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

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Today we launch 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).

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.  

1. How would you describe 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.

2. How did ACT come to be? What types of philosophies inform it?

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.

3. How hands on is the therapist in a ACT-style therapy

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.

4. Please share three different real but anonymized examples of what ACT looks like in the room.

  • 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.

5. Please share three or more issue areas ACT is particularly helpful in working through. 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.

6. How long does a ACT treatment generally 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.

7. 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!

8. Are there certain personality types that may not enjoy working with ACT?

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.

9. How do you know if ACT is working for someone? 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.

10. How should a therapy-goer prepare for a ACT session? What type of work is entailed?

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.

11. 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.

12. What advice might you give to a therapy-seeker wondering if ACT 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!

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 vanessa@vkpsychotherapy.com

Any thoughts, questions, or feedback? We'd love to hear from you. Reach our team any time at connect@mywellbeing.us.