is intimate work that requires a sense of safety for vulnerability to exist. Spend the time needed to find a therapist that creates that safe space and that you feel comfortable with.

What is your favorite thing about ACT?

Compassion! ACT doesn’t pathologize your thoughts or emotional experiences; it doesn’t tell you that your thoughts and feelings are “wrong” or “unhelpful” or “irrational” or “distorted.” Instead, it encourages you to practice acceptance, which in turn creates energetic space for change! Making room for emotional discomfort also makes room for growth. Building this compassionate and accepting relationship with myself has been life changing for me and for my clients.

What advice might you give to a therapy-seeker wondering if Acceptance and Commitment Therapy is right for them?

If you have been in therapy before and it has been unhelpful or not as successful as you hoped, ACT will likely be a refreshing and effective change. It integrates acceptance and mindfulness, aspects that might have been missing from your previous therapeutic experiences. If you’ve never been to therapy before and are looking for a way to change that will be empathetic, you cannot go wrong with ACT!

What conditions can acceptance and commitment therapy (ACT) treat?

ACT can aid in treating various mental and physical conditions. These include:

  • Anxiety disorders: Research reveals that ACT aids in improving symptoms of Generalized Anxiety Disorder (GAD), and it is ideal for aged adults who have the condition.
  • Eating disorders
  • Depression
  • Obsessive-compulsive disorder (OCD)
  • Chronic pain
  • Workplace stress
  • Psychosis
  • Substance use disorders

What should a therapy-goer expect when going for acceptance and commitment therapy (ACT)?

Once you decide to go to ACT therapy, an ACT therapist will often allow you to listen to how you talk to yourself about your relationships, traumatic life events, physical restrictions, anxiety and depression, other challenges, or simply your self-talk. Only then can you determine if an issue necessitates immediate change or action or if it should be handled as it is while you develop behavioral changes to help transform the situation.

ACT was developed from Relational Frame Theory (RFT), a school of thought revolving around cognition and human language. RFT implies that the human mind's analytical problem-solving skills may be inefficient in assisting people in overcoming psychological discomfort. ACT therapy was established in response to this statement to teach individuals that, while psychological discomfort is normal, we can learn to live healthier and more prosperous lives by changing our perspective about pain.

Thus, you and the ACT therapist will determine approaches that have not worked in the past when dealing with pain and negative thoughts while helping you work on more effective methods. They will also help you stop negative thoughts and behavior patterns, potentially leading to greater and long-term issues. After addressing and accepting your current circumstances, you can now engage in committed actions of letting go of emotions and past experiences. Depending on your set goals and belief system, you will start practicing self-confidence and optimistic behavior.

Unlike behavioral and cognitive therapies, ACT does not aim to diminish the intensity and frequency of negative inner experiences such as unsettling cognitive distortions, urges, or emotions. Instead, the goal of ACT is to increase psychological flexibility. This involves the ability to modify your behavior and thoughts and embrace emotional openness based on your goals and values. ACT aims to eliminate your battle to control while boosting your participation in present moment life experiences.

Below are six techniques used to encourage the development of psychological flexibility.

1. Acceptance

Acceptance entails accepting and appreciating your entire spectrum of ideas and emotions instead of attempting to evade, deny, or change them.

In other words, it is allowing your inner feelings and thoughts to arise without attempting to alter or suppress them. Acceptance is a process that requires a lot of intention,  effort, and grace.

2. Cognitive Defusion

Distancing oneself from uncomfortable feelings and thoughts and adjusting how you respond to them is known as cognitive defusion. It involves receiving a thought or idea without prejudice or judgment, articulating the thought, and identifying the automatic reaction. As a result, this enables you to perceive thoughts for what they are, without the weight given to them by your mind.

3. Being in the Present Moment

Being in the present moment entails being aware of what is happening in your surroundings and monitoring your feelings and thoughts without criticizing or attempting to change them—as such, going through events directly and clearly can aid in behavior modification.

4. Self as Context

The concept of self as context seeks to broaden the definition of identity and self by claiming that individuals are essentially more than just their feelings, thoughts, and experiences. It entails distinguishing your emotions and thoughts about yourself from your actions.

5. Values

Values involve adopting personal values and beliefs in various sectors and seeking to act by these principles in various life experiences. Living by your values is contrary to performing acts motivated by a desire to avoid pain or meet the expectations of others, for instance.

6. Committed Action

Committed action entails making intentional and practical actions to integrate modifications that match your values and beliefs, ultimately leading to positive change. It may include setting goals, skill development, and exposure to uncomfortable thoughts or situations.

If you're wondering how you will apply all these techniques in your life, don't fret! Your therapist will work with you closely and help you with each step. They will hold your hand through every concept, from embracing cognitive defusion to practicing acceptance to establishing self as a context.

Generally, ACT sessions are very hands-on as they involve mindfulness exercises intended to promote a non-judgmental and healthy understanding of emotions, thoughts, memories, and sensations. You and your therapist will go through various life experiences that did not meet your values while assisting you to realize behaviors that would better fit the situation.

You will also get homework to practice specific techniques in between sessions. These may include exercises involving acceptance and mindfulness, value clarification, and cognitive. You and your therapist will agree on the assigned homework, and it can be customized as needed to make it as personal and beneficial as possible.

How Do You Start ACT?

Several mental health professionals can offer ACT, including but not limited tosocial workers, psychologists, psychiatrists, and mental health counselors. If you're interested in this type of therapy, you can seek out an ACT professional or simply inquire about the experience of your treatment provider.

Note that there is no explicit ACT certification for practitioners. Generally, ACT skills are acquired through workshops, peer counseling, or other training programs. However, as you search for an ACT therapist, it is vital to find one with whom you are comfortable.

Alternatively, the Association for Behavioral and Cognitive Therapies (ABCT) or the Association for Contextual Behavioral Science (ABCS) can provide recommendations for ACT resources. You can also filter for a therapist who specializes in ACT when you find your therapist through MyWellbeing. Other than audio and video resources as well as mindfulness exercises, contacting these associations is an excellent starting point in your ACT journey.

Remember that your ACT-trained therapist will play a primary role in being an active and empathic listener. However, they will also be active guides who encourage non-judgemental awareness and deeper self-exploration. You will discuss your core values and beliefs and set goals to guide your behavior and conduct in the future.

Any final thoughts for someone considering ACT? How do they know if ACT is the right option for them?

If you're looking for ways to embrace your emotions and thoughts and fight feelings of guilt in your daily life, you should definitely give ACT a try! Although it might seem overwhelming or confusing at first, it has proven to be a clinically effective method of enjoying a happier, healthier, and more fulfilling life, especially when paired with mindfulness techniques. Share your preferences today to be matched with a therapist who’s familiar with ACT, or search for your provider on MyWellbeing and filter for ACT speciality. Care and relief are just around the corner.

Thank you, Vanessa, for sharing your perspective with us and helping us learn more intimately and humanly about Acceptance and Commitment Therapy (ACT).

If you would like to reach Vanessa directly to continue the conversation or schedule an appointment, please email her at [email protected]

Any thoughts, questions, or feedback? We'd love to hear from you. Reach our team any time at [email protected]

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About the author

Vanessa Kensing is a licensed clinical social worker (LCSW), therapist, and owner of VK Psychotherapy. She specializes in working with those who struggle with perfectionism, anxiety, codependency and addiction issues. She has her Master's in Psychology from The New School of Social Research and her Master's in Social Work from Hunter College. Vanessa brings experience to the therapeutic room with almost a decades time working in community-based and private mental health and substance abuse settings, but also considers herself a life-long learner, committed to continued growth and development. When she is not working she can be found doing her favorite things: eating, reading, watching HBO or dancing.

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