Acceptance and Commitment Therapy (ACT)
A New Treatment Approach

Victoria J. Peters, Ph.D. 

(This article is derived from material in Acceptance and Commitment Therapy for Anxiety Disorders by Georg H. Eifert, Ph.D. and John P. Forsyth, Ph.D. (2005, New Harbinger Publications, Inc.)

Acceptance and Commitment Therapy (ACT), originally developed by Dr. Stephen Hayes and colleagues at the University of Nevada, is a new-generation behavior therapy which is proving to be effective in the treatment of a variety of disorders in which depression and anxiety symptoms occur. ACT addresses various forms of experiential and emotional avoidance that keep people stuck and suffering. The overarching goal of ACT is to help the client become better at living a full, rich and meaningful life rather than simply targeting symptoms which would seem to prevent having such a life.

Whereas many of the older behavior therapies are focused on symptom alleviation and control as therapeutic goals, ACT uses behavioral principles as a foundation to address issues that are part and parcel of being human. The traditional behaviorist would probably not be concerned with the question, "What does it take to create a meaningful life?" However, many people are asking just this question in some form. Like many of us, they are seeking more clarity about the meaning and purpose of their lives. Issues of spirituality, emotion, commitment, creativity and so on have not traditionally been the focus of behavior therapy. ACT takes seriously these existential issues, but instead of just talking and thinking about them, ACT urges clients to move their feet, hands, and mouths in the direction of what they value in living. ACT is less concerned about whether a given thought or emotion occurred; instead it is concerned with how to change the pathological functions those thoughts and emotions might have.

Cognitive behavioral therapies (CBT) have been the treatments of choice for depression and anxiety disorders. These therapies focus heavily on symptom alleviation as a therapeutic goal and are set within a mastery and control framework. The main therapeutic goal of CBT interventions for anxiety is to teach clients more effective ways to gain control over their anxiety, fear, and related symptoms. Although no one would dispute that it feels better not to have symptoms, and that symptoms of anxiety cause impairment and suffering, the idea that the "symptoms" are the problem misses the point. If symptoms were the whole problem, people would likely just take medication to get rid of the symptoms and go about their lives. However, in my experience, clients are deeply concerned about the quality of the lives they are living. Clearly these are issues that go beyond just symptom alleviation. In fact, many clients, particularly those who are taking medications for anxiety and/or depression, do not come into counseling with symptoms as their primary concern, but rather they are seeking help with their lives. Many also don't want to be unnecessarily dependent on medications.

The idea that unwanted emotions and thoughts need to be managed and controlled in order to live a valued and meaningful life is not supported by human experience. For example, many clients who are seeking help in particularly distressing situations admit they have had anxiety most of their lives ("I've always been a worrier"). Yet most of these people have been living meaningful lives without controlling their internal private experience. Although they express a desire not to have their anxiety, most are seeking help because of specific painful events they are experiencing now. Not uncommonly, the events that precipitate a spike in symptoms are themselves out of the realm of control. Sudden loss of a job, the ending of a significant relationship, being diagnosed with a serious illness-these are all events over which we have little or no control and which are often perceived as threatening to our life and well-being. The anxiety that typically accompanies such events is usually what propels people into treatment.

Practitioners of ACT do not hold the same assumptions about anxiety as most clients and many therapists do. We do not assume that anxiety is ‘bad,' or that anxiety is necessarily the cause of one's problems and suffering. ACT therapists do not assume that our task is primarily to help clients decrease or eliminate the feelings, irrational thoughts, and urges associated with anxiety and fear, although this if frequently a consequence of ACT. In short, ACT therapists strive to help clients do three things: accept themselves and others with compassion, choose valued directions for their lives, and commit to action that leads them in those directions.

ACT, like Mindfulness Based Cognitive Therapy (MBCT), teaches us that we cannot control what unwanted thoughts and feelings our minds and bodies come up with, but we can choose how we relate to our experience, whatever it is. It's the difference between living from a state of fear and relating to an experience of fear. When we relate to our experience rather than from it, we are empowered to act in ways congruent with our most deeply held values and convictions. We live authentic lives rather than desperately trying to get rid of or silence the truth of what we are experiencing. While traditional CBT treatments for anxiety have focused on helping clients master their symptoms, ACT teaches people to master their experience of anxiety symptoms. People who suffer from anxiety disorders have desperately tried to relax away fear and anxiety by pushing their unwanted thoughts and feelings away. Instead, ACT therapists want to help people relax with their anxiety by being and moving with it.

ACT has two major goals: (1)-fostering acceptance of unwanted thoughts and feelings, and (2)-commitment and action toward living a life the client values. Acceptance is a difficult concept for most people. In common parlance, "acceptance" seems to suggest we become "resigned" to the unwanted experience. The word resign actually has nothing to do with accept. Linguistically, accept is a verb with a number of meanings. Although we usually associate it with "receive,' or "welcome," or even (erroneously) "resign," accept also means simply to "let in." In the context of ACT, acceptance means that we "let in" the feelings and thoughts we experience rather than trying willfully to push them away. Letting in our feelings and thoughts, however unwanted, does not mean we are paralyzed to take action. ACT is about acceptance and change at the same time.

ACT not only stands for Acceptance and Commitment Therapy, but it is also an acronym that signifies the three core themes of this approach-Accept thoughts and feelings, Choose directions, and Take action. Through various mindfulness exercises clients learn to accept and embrace the thoughts and feelings, particularly the unwanted ones, that they already have. They learn they can live with their critical, evaluative mind. During the values clarification stages in ACT therapy, clients learn to choose directions for their lives by identifying and focusing on what "really matters" and what they value in life. Clients learn that they can move forward in their lives and accept what is inside them, and what comes with them along the way. In order to move in a valued direction, one must take committed action. Clients learn how to commit to taking action to change what can be changed. In this stage of ACT, clients learn that there is a difference between them as a person, the thoughts and feelings they have about themselves, and what they do with their lives.

In future articles, I'll be describing more specifically how ACT works in the treatment of anxiety. In the meantime, interested readers can find more information about ACT from the Association for Contextual Behavioral Science website at the following URL: http://www.contextualpsychology.org/. This website is intended for professionals but also has lots of good information for the general public. One of the ACT books my clients like best is Hayes, S. C., & Smith, S. (2005), Get Out of Your Mind and into Your Life: The New Acceptance and Commitment Therapy. Oakland, CA: New Harbinger. This is the first general purpose book on ACT for the public and it is written in easy to understand language with lots of exercises designed to help the reader experience the principles of ACT and apply them to their particular problems.