I didn’t know much about this therapy until I decided to write this article, although it was on my list of therapeutic approaches I wanted to study. Anyway, I hope you find this guide to acceptance and commitment therapy useful and informative.
What Is Acceptance And Commitment Therapy (ACT)
At first, acceptance and commitment therapy might sound like a nonsensical form of therapy because it doesn’t attempt to reduce our symptoms directly, but rather as a byproduct (Harris, 2006). But bear with me.
Another thing you might be surprised about is that acceptance and commitment therapy is a form of cognitive-behavioural therapy (CBT; Twohig and Levin, 2017). Acceptance and commitment therapy is considered part of the third wave of CBT (Shin, Kim, Shin, Park, and Park, 2023).
Acceptance and commitment therapy has been shown to provide a powerful path for navigating life’s challenges and cultivating a meaningful existence, even when confronted with difficult thoughts and feelings.
It’s a therapy that’s firmly grounded in empirical science, yet focuses on values, forgiveness, acceptance, compassion, living in the present, and striving for a transcendent sense of self (Harris, 2006). It’s very much a mindfulness approach.
The Basics Of Acceptance And Commitment Therapy
There are two main focuses when it comes to acceptance and commitment therapy: learning to accept that which we can’t change, such as unwanted experiences outside of our personal control, and taking actions towards living a life that’s valued (Harris, 2006).
Acceptance and commitment therapy follows six core principles: acceptance, cognitive defusion, values, being present, observing self, and committed behaviour (Shin, Kim, Shin, Park, and Park, 2023; and Harris, 2006). These six core principles help us to develop psychological flexibility (Harris, 2006).
Acceptance
According to Twohig and Levin (2017), acceptance is the opposite of avoidance, which doesn’t work, especially in the long term. This means ditching avoidance behaviours like engaging in distractions (keeping ourselves too busy) and thought suppression (Harris, 2006). Instead, we’re to learn to make space for unwanted thoughts and feelings without struggling against them.
For example, people with anxiety are taught to feel anxiety as a feeling, fully and without engaging in self-soothing or safety behaviours (Hayes, Luoma, Bond, Masuda, and Lillis, 2006). This is also something that is done in exposure therapy. It’s not about changing what may have happened to us in the past, but rather the acceptance of our pasts. That doesn’t mean we accept that what might have happened to us was ok, but rather that it did happen, and that it doesn’t define us.
Cognitive defusion
This is the process of seeing our inner experiences as what they are, such as a sound or just a thought, without the added inner function they’ve been given (Twohig and Levin, 2017). For example, fusion would be how symptoms of anxiety might be given added functions, which shape our experiences. So if we have a racing heart, which was once just accepted as normal in certain situations, an anxious person might add the function that this is a sign that something is dangerous. This, in turn, leads to anxiety getting worse and avoidance behaviours being used.
Put another way, acceptance and commitment therapy helps to change how we interact with or relate to our thoughts by creating contexts in which unhelpful functions diminish (Hayes, Luoma, Bond, Masuda, and Lillis, 2006).
Values
Values are chosen qualities that we pick to help create life directions for ourselves, while undermining thoughts that can lead to avoidance, social compliance, or fusion (Hayes, Luoma, Bond, Masuda, and Lillis, 2006). For example, living by someone else’s values, like a parent, or falling into the cognitive bias of “should” statements, like I should value XYZ.
The values we should be living by are the ones we identify that truly matter to us on an individual level. These are our values. And these values can become our motivational factors.
Being present
The idea is to view psychological events and events in the environment they occur in a non-judgmental way, experiencing the world more directly, helping our actions to become more consistent with our values (Hayes, Luoma, Bond, Masuda, and Lillis, 2006). This is what makes it a mindfulness style of therapy.
For example, if we had anxiety, then being able to flexibly shift attention to relevant stimuli, rather than the stimuli that our anxiety is drawing us to, can help manage the situation and our anxiety (Twohig and Levin, 2017).
Observing self
Sometimes known as ‘self as context’, it is the ability to observe our thoughts, feelings, and sensations from a detached, objective perspective, rather than identifying with them or being consumed by them. Because our minds can and do lie to us, when we have thoughts like, “I’m worthless”, if we believe that full-heartedly, then this can lead to the creation of a core belief where being worthless will then shape how we see ourselves and the world around us.
Committed behaviour
This is where we use our values to guide our actions, with acceptance and commitment therapy helping us to shape our behaviour to our short-term, medium-term, and long-term behaviour change goals through interventions like exposure work and skill acquisition (Hayes, Luoma, Bond, Masuda, and Lillis, 2006).
Thus, once we’ve identified what truly matters to us (our values), we take consistent steps towards living in alignment with those values. This provides direction and purpose, guiding your actions even when faced with discomfort. This is because when our actions are guided by our values, it gives those actions meaning (Twohig and Levin, 2017), which can make our lives feel more fulfilling.
How To Use Acceptance And Commitment Therapy
Step 1
To navigate our inner world effectively, we need to become a curious observer and cultivate self-awareness, noticing our thoughts and feelings. In short, getting to know our inner landscape.
First, we need to accept that our thoughts or feelings don’t define who we are. This is important because our brains use intrusive thoughts, which can be both good and bad, neither of which we have control over. Yet, if we’re unaware of this, those negative intrusive thoughts can be traumatising.
In life, we will always encounter one form of unpleasant and unwanted private experiences, such as our thoughts, feelings, and urges (Harris, 2006). I’ve had intrusive thoughts about wondering what it’d be like to stick my arm out in front of a fast-moving lorry. A common one for parents is thoughts about hurting their children. These thoughts are perfectly normal, but if they do become overwhelming, please speak to a professional.
So, observe our thoughts and feelings like we’re watching a movie, or we’re a researcher watching participants through a one-way mirror.
Create small periods of mindfulness moments throughout our day so we can simply notice what’s happening in our mind and body without judgement. What thoughts are arising? What emotions are present? What physical sensations do we notice? We can do this mentally, but we could also turn this into a journaling exercise. Find the approach that works best for us.
Take this very moment, for example. Close your eyes and pay attention to your breathing, pay attention to the sounds around, feel the physical sensation of your body breathing, and make a note of the thoughts and feelings that pop up during this.
With the emotions we’re feeling, give them a name. This can help create a sense of distance, but can also help us understand what we’re feeling, as often feelings can be confusing, aren’t what we expected to feel, and we can feel several things at the same time, often conflicting feelings. This type of observation can help us avoid being overwhelmed by our feelings.
Step 2
As humans, and as is the case for pretty much all living things, we want to avoid discomfort and difficult feelings. However, as humans, this can lead to unhealthy coping strategies. Thus, recognising what we’re trying to avoid is critical for giving us our quality of life back.
With acceptance and commitment therapy, it’s not about trying to reduce, change, avoid, suppress, or control our inner experiences, but rather to reduce their impact on our feelings and thoughts instead (Harris, 2006).
Therefore, think about what we do to avoid or get rid of unwanted thoughts and feelings, such as our distraction techniques like doomscrolling, suppression of our thoughts, or increased or abusive use of substances and alcohol.
We can’t help but search out a sense of control in situations where we don’t feel we have it, but the control we try to use over our thoughts and feelings more often than not makes them worse. Those efforts are like throwing fuel onto a fire (Harris, 2006).
Such coping strategies often work in the short term, which is why we use them. While the temporary relief can be very alluring, it can reinforce the thing we’re trying to avoid. There’s always a cost to such forms of avoidance. Often becoming part of the problem. So, we need to reflect on the long-term consequences of these strategies.
Step 3
It’s time to start practising acceptance. One thing people often get wrong about acceptance is that it doesn’t mean we have to like it or forgive anyone, let alone enjoy the difficult feelings we’re dealing with. Instead, it’s about our willingness to experience them without engaging in our resistance-based behaviours, like thought suppression.
By allowing ourselves to sit with the discomfort, we’re helping ourselves become stronger, something that we deny ourselves by avoiding this. Don’t get me wrong, learning to do this can be tough, but the long-term outcomes are worth it.
There’s a good technique for this called “RAIN”.
- Recognise: Notice the feelings and thoughts that are present, and label them.
- Allow: Let the feeling be there without trying to change it. Refrain from seeing them as good or bad.
- Investigate: Gently explore the sensations in our bodies, asking ourselves, “Where in our body are we feeling this?”. Take it a step further and investigate what might have triggered it, and maybe ask ourselves what we need right now.
- Nurture: Remind ourselves that our thoughts and feelings aren’t us, and they will pass. Offer ourselves kindness and understanding.
Step 4
Now we move on to some cognitive defusion. We start by remembering that thoughts are just words, and that our mind can and will lie to us. What we think and feel isn’t always fact; in fact, this is a cognitive bias we can find ourselves trapped in, where we assume what we think and feel is fact.
We can also thank our minds for the random thoughts it keeps giving us, which might sound a little weird, but it helps to acknowledge the thought, which is our mind’s job, even when it’s not helpful. A tweak using some reframing of our thoughts can also be used here.
If we have the thought, “I suck at my job”, we can reframe that to “I’m having the thought that I suck at my job” (Hayes, Luoma, Bond, Masuda, and Lillis, 2006). A subtle difference with a big impact. Another strategy is to add the word “and” followed by a value-consistent action to the thought. For example, “I’m a failure, and I’m going to start working on this project”.
One thing I’ve been doing with my negative intrusive thoughts about my weight is to turn the thoughts into a little song in my head while carrying on with what I was doing. This can also help with defusion.
Lastly, if we experience recurring patterns and themes, which create “stories” for our minds, naming them can help drive distance. For example, if we keep having thoughts about how we’re not good enough, we’re going to create a story for ourselves that we’re not good enough, going from fiction to a non-fiction story.
Step 5
This is where we take advantage of the motivation we can experience from our values, creating purpose and meaning. To start, we need to figure out what our values are, the inner compass that’ll guide us.
Explore what things we find important to us in all aspects of our lives. For example, relationships, work, community, personal growth, etc. Ask ourselves what kind of person we want to be, what qualities we admire, and what gives us a sense of purpose and meaning in life.
With some trial and error, we can learn to tie our actions to our values, helping us use our values as motivational factors (Twohig and Levin, 2017).
Step 6
It’s important to distinguish our values from our goals, as values are ways to live, while goals are the achievements we can make along the journey we call life.
When we come to creating goals, think about how those goals align with our values, because goals that align with our values will have meaning for us. A good way to create goals is to follow the SMART Goals process, which you can find here.
It’s important not to focus on just the end goal, such as I want to lose 20kgs. Instead, create the stepping stone goals that’ll get us there. For example, for half my meals, I’ll go vegetarian, or I’ll reduce my snacking by 10% each month.
Step 7
Now it’s time to get committed to our actions, and the easiest way to do that is to start small. Small steps help us avoid feeling overwhelmed and help avoid procrastination sneaking in. Furthermore, with small steps that can be taken, we can build momentum with our achievements, all adding to our motivation (Twohig and Levin, 2017). This is how we can build consistency.
There may be resistance from our minds, so we may experience difficult thoughts and feelings as we take actions that will lead to change. We just need to keep working on our acceptance and defusion as we improve our quality of life.
Setbacks and obstacles will happen. A proverb to keep in mind is how “No plan survives the first contact” with the enemy, which is a military thing. No matter how well thought out and great our plans might seem on paper, something is likely to go wrong, and the more complex our plans are, the more likely something will go wrong, according to normal accident theory.
So remember to treat ourselves with kindness, acknowledge our efforts and track them in a journal, and be flexible. Life will always cause us to have to make adjustments.
Step 8
We need to start engaging with our present moment, the here and now. We can do this during everyday activities, such as paying attention to the sights, sounds, and colours of our local parks. There are also things like mindful eating.
It’s just about bringing our full attention to the tasks we’re doing, whatever they may be. Body scanning meditation is a popular way of doing this, whereby you bring attention to parts of your body, one at a time, noticing sensations, but without judgments. By being present in the things we do, it allows us to connect with our behaviours (Hayes, Luoma, Bond, Masuda, and Lillis, 2006).
Someone experiencing an episode of agoraphobia can get swept up in their bodily sensations and their anxious thoughts. But if they focus on that moment, where they find themselves in the here and now, and look for other interesting stimuli, then they can diminish the episode (Twohig and Levin, 2017). This is what is known as a grounding technique, which is used for anxiety disorders and post-traumatic stress disorder (PTSD).
Step 9
Now we’re bringing ourselves into the picture. Ask ourselves when we experience a powerful thought or feeling, who is noticing? When we find ourselves in any given situation, try to see it from different perspectives.
Step 10
When it comes to self as context, the language we use is key. This is how we’re able to create a degree of separation in what we’re doing, so we can see ourselves as an observer of what we’re doing, thanks to language (Hayes, Luoma, Bond, Masuda, and Lillis, 2006). Hence, “I’m useless” becomes “My mind is telling me I’m useless”.
How we evaluate and reevaluate ourselves and the words we use when we do so can have a significant effect. When we refer to ourselves as being old, we tend to slow down. This was demonstrated in a study by Warmoth et al. (2016), where being labelled by others as ‘old and frail’ helped lead to the development of an old and frail identity, causing attitudinal and behavioural changes to live up to the label. In short, don’t act your age or you’ll be your age.
Basically, our use of language is important, and we can benefit from thinking of ourselves in a certain way during appropriate situations.
Summary
Acceptance and commitment therapy isn’t about eliminating difficult experiences, but about changing our relationships with them (Harris, 2006). Where we can live with them in a way that they no longer have a negative effect on us.
Learning and integrating acceptance and commitment therapy principles takes time and practice, so try not to get discouraged if we don’t see results immediately. Be kind to ourselves as we work through this process. In fact, always be kind to ourselves, as there will always be bad days. All we need to do is our best and try to be as consistent as we can. Even if that means just setting aside five minutes a day to practise mindfulness, defusion, and reflecting on our values. It all adds up.
‘ACT’ is a good abbreviation for acceptance and commitment therapy, because it’s about how our mindful actions create a meaningful life (Harris, 2006). Having a life where we get a sense of purpose and meaning is important to us as human beings, and this approach is all about giving us that purpose and meaning through our values.
By learning to accept what we cannot control and committing to actions that align with our values, we can navigate life’s inevitable ups and downs with greater clarity and purpose. Hopefully, this self-help guide provides a good starting point.
As always, leave your feedback in the comments section below. Also, please share your experiences with acceptance and commitment therapy in the comments section below as well. Don’t forget, if you want to stay up-to-date with my blog, you can sign up for my newsletter below. Alternatively, click the red bell icon in the bottom right corner to get push notifications for new articles.
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References
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25. Retrieved from https://www.actmindfully.com.au/upimages/act_model_processes_outcomes.pdf.
Shin, J. W., Kim, S., Shin, Y. J., Park, B., & Park, S. (2023). Comparison of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) for Chronic Insomnia: A Pilot Randomized Controlled Trial. Nature and Science of Sleep, 15, 523–531. Retrieved from https://doi.org/10.2147/NSS.S409981 and https://pmc.ncbi.nlm.nih.gov/articles/PMC10329838.
Twohig, M. P., & Levin, M. E. (2017). Acceptance and commitment therapy as a treatment for anxiety and depression: a review. Psychiatric Clinics, 40(4), 751-770. Retrieved https://www.researchgate.net/profile/Michael-Levin-16/publication/321434024_Acceptance_and_Commitment_Therapy_as_a_Treatment_for_Anxiety_and_Depression/links/5a22df9fa6fdcc8e8666d98f/Acceptance-and-Commitment-Therapy-as-a-Treatment-for-Anxiety-and-Depression.pdf.
Warmoth, K., Lang, I. A., Phoenix, C., Abraham, C., Andrew, M. K., Hubbard, R. E., & Tarrant, M. (2016). ‘Thinking you’re old and frail’: a qualitative study of frailty in older adults. Ageing & Society, 36(7), 1483-1500. Retrieved from https://www.cambridge.org/core/journals/ageing-and-society/article/thinking-youre-old-and-frail-a-qualitative-study-of-frailty-in-older-adults/49CD922BEDECD768F1E556019C270FEF.
