Acceptance Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT, pronounced as the word "act") is a "3rd wave" behavioral therapy developed by Steven Hayes. It is built on 6 core processes meant to help people increase their "psychological flexibility" and live in ways that are more accordant with their values. ACT utilizes mindfulness/meditation, experiential exercises, metaphors, and a list of other creative and adaptive strategies to help people live a life where they feel able to do the things that are important and meaningful to them. 

For our client's, the ACT "process" can mean many different things and look very different from client to client, however, ACT is based on 6 "core principles" from which all interventions utilizing it are derived. They have fancy names but most of them are pretty simple concepts. 

1) Present Moment: Focusing on the here and now.

2) Acceptance: Be willing to experience difficult thoughts. 

3) Values: Discover what is really important to you. 

4) Self-as-context: Notice your thoughts. 

5) Cognitive Defusion: Observe your thoughts without being ruled by them. 

6) Commitment: Take action to pursue the important things in your life. 

These six processes are all meant to work together to promote a learner's overall psychological flexibility, which Hayes defines as "the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends." For the client's we serve, these principles may be applied to a variety of presenting behavioral challenges in order to develop interventions that assist in decreasing the frequency and intensity of challenging behaviors, while also focusing on building values-based skills. 

For example, for a child with challenges related to regulating their own emotions and impulses because of uncomfortable thoughts or feelings, the use of an ACT metaphor which focuses on mindfulness and cognitive defusion may be a beneficial strategy. One of my favorites is the glitter bottle metaphor. We start by putting glitter into a water bottle and putting the cap back on. 

We then tell the learner, "pretend the bottle is your mind, and each speck of glitter is one of your thoughts. When you feel calm your thoughts stay settled in your mind like they are now. But when you feel angry and upset your thoughts start flying around like this!" I then shake the bottle so all the glitter is suspended in the liquid. Then I ask the learner, "if I wanted to get all the glitter to settle back down on the bottom of the bottle what would I have to do? Should I try to shake it up more hoping it will all eventually go to the bottom or is there another way?" 

At this point the learner will usually say you just need to leave the bottle alone and let the glitter settle by itself. I ask the learner if they would join me in focusing on the specks of glitter as they begin to settle back to the bottom of the bottle and to imagine them as our thoughts. I then point out that maybe our thoughts are like the specks of glitter in the bottle, sometimes the best thing we can do to settle them down is to just notice them and let them be.

This quick exercise allows the learner to be in contact with the present moment, encourages them to be open to experiencing challenging thoughts, and shows them that accepting the existence of these challenging thoughts (and not always trying to change them) may be the most effective way in not feeling so greatly affected by them anymore. ACT operates on the assumption that negative thoughts and feelings, even really painful ones, are part of a natural process of the human mind and that by denying them, thinking they're bad, or otherwise trying to change them can actually give them more power and serve to increase our unhappiness and struggle against them. The word "acceptance" in ACT should not be confused with ambivalence, however. In this context, acceptance means simply acknowledging the presence of a particular experience. It does not mean that that experience should be viewed as deserved, warranted, preferable, fair, or unchangeable. The purpose of ACT is to help people see the ways in which they are "fusing" to their thoughts (especially the negative ones), and by doing so, help them decide on a different action to take-- one that is more aligned with their values than being worried or feeling upset. 

ACT is notable because it reckons with human language and cognition in a way other behavioral and psychotherapeutic theories do not. It avoids pathologizing the existence of uncomfortable thoughts (especially because we don't get to choose our thoughts!) and instead grounds itself in the idea that while anxiety and worry have been beneficial for keeping us alive through human history, they aren't very beneficial in increasing our happiness or fulfillment. Our negative, defeating, worried thoughts are examples of how this anxiety has filtered into our language and inner thought process. ACT's response then, is to acknowledge this fact, acknowledge the pain that comes with it, and then make the decision to focus our attention on something else--something that is meaningful, rewarding, and more in-step with what we value as a person. This could be a weighty value related to our identity, morals, spirituality, or politics, but it also could be lighter and more whimsical, like the way we may value a delicious scoop of ice-cream, a walk in the park, or petting our dog. In this way, ACT can be a great tool for clinicians in helping clients identify what is actually important to them while fostering strategies that allow them to live in ways congruent and compatible with what is important in their lives. 

Written by: Nicholas Lea, Miren Behavior Consultant