Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) has been shown to be useful in treating anxiety, depression, substance abuse, eating disorders, trauma, couples distress and personality disorders. The January 2006 edition of Behaviour Research and Therapy summarized the results of 13 clinical trials. Individuals treated with ACT showed greater improvement than those who received other types of therapy in 12 out of the 13 trials.

The goal of ACT is to maximize your potential for a rich, full and meaningful life by teaching you skills to deal with painful thoughts and feelings so that they have much less impact and influence over you (these are mindfulness skills). This process involves clarifying what is truly important and meaningful to you to inspire, motivate and guide you to live your life to the fullest.

In this way, ACT is about both acceptance and change. Acceptance of your anxious thoughts and feelings allows you to focus more clearly on the present and to take the steps that move you closer to the life you truly want to live.

Acceptance and commitment therapy is based on the following concepts: Control Paradox, Acceptance, Mindfulness and Commitment.

We absolutely love to control. And our big, developed brains allow us to exert an amazing degree of control over our environment.  This has been very helpful in protecting us throughout time and it’s not surprising that one of our first instincts when confronted with an unwelcome experience is to somehow try to control that experience.  Our “control instinct” often works quite well. If you spill a glass of water, you exert control by wiping it up. Every day, all day long, we are exercising control and tend to feel pretty good doing it.

Control of Feelings

However, while control works for us in many situations, when it comes to controlling our feelings, control seems to have the opposite effect.  This is particularly true when you try to control or get rid of your anxiety.

As soon as someone says “don’t be nervous,” what immediately happens? Most people describe images of bad things happening, your heart starts to beat, your thoughts start racing. You’re nervous and anxiety has set in!

Usually, the harder we try not to experience anxiety or our feelings the more anxious we become! Why is this? Remember that anxiety is the fight-or-flight response. This is the response that helps us to take control of a threatening situation. If the situation that we need to control is anxiety, however, then we are eliciting the very response that we want to get rid of. This is the control paradox.

Control of Thoughts

A similar paradox applies when we try to control our thoughts. Most people find that the more they want to avoid thinking about something, the more likely they are to think about that very something. In fact, it is only when we decide that “I must not think about X” that we begin to experience thoughts about X repeatedly. In some cases, when thoughts are especially disturbing and we believe that we absolutely, positively,must not think them, these thoughts can become obsessions.

The opposite of control is acceptance.
The goal of ACT is to increase your acceptance of anxious feelings and thoughts through interventions that develop your awareness as an observer so that anxious thoughts and feelings can have less impact and you can move your attention to more meaningful aspects of your life.

An observer stance: You Are Not Your Anxiety.
When we experience strong emotions, there is a tendency to respond as though we are our emotions and beliefs. We believe it all and can’t see beyond the strong feelings and thoughts. We see it in how we talk about experience with things like “I am anxious.”  The reality thought is that anxiety is just one aspect of your experience. It is something separate from the “You” that is experiencing it. “You” with all the different pieces and experiences.

ACT therapists use mindfulness training as well as other techniques to help you to move toward perceiving anxiety as just another aspect of your experience.

Ah, the trap of living in the past and/or the future.  If you were to get really curious about the things that you are most often upset about, you will likely find that the majority of those things exist either in the past, or in an imagined future. Anxiety and worry often focus on events that may or may not occur in the next hour, weeks, or even years. At the moment you are imagining these events, they are images of possibilities. The present moment is very different from the imaginary future. When people are able to exist more fully in the present moment, they often find less cause for concern.

Mindfulness means simply paying attention and being willing to exist more fully in the moment that you are attending to. When we do this, we often find that the present moment holds more peace and contentment than either the past or the future. The experience of grounding in the present moment can be found in many of the usual, simple practices in life. Playing sports, an instrument, being with your children, pets or friends, hobbies, cooking and even cleaning!

This focus on the present moment does not mean that we are distracted from anxious thoughts and feelings. Our present moment awareness will often include thoughts about the past or future. When we observe these thoughts mindfully, however, it is with the recognition that they are only thoughts, and that the past and future that they refer to are not real right now.

When we talk about the idea of accepting the experience of anxiety most people rightly ask “why would I want to do that, anxiety is miserable!” The commitment part of acceptance and commitment therapy addresses this.

As we learn to notice the control paradox in our attempts to “stop anxiety” or “control the uncontrollable” we find that we often aren’t really making much progress. But then what?

By developing a new relationship with anxiety, making room for it, and identifying values and actions in the present to commit to that are more meaningful to us than the daily battle with anxiety, we may be allowed to move forward in ours lives in more rich and meaningful ways.

What will the acceptance of anxiety allow you to do with your life?

For the people who successfully change their relationship/response to anxiety, the most important changes are not just that they wash their hands less, or that they no longer avoid driving or going to parties, but that they are more engaged with life, enjoy time with friends more, are more successful in their careers, and feel that they are better parents and spouses.

ACT emphasizes the importance of clarifying your values to strengthen your commitment to acting in ways that are consistent with those values.