How does Acceptance and Commitment Therapy (ACT) work?

ACT therapy (Acceptance and Commitment Therapy) is one of the so-called third generation therapies. The latter come from behavioral therapy; however, it is differentiated from it by the conjunction of the following premise: “they do not focus on the elimination, change or alteration of private events (thoughts, emotions, memories, sensations…), but on the alteration of the psychological function of the particular event” (Hayes et al., 1999; Luciano et al., 2004).

Basic premises of ACT

1. Human suffering is inevitable, universal, part of life and inherent to the human condition.

2. Part of human suffering comes from language.

3. Most unwanted internal experiences (or private events: thoughts, emotions, memories, sensations…) cannot be eliminated or controlled.

4. The problem is the attempt to control private events (i.e., the struggle to eliminate discomfort, painful feelings and negative or unpleasant thoughts).

5. What can be controlled is behavior and learning skills to manage thoughts and feelings much more effectively.

Taking these premises into account, the contextualization of the therapy is fundamental. Unlike other types of therapy, the therapeutic relationship takes on a different meaning. The therapist will no longer be someone “superior”, who knows everything, whose function is to solve problems, but someone who, together with the patient, will work as a team, following and being guided by the patient’s values, maximizing the person’s strength to carry out his or her life.

In which cases is it performed?

Acceptance and Commitment Therapy, due to the fact that it is the most complete of the TTG (Third Generation Therapies) and for being the only one that is intimately related to a modern theory that addresses the study of language and human cognition (theory known as the Relational Frame Theory (RFT: Hayes, Barnes-Holmes and Roche, 2001), has been effectively applied in problems as diverse as: anxiety, alcoholism, eating disorders, chronic pain, obsessive-compulsive disorders, social phobia, drug abuse, psycho-oncological problems, depression, schizophrenia and psychotic outbreaks, multiple sclerosis, personality disorders, work stress, diabetes, hyper-sexuality problems, partner violence, trichotillomania, epilepsy, burnout, post-operative states, sports and chess performance.

How does the therapy work?

From the first session, psychologists gather information about the patient’s previous experience (why he/she suffers, intensity of such suffering, previous attempts of how the person has tried to alleviate his/her discomfort and what has worked or not…). The therapist is committed to helping the patient achieve a life as rich as possible in terms of the person’s own values.

The tools in ACT are based on metaphors, paradoxes, experiential exercises… In such a way that the patient always has an active part in the whole process. It is not a matter of the expert offering a dialectical discourse, but of the patient being able to live and integrate his own experience.

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Both the assessment and the intervention will be based on different vertexes on which the therapeutic work in ACT is based:

  • Flexible attention to the present moment: are you in touch with the present moment? What could it bring you to the present?
  • Acceptance: it is important to note that acceptance is not resignation.

What does the patient avoid or try to avoid: emotions or feelings, thoughts or memories, sensations? How does he/she avoid them?

  • Values: assess the extent to which we are aware of our values (i.e. the direction of our life).
  • Defusion: if the patient shows an excess of evaluative thoughts, judgments, conceptual categories (“good and bad”), excessive use of “giving reasons”, excessive importance of “understanding, understanding things, intolerance to uncertainty…”.
  • Commitment to action: from what we can change and from where we really have control.
  • I as context: “I am…”, “I have always been”. How I define myself and based on what.

All of them from the context of cognitive flexibility following the points below:

  • To generate creative hopelessness (i.e., to make the patient aware of why the strategy he/she has followed up to now has not worked).
  • Patient’s understanding that control is the problem.
  • Experiential contact with private events through acceptance and exposure.
  • Develop willingness to accept. Work with the patient on the cost of avoidance.
  • Clarify values.
  • Set in motion an agenda for change through committed action. As well as setting specific goals consistent with those values.
  • Plan and carry out committed actions, contacting the patient’s barriers.
  • Dissolving barriers through acceptance, defusion and other strategies.
  • Generalize to other contexts.

Guidelines and phrases that can help us

Most of our patients generally come with a clear objective, for example: “I want you to take away my anxiety, the thoughts that bother me, this feeling of discomfort…”.

However…

  • The attempts at control that you maintain over your private events, what you think should be done is not the solution to your problem; rather, such attempts at control are an intrinsic part of the problem itself.
  • “Happiness and freedom begin with a clear understanding of one principle: some things are under our control and some things are not” (Epictetus).
  • “Love entails suffering because you can lose it, but refusing love to avoid suffering does not solve it, since you suffer for not having it. So, if happiness is love and love is suffering, then, happiness is also suffering. The two sides of love” (W Allen).
  • “If the child you were met the person you are now. What would I think of you?”
  • “Much suffering and much unhappiness come when we take as true every thought that comes into our heads…” (Eckhart Tolle).