You may have heard of Acceptance and Commitment Therapy (ACT), but may not be familiar with this method of therapy. For nearly four decades, this action-oriented form of therapy has helped individuals change their relationship towards negative behaviors and feelings, allowing them to move beyond the things that have held them back. Learn more about ACT, how it can help you, and more.
What is Acceptance and Commitment Therapy?
Acceptance and Commitment Therapy (or ACT) was developed by Steven Hayes in 1982 (Hayes et al., 2011). Dr. Hayes is a long-term professor of psychology at the University of Nevada, a former president of the APA, and the author of 47 books and over 600 articles. In addition to founding ACT, he also developed Relational Frame Therapy and was the co-developer of Process-Based Therapy. Acceptance and Commitment Therapy was inspired by Dr. Hayes’s own struggle with anxiety as a bridge between theories of cognitive and behavioral therapy (About, 2012).
This intervention was developed with both cognitive and behavioral components, utilizing the core tenets of acceptance and mindfulness to create change and lessen distress in a client’s life (Hayes, 2004). ACT presumes that there are normal cognitive processes that every human experiences that can cause mental anguish and behavioral issues when repressed or not accepted (Dindo et al., 2017). According to Russ Harris, who wrote a book about applying ACT to your everyday life, “The more we try to avoid the basic reality that all human life involves pain, the more we are likely to struggle with that pain when it arises, thereby creating even more suffering (Harris & Hayes, 2008)”.
What makes Acceptance and Commitment Therapy unique
There are some important components of Acceptance and Commitment Therapy that make it unique, which make up the ACT Hexagon. They include: accepting negative and natural thoughts and learning to diffuse from them, self as context (a flexible view of oneself that can change depending on the context), being in the present moment, understanding moving towards values, and committed action (Practitioners, 2012). These components have been replicated in several studies and are considered evidence-based (Hacker et al., 2016).
A guiding principle of ACT is that negative thoughts are natural and can’t be avoided. Due to our primitive ancestors, our brains have evolved to compare ourselves to others and be anxious when it senses that we are in danger (Harris & Hayes, 2008). ACT works to reduce the avoidance of these thoughts that lead to behaviors that don’t move a person towards their values. Instead of trying to get rid of these negative thoughts, a person would work to be less impacted by them and observe them (Dindo et al., 2017). A client can start to do this by accepting that negative thoughts are normal, acknowledging them, and then asking themselves, “Is this thought helpful?” in contrast to other interventions such as Cognitive Behavioral Therapy that would ask if a thought is true or false (Harris & Hayes, 2008).
Another important concept in ACT is the importance of each individual person defining what their values are. Values are not goals to be accomplished but are guiding principles that tell us who we want to be (Values Exercises, 2022). When a person is living in accordance with their values (trying to be the person they want to be), they feel more at peace. When a social worker is using ACT as an intervention, it is important to understand a client’s values to help them move toward them and feel less psychological distress (Harris, 2010). When we take action or behave in service of our values, we are working towards another part of the ACT Hexagon called committed action (Moran, 2020).
A helpful aspect of Acceptance and Commitment Therapy is its wide applicability. ACT has been shown to be just as effective as Cognitive Behavioral Therapy for those who are trying to quit smoking (Hernández-López et al., 2009) and for improving the lives of those living with cancer (Feros et al., 2011). People who are suffering from depression have also proven to have their symptoms alleviated through using Acceptance and Commitment Therapy (Zettle, 2015) and has also been shown to be a viable option for those with anxiety and OCD symptoms (Bluett et al., 2014). ACT has been shown to have positive results for various ages-ranging from teenagers (Hayes & Ciarrochi, 2015) to older veterans (Zettle, 2015). In the early days of Acceptance and Commitment Therapy, there were criticisms from the founders of Cognitive Behavioral Therapy (Gaudiano, 2011), but there has been much research since then showing its broad effectiveness.
Who can Acceptance and Commitment Therapy help?
Acceptance and Commitment Therapy has been shown to be helpful in reducing stress for diverse populations (Fung, 2014). Some specific populations that ACT has been shown to benefit include gay men with eating disorders (Walloch et al., 2012), those with an Asian cultural background or from the Buddhist perspective (Moodley et al., 2017), the Black community, especially in regards to healing from the trauma of racism (Abrams et al., 2020), young people with learning disabilities (Brown & Hooper, 2009), those on the autism spectrum (Byrne & O’Mahony, 2020), those with chronic diseases (Hughes et al., 2017), and those part of the LGBTQ+ population facing heteronormative social pressure (Stitt, 2014).
In order to apply this population to a diverse population, social workers should be working on their own cultural competence to understand what issues might be causing anxiety and stress for each population and which ACT interventions could be used to treat those specific issues (Standards and Indicators for Cultural Competence in Social Work Practice, 2015). For example, a study was done where Acceptance and Commitment Therapy was used as an intervention for Turkish-speaking communities in London. As ACT is an intervention to relieve mental distress, the practitioners working with this population kept in mind the socioeconomic factors that this population was a part of to understand what anxieties they might be facing. As understanding and moving toward values is an important aspect of Acceptance and Commitment Therapy, it was important for those working with these groups (specifically Kurdish, mainland Turks, and Turkish Cypriot communities) to understand the cultural values of these communities. It was also crucial to understand the history of Turkey and the unique trauma that might have been experienced by those participating in this research. ACT is easily applicable to various circumstances because it involves commonly accepted ideas, but it is up to the clinicians using these techniques to be culturally competent to be aware of what types of issues populations might need help working through with this intervention.
Does Acceptance and Commitment Therapy have limitations?
As far as limitations for Acceptance and Commitment Therapy go, there have been criticisms that it is not distinctly different from other behaviorist interventions (Hofmann & Asmundson, 2008), and as previously stated, the original train of thought was that ACT was not different enough from Cognitive Behavioral Therapy (Gaudiano, 2011). The strength of Acceptance and Commitment Therapy is its wide applicability. It has been applied time and time again for populations ranging in age, race, differing degrees of health, various backgrounds, cultures, religions, varying levels of trauma, and sexual orientation.
A diagnostic tool that Acceptance and Commitment Therapy uses is called the hexaflex, which contains six pillars of the intervention: acceptance, values, cognitive defusion, self-as-context, committed action, and the present moment. Though ACT presents these pillars together in an organized intervention for the first time, these principles can be found throughout Western and Eastern thought and philosophy throughout time and are widely applicable to anyone who wishes to stop suffering and live a more meaningful life (Bach & Moran, 2012). As the founder of ACT, Steven Hayes, once stated, “The goal is not to ‘fix’ people but rather to empower them. What the psychological flexibility model provides is a characterization of key features that can be changed, but it does not specify how to link history to those features, nor precisely how to intervene in a step-by-step fashion. (Hayes et al., 1999)” If social workers are looking for an intervention that empowers clients, is evidence-based, and provides flexibility, Acceptance and Commitment Therapy is a wonderful option.
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Acceptance and Commitment Therapy can help you learn new skills to process the negative emotions and events of your life. Request an appointment with one of our team members today and see if ACT is the right modality for you.