ACT

Acceptance Commitment Therapy

cognitive therapy services “Imagine a therapy that makes no attempt to reduce symptoms, but gets symptom reduction as a by‐product.” This is the opening sentence in an article I often recommend that my clients read in order to get an overview of Acceptance and Commitment Therapy (ACT).

ACT is a mindfulness‐based therapy that has been found effective with a wide range of presenting problems and is the form of therapy I most frequently recommend for my individual clients. ACT points out that in most instances a person seeking help for depression, anxiety, stress, work problems, relationship problems, addiction, OCD, PTSD or other issues has usually tried all kinds of ways to get rid of unpleasant thoughts or feelings. This includes such methods as positive thinking, prescription medications, alcohol, non‐prescription drugs, self‐help books, prayer, exercise, meditation, visualization, affirmations, and therapy. These and other types of interventions are often helpful at least to a degree and for some perhaps they work perfectly well and nothing new or different is needed. However those who are still suffering only need to consider that they are still seeking help to realize that past efforts, while they may have helped temporarily, or provided useful but not sufficient help, have not resulted in the type of significant life‐changing improvement for which they had hoped.

ACT provides an alternative approach, one that de‐emphasizes symptom reduction and instead emphasizes living in the present moment and making room for whatever thoughts and feelings are present, no matter how unpleasant or unwanted. By making room for whatever is happening in the present moment, by developing skills at creating a different mindset and a different relationship to what is present in one’s thoughts and feelings, it is possible to have more willingness to allow whatever is present to be present. This is counter‐intuitive and contrary to our almost knee‐jerk reflexive response to solve problems and make things better. Interestingly when a person develops more willingness and openness to unpleasant thoughts and feelings, often there is a diminishment of those very thoughts and feelings. ACT is all about dropping the struggle and resistance. This does not mean that we advocate a passive “grin and bear it” or “just take it” attitude. In fact there are numerous mindfulness skills and experiential lessons that actively promotes changes in how one thinks, feels and relates to one’s problems.

Like the opening statement in this section suggests, we often get symptom reduction as a consequence or by‐product of this therapy even though the stated goal is to live life with more flexibility and vitality. It’s tricky because people get to the point of seeking help because they want symptom reduction and to tell people we can help but not by trying to reduce their symptoms, it sounds at first contrary to what they want. Upon experiencing ACT, however, this new approach starts to make sense. ACT also helps not so much by a change in rational thought (like most cognitive therapies attempt to achieve) but by incremental changes that happen at a gut level as well as through rational thought, through experiential exercises in the office and “homework” away from the office that build over time and can create an entirely new outlook towards life and towards one’s problems.

There is also considerable time spent exploring and evaluating one’s values. The “commitment” part of Acceptance and Commitment Therapy is committing to do everything in one’s power to live life as closely as possible in accordance with those values. Often this might mean living according to those values despite uncomfortable, unpleasant thoughts or feelings. That’s what ACT helps a person do, live life with more flexibility, living in the present moment, while making room for unwanted thoughts or feelings if they are present. The nice thing is that more and more of the time it seems that after a course of ACT there are fewer and less intense unwanted experiences to contend with and life can be lived much more flexibly.

I am convinced this approach can work well for many different presenting problems. If you are interested in talking more about this treatment, please contact me by phone or through e‐mail and I will be happy to discuss it with you in more detail.