Despite the prevailing stigma (and the potential barrier of cost), nearly everyone can benefit from healing work — and this especially includes therapy. While it’s easy to get caught up in the minutiae of our daily lives, there’s rarely a bad time to seek out a therapist. And this is especially true as we grapple with the ongoing impacts of COVID-19, which is hitting Black, Brown, and Indigenous communities the hardest.
Between losing relatives and navigating unemployment to being separated from friends and partners, it can feel like there’s no end in sight to this pandemic and its negative effects. On top of that, there’s stress and anxiety that comes from the Trump administration continuing to roll back reproductive, transgender, and environmental rights and more while Black people continue to be victims of police brutality seemingly every day.
Needless to say, there’s a lot to navigate emotionally right now but the good news is you don’t have to do it alone. Anyone starting therapy for the first time might be feeling overwhelmed by all the different kinds available. If you’re tired of avoiding your challenging emotions or acting out unhealthy behavior patterns in your relationships, then Acceptance and Commitment Therapy (ACT) might be the perfect therapeutic approach for you.
What is Acceptance and Commitment Therapy (ACT)?
ACT is a form of psychotherapy in which mindfulness practices are used to address different distressing emotional states. According to James Powell, an LMSW based in Brooklyn, New York who practices the approach, ACT recognizes that experiencing pain — for example, anxiety, depression, grief, anger, and fear — is a natural part of being a human.
ACT is all about honoring your inner struggles and accepting them as part of your journey, Powell says. While this may sound easier said than done, Powell asserts that ACT invites clients to really acknowledge and welcome the hard things they would typically attempt to suppress and instead consider that these things are, in truth, a normal part of life. In fact, ACT is all about stopping and being with oneself — or as Powell says, it’s “the antidote to avoidance and banishment.”
“Rather than focusing almost exclusively on thoughts and memories, ACT often uses evocative metaphors and mindful present-moment awareness,” says Jason Walter, an LMSW based in New York City. In his practice he has found that, with ACT, he has seen clients make fundamental changes to the way they approach living and report a greater sense of meaning and satisfaction in general.
“I use ACT as a creative, often funny, methodology to help my clients learn emotional intelligence and reorient how they relate to their emotional/physical pain, thereby relieving suffering,” says Christine Carville, an LCSW-R and professor at the Columbia School of Social Work. “Using lots of amusing, memorable metaphor, and practical exercises to guide the experience, ACT emphasizes being open, mindful, centered, and actively pursuing values.”
“ACT is founded on acceptance-based principles, which promote individuals to actively receive, accept, and mindfully engage with all of their thoughts, feelings, behavioral urges, and bodily sensations instead of reflexively avoiding, running from, altering, or defending against what is disfavored or dreaded,” Carville explains.
Rather than trying to get to the root of one’s emotions, this type of therapy instead teaches clients to accept the inevitability of difficult emotions, “while stymieing their ability to detract oneself from creating a meaningful, vital life,” says Powell. In this way, Powell says the approach encourages people to befriend pain since it will always be a part of their life, and in doing so, it releases them from the struggle of trying to remove internal discomfort from their lived experience. “The basic premise of ACT is to accept what cannot be controlled, i.e. your thoughts, feelings, and certain particulars of an external experience and to continuously commit to taking actions that are aligned with your values.”
How does ACT work?
The mission of ACT is not symptom reduction or to change how someone feels about something, rather it is meant to shift how an individual relates to their thoughts and feelings. In this way, you are pursuing what Powell calls a “value-congruent” lifestyle, or a fancy way of saying matching one’s behaviors to their values. “Anytime we try to change something about our experience, we are protesting reality — ACT is about accepting and engaging with reality just as it is,” Powell offers. When we can accept and engage with our reality, even when it’s painful, we can ultimately mitigate any psychological suffering.
While symptom reduction can occur over the course of treatment, Powell says it’s not the primary objective of this approach. “According to ACT, ‘suffering’ is our struggle against and our attempts to change our thoughts and emotions,” she explains. Under this philosophy, the goal is to reframe the experience of pain as normal, so clients do not experience it as suffering.
According to her, “ACT’s six core processes: acceptance, cognitive defusion, being present, self as context, values, and committed action help us to mindfully engage with reality, thereby enhancing our psychological flexibility.” And it is from this flexibility that she says we can experience a greater sense of freedom to pursue a life worth living.
How does ACT differ from other approaches?
As an evidence-based practice, Walter says ACT fits under the umbrella of cognitive and behavioral therapy (CBT) but ACT represents an innovation to traditional cognitive behavioral therapy by drawing upon more recent scientific research. According to him, traditional CBT views psychology in a very mechanistic way, seeing unwanted emotions as a direct result of irrational thoughts, and behaviors as an automatic result of those emotions, like one billiard ball striking the next — essentially, people feel what they think and act how they feel.
In the past 50 years, Walter says that a large body of evidence has found that the same person can have a thought and a feeling in one context and have the same thought and a totally different feeling in another — which is the basic theory behind ACT. “The evidence also bears out that someone can behave differently while having the same emotion in different contexts as well,” he explains. “One can have practically any thought while having any feeling while behaving in whatever way.” While this may seem like merely a semantic distinction, Walter considers it a big deal because it enables him to help his clients see that they are free to act in any way they choose, preferably in service of what’s ultimately important to them, no matter what their thoughts and feelings might be telling them at the time.
ACT is both similar to and different from two other acceptance-based models of therapy including Dialectical Behavioral Therapy (DBT) and Mindfulness-Based Cognitive Therapy (MBCT). “Both DBT and ACT pursue mindfulness, acceptance, and useful action,” says Powell. “A major difference between DBT and ACT is in the area of skill-building.” While DBT is a manualized form of treatment involving regular skills-training groups where participants are taught specific techniques, such as acceptance and mindfulness, to develop their behavioral skills, ACT teaches people acceptance and mindfulness as actual skills of behavior.
“If acceptance is the first step, you notice it, face it, move through it and have the fortitude to problem solve, changing the future for the better,” says Carville. “This underlies both ACT and DBT but ACT adds a richer layer of how to identify goals and values and apply them with committed action.”
More than this, this form of therapy challenges the conventional wisdom of Western psychology in which one must have their symptoms reduced before they can begin experiencing a better quality of life, Powell explains. According to her, when your quality of life is determined by mindful, value-guided actions, it allows one to create a life of meaning no matter how many mental health symptoms you have, which is a complete paradigm shift. “I think it can be hard for people to conceive of, even mental health professionals, that we can live with our symptoms and get on with life in a way that feels good,” she tells Allure.
Who is ACT good for?
This therapeutic approach can be good for everyone and all challenges, conditions, and symptoms, according to Powell. Walter adds that it is philosophically transdiagnostic, meaning that it sees most, if not all, psychiatric diagnoses as involving the same basic mechanisms of dysfunction. For this reason, he says that ACT has been adapted for use with practically any clinical issue. “A version of ACT is even used for sports and performance psychology, which has its own rapidly growing body of research.”
Carville has seen clients who have chronic pain, health anxiety, generalized anxiety, chronic worry, rumination, perfectionism, and eating disorders who have all benefited greatly from ACT. “Clients who struggle with the burden and isolation of business leadership or those who feel that they are just putting one foot in front of the other greatly benefit from the values exercises and compass metaphors,” she says.
“ACT helps clients understand that they can notice and honor their thoughts and feelings without being governed by them,” says Walter. Using ACT, he supports clients in figuring out what they want their lives to be about, and then helps them plan and commit to behaviors that will make it easier for them to live that life, moment-to-moment, while bringing their thoughts and feelings along for the ride. If this sounds like something you’d benefit from, Walter says therapists who practice ACT will often list it in their treatment modality preferences on their website or psychologytoday.com profile. He also says, “Therapist profiles that mention mindfulness or third-wave interventions would be a good place to start.” He recommends asking what type of training a therapist has and if they have experience with ACT when doing a consultation.
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Originally Appeared on Allure