Acceptance and Commitment Therapy, called ACT (said like the word “act” rather than A-C-T) is a type of therapy that was created by Steven C. Hayes.

It is deemed the “cousin” of Cognitive Behavioral Therapy (CBT) because it has some similar underpinnings to CBT in that it incorporates both cognitive and behavioral aspects, but looks at behavior and cognitions through a different lens. ACT also finds inspiration through Buddhist teachings.

The therapeutic goal of ACT is psychological flexibility, which means you are capable of staying present to the present moment and all it encompasses, including painful or unpleasant experiences, and adapting to the moment in a way that allows you to live a meaningful life. This philosophy means that we are not able to control what thoughts and sensations we have; rather unpleasant thoughts and sensations will always be present.

But we can change our relationship to thoughts, emotions, and sensations in a way that enables us to move through the discomfort and towards what is meaningful to us.

This differs from CBT in that CBT aims at replacing dysfunctional constructs with more flexible and adaptive cognitions by restructuring. ACT does not focus on replacing, but rather bearing witness to and acknowledging, which in itself leads to positive psychological change.

ACT is based on six core processes that lead to the therapeutic goal of psychological flexibility. The six core processes are:

• Acceptance
• Present Focus
• Cognitive Defusion
• Values (see my past blog on values here.)
• Committed action
• Self as Context

The name, Acceptance and Commitment Therapy names itself after two of the six core concepts of ACT, acceptance and commitment. The word “acceptance” sometimes brings both confusion to what ACT really is because it is not simply accepting everything and anything.

Acceptance in ACT does not mean accepting someone’s abusive behavior, or accepting your circumstances in life and not doing anything about it.

Those who use ACT as a theoretical approach to therapy often refer to acceptance as willingness instead because it better encapsulates what acceptance means. It boils down to, are you willing to experience discomfort in order to live a meaningful life? To be psychologically flexible, you need to be open to life experiences.

The second process in the name ACT, is committed actions. Committed actions is one of the main behavioral components of ACT.

Committed action means actually engaging in behaviors that are in line with your values. It is important to know your values but to live meaningfully means to do things that are towards your values, another one of the core processes of ACT. Your values are what is most important to you in life. The blog that is linked above explains values in more detail but the basic idea is “What do I hope someone will say about me and how I lived my life by the time I turn 80?”. That question leads us to understand what our values are and what we want to live our life doing. Through knowing our values, we can then identify actions that help us live in line with what matters most to us, which is committed action.

Present focus is the process that is more well known in ACT, because present focus is mindfulness.

Mindfulness means to be present in the moment without judgment. To be psychologically flexible, we need to be able to be psychologically, consciously, present and engaging in the moment. This can be hard to do because people are prone to avoiding discomfort as it is unpleasant, but it is essential to making change in life.

Another core process of ACT is Cognitive Defusion.

Fusion, as we know it outside of ACT, means the process or result of joining two or more things into a single entity. ACT focuses on how we fuse with our thoughts and the impacts this has on us. We all have an inner dialogue in our minds and when we are cognitively fused, it means we are taking our thoughts as truth, which causes us to get caught up in our thoughts or give them more meaning than they are worth. This means that if I have the thought that people will not like this blog post, I take that as the truth and therefore feel upset and stressed by it.

Cognitive Defusion means that we can acknowledge that our thoughts are simply thoughts, not always true, and do not need to hold the meaning we give them.

We can instead step back,notice and watch our thinking, and recognize thoughts as simply thoughts. This gives us more flexibility and freedom.

Finally, Self-as-Context is one of the core processes.

This process can be a little difficult to explain at first but Self-as-Context is the identification that we are not defined by our thoughts, emotions, and sensations. The opposite of this, is Self-as-Content, which means that our sense of self is fused with what we are experiencing. If it is raining outside, the sky does not change what it is. If it is 75 degrees and sunny, the sky does not change who it is, because the sky is the sky regardless of the weather. The weather does not change what the sky is. The weather may change around it and the conditions may differ day to day, hour to hour, but the sky remains the sky throughout. Self-as-context is the recognition that we are the sky, not the weather. As you go through life, your thoughts, emotions, and even roles may change, but the core “you” does not. That stability of a sense of self is an important part of psychological flexibility.

There are pros and cons to every type of approach to therapy.

However, I find ACT is a valuable theoretical approach that is both validating of life’s experiences and enables positive growth and change for clients. If you are interested in seeing a therapist who incorporates ACT into their work, reach out to our front desk to see who may be a good fit for your needs.

Medication and therapy both help people relieve and manage psychological wellbeing.

There are many reasons why a person may choose to only use medication or only participate in therapy. As clinicians, we always hope to foster a sense of autonomy for clients in choosing the best course of treatment for them. However, researchers have demonstrated that the combination of medication and therapy work best together, which is why your therapist may suggest meeting with a psychiatrist, or a psychiatrist may recommend beginning therapy. 

When I work with clients and decide to recommend medication for their mental health symptoms  to supplement our work together in therapy, I frame it as this:

Medication can help reduce symptoms enough that you are better able to engage in the coping skills you learn in therapy.

The idea is that once you can better access the ability to engage in coping skills consistently, the coping mechanisms will be a learned behavior that you will be able to use more effectively going forward. 

At this point, if a client does not wish to continue to be on medication, they can work with their prescriber to try to taper off medication. The idea being that the coping skills are more ingrained at that point, so the client will likely be better able to manage their symptoms without medication.

However, some clients benefit from long term use of psychiatric medication and for some disorders, long term use of medication is highly recommended.

Psychological disorders have biological bases. A person’s brain is an organ and our psychological wellbeing is largely dependent on neurotransmitters. People with depression, anxiety, OCD, Bipolar I or II, ADHD, schizophrenia and more, have neurotransmitters that are not working to the degree that they are intended to work. Medication allows balance of neurotransmitters. Some medications work to slow down the reuptake of neurotransmitters so that they have the time to do their job effectively. While some medications work to increase the activity of a neurotransmitter at the appropriate receptor or block the receptor so the appropriate amount of a neurotransmitter is accessed.

Whether you are in therapy, taking medication, or both, know that you are engaging in committed actions towards taking care of your wellbeing.

The combination of medication and psychotherapy can be the most beneficial for many clients, so talk to your providers about this if you are interested in how both methods of treatment may suit you. If you are interested in therapy, medication, or both, feel free to reach out to us at OMHG. We have a team of medication management providers and therapists ready to help!

References:

Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T. A. (2020). A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry, 19(1), 92—107. 

Kamenov, K., Twomey, C., Cabello, M., Prina, A. M., & Ayuso-Mateos, J. L. (2016). The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: A meta-analysis. Psychological Medicine, 47(3), 414—425.