Acceptance and Commitment Therapy: An Introduction
Acceptance and Commitment Therapy (ACT) is a “transdiagnostic” therapy, which means it works well on underlying causes found to maintain mental health difficulties, across a spectrum of diagnoses. It is also an evidence based supported treatment for mood disorders, mixed anxiety disorders, psychosis, chronic pain, and obsessive-compulsive disorder. See here.
ACT is like the offspring of Cognitive Behavioural Therapy (CBT) because CBT came before ACT and both are focused on changing mental health difficulties with behaviour. However, CBT originally had the idea that thoughts cause feelings which causes our behaviour. So, a lot of CBT therapy focused on changing the way you think about something to influence your feelings and actions**. ACT adjusted by taking the perspective that not all feelings are caused by our thoughts, and this is true. Our autonomic nervous system (ANS) feeds us physical responses and sensations within under a second.
The ANS is an important part of survival because if we had to think about how to respond to threats every time we faced one, we may not be here as a species. Imagine having to consider what we need to do next when being chased by a predator, devoid of feeling, weighing the pros and cons of whether to fight, run away, or freeze! This system that developed for more severe, imminent life or death situations is the hardware we have to work with for varying degrees of threat to our well-being (from social acceptance, to moving, to navigating our careers, etc.).
Getting caught up in trying to control the way we think or feel about a specific problem may sometimes actually be the barrier towards better mental health outcomes. Some may relate to the experience of trying to logic our way out of a thought, impulse, or feeling, only to feel shame when we can’t change the intensity of what we’re experiencing, and the resulting sense of helplessness to adjust how we act. Or, even feeling invalidated because there is validity to our feeling from past trauma experiences.
For example, I got more fearful in recent years with a lot of misinformation about trans people circulating. I have previous experience to back this fear as I have been approached in public settings, told nasty things, and I have loved ones in my trans community who have also experienced this. However, it isn’t my experience most of the time. From a CBT perspective it could be said that I am overgeneralizing my fear to the general public. Doing a thought evaluation for how true my fear may be can be enough to help me come down in my fear. However, there is a part of me that may feel like I’m invalidating myself by trying to diminish my fear, and a counter response of “what if?” may still keep coming up.
Alternatively, ACT operates from the idea that most of our difficulties stem from either becoming so fused with a thought or feeling, or fearful and avoidant of a thought or feeling, it overrides our ability to make intentional decisions about how we want to be. I don’t have to prove or disprove a belief to change how I want to be despite these fears. So, some aspects of ACT focuses on trying to hold dual attention (I can notice the intense thoughts/feelings and ground at the same time), develop better distress tolerance, and reconnect with the here and now using your values to act on what matters to you.
Yeah, some part of this world is hostile to people like me, and that may grow as culture wars are stoked by those holding more power than myself. There is only so much control I have, and so how I want to take care of that fear may look like grounding in my values, and taking peace from how I act in the face of distressing interactions. If I don’t want to isolate, but this fear makes me want to isolate, I have to figure out how I want to balance my value for safety and self-expression. Once I have something to move towards that is more important than the first-thought-worse-thought, facing possibility of painful situations may become more tolerable. My mind that is just trying to keep me safe —and long-term avoidance of the risk that comes from living as a trans person in this world will likely have more negative outcomes for my overall well-being. Overall, I can get better at observing what this feeling or thought is communicating and better decide what I want to do with it.
A common metaphor for ACT is seeing our thoughts and feelings as a game of chess (there is a great, short animated video by Russ Harris on this concept, here). We may solve the game by challenging our worst instincts with alternative ways of thinking. But sometimes it can feel like there are an infinite number of negative thoughts as there is positive, or the negative thoughts so heavily outweigh the positive. ACT focuses in on mindfulness tools to become less like the individual chess pieces and more like the chess board, able to observe our thoughts and feelings, and scope out in our perspective. It’s dropping the struggle and reconnecting with the bigger picture for ourselves.
