Chances are you’re aware of the shared history between modern mindfulness and the ancient Buddhist traditions of contemplation. And if you’ve spent some time on this site, you already know that the Greek mythological centaur, Kairon, symbolizes self-transformation through making peace with our deepest wounds. But what is Acceptance and Commitment Therapy (aka: ACT)? How is it different from traditional Cognitive Behavioral Therapy (CBT)? And how does it all connect to Kai, our AI companion for mental health and wellbeing?
For that we have to go back to the early 1980s…
Sitting on his living room floor at 2am after a full blown panic attack, the young psychologist Steven Hayes emerged with a clear understanding that denial and resistance are not the way to cope with our darkest feelings. He vowed to always try to meet his own pain with love and kindness, and to teach others to do the same. A few years later, Hayes developed ACT into a mindfulness-based form of psychological treatment that would become the new wave of CBT.
ACT combines mindfulness with a values-based approach to help people develop psychological flexibility. It gives meaning to the suffering we all face at certain points in our lives. This is what the mythical Kairon so nobly demonstrates when fate deals him a difficult hand. Instead of agonizing in pain for eternity, he chooses to trade his immortal life for the greater good of mankind.
It turns out ACT is in our brand hero’s DNA. 🙂
Useful definitions related to Acceptance and Commitment Therapy
Stephen Hayes defines ACT as “a psychological intervention based on modern behavioral psychology, including Relational Frame Theory, that applies mindfulness and acceptance processes, and commitment and behavior change processes, to the creation of psychological flexibility”. In simple terms, you commit to being more accepting of yourself, or your thoughts and feelings. Especially the difficult ones.
In this way, ACT is different from traditional behavioral therapies, which try to limit our experience of pain. Though both approaches can ultimately help with suffering, the main goal of ACT is to be present to all of life’s experiences. It uses them to arrive at a better understanding of what we truly value.
What is psychological flexibility?
Psychological flexibility is defined as the ability to stay aware in the present moment, regardless of difficult thoughts, feelings, and sensations. It involves consciously responding in such situations, and remaining aligned with our personal values.
What is Relational Frame Theory?
ACT is built on the Relational Frame Theory, or the idea that our ability to relate is the basis of language and cognition. The following examples provided by PositivePsychology.com shed some light. “If we can relate the word “cookie” to the experience of eating a cookie, then we can also relate the word “worthless” to feeling that we are worthless.” Applying mindfulness to our feelings can help us change those relations.
The 6 building blocks of Acceptance and Commitment Therapy
These are the six processes that make up the core of Acceptance and Commitment Therapy.
Acceptance: With ACT, acceptance is not a goal in itself, but a way of encouraging action that leads to positive outcomes. Acceptance means actively allowing ourselves to experience unpleasant emotions or thoughts, instead of avoiding them.
Cognitive Defusion: The psychological definition of defusion is, “The separation of an emotion-provoking stimulus from the unwanted emotional response as part of a therapeutic process; in the same way as when a bomb is defused.” The bomb metaphor highlights how the process of defusion can prevent a painful explosion in the form of unconscious release. In ACT, we use cognitive defusion not to change our thoughts and feelings, but to learn how to react to them differently.
Being Present: The place to accept what is happening and create a healthy space around it is always in the present moment.
Self as Context: It’s hard to separate presence from acceptance or defusion, but the nuance is on noticing yourself as the silent observer.
Values: As you make your way through difficult experiences, it helps to consciously hold your awareness on the values that matter most to you. Think of someone you hold in high regard, and consider what they might do in a similar situation.
Committed Action: ACT requires consistent practice and committed action so that we don’t slip back into avoidance.
ACT for preventing and treating mental health disorders
Adopting the principles of ACT as part of a daily practice is beneficial to our wellbeing because much of the chronic, low-grade stress that we experience is due to avoidance. By consciously defining our values, and aligning them to our daily actions, we fill our lives with purpose. This makes good experiences better. It also helps challenging experiences bear the fruit of awareness so that we don’t keep repeating the same painful lessons.
ACT for anxiety, depression, addiction and more:
ACT is thought to be beneficial in treating anxiety and depression because it works with problematic thoughts and feelings instead of trying to change them.
In one study of cancer survivors, research highlighted the benefits of ACT compared to traditional cognitive behavioral therapy. ACT showed significant improvements in social impairment and the tendencies to ruminate that are often displayed by this cohort.
Another study on a web-based prototype of ACT among college students showed benefits in changing behavior and preventing mental health issues.
One of the most notable studies is this meta-analysis from 2015 of 39 randomized controlled trials on the efficacy of Acceptance and Commitment Therapy. The analysis highlights ACT as an effective intervention for patients with mental disorders including anxiety, depression, addiction, and health problems.
Another interesting application of ACT is in treating patients who experience chronic pain. The majority report an improvement in quality of life, even when the pain itself does not disappear.
How to use ACT to align with your values
Though empirically-based, ACT is an orientation to psychotherapy rather than a specific set of protocols.
One of the best ACT tools for starting out is The Valued Directions Worksheet by John Forsyth and Georg Eifert.
This tool offers a clear path to prioritizing your values and gets you thinking about how to align them with your life.
Here’s how it works:
The Valued Directions worksheet asks you to rate the following ten value domains on a scale of 0 to 2 (0 = not important, 1 = somewhat important, 2 = highly important). Don’t think about how you should rate any of the domains, just write what you feel.
- Intimate relationships
- Education/learning/personal growth
- Friends/social life
- Health/physical self-care
- Family of origin (or relationships other than marriage or parenting)
- Spirituality Community life/environment/nature
Rate your level of life satisfaction in each of the domains (0 = not satisfied, 1 = somewhat satisfied, 2 = very satisfied).
Look at the value domains you rated 1 or 2 in importance. Think about what’s currently working for you and how you can maintain it, or what’s not currently working for you and how you can change it.
Remember that these goals are life-long processes, not quick wins.
What does neuroscience reveal about ACT?
Since ACT is a mindfulness-based therapy, neuroscientific research for ACT relates primarily to research on mindfulness. Mindfulness affects our neurological functioning through enhanced self-regulation processes, including attention control, emotion regulation and self-awareness.
Though neurological research into mindfulness is still in its early stages, we already know that practicing mindfulness creates changes in brain structure. For example:
*Changes in activity and structure of the anterior cingulate cortex, the area of the brain associated with attention, are consistently reported with mindfulness practice.
*Front-limbic networks involved in emotional regulation and stress reduction show specific patterns during mindfulness practice.
*And the networks which support self- and present-moment awareness, the midline prefrontal cortex and the posterior cingulate cortex, have shown to be altered after mindfulness practice.
Neurological research for ACT has shown that it successfully facilitated behavioral changes in college-age gamblers compared to a control group. Another study used functional MRI to test an ACT intervention on patients suffering from chronic pain. After four weeks, patients showed decreased depression and pain interference, as well as increased participation in social roles.
What does science say about the benefits of ACT?
ACT is supported by a high standard of empirical evaluation that is recognized by professional groups. These include the American Psychological Association and the Society of Clinical Psychology. In the past decade, hundreds of randomized clinical trials of ACT have been performed, along with dozens of meta-analyses. A 2015 review found that ACT was better than placebo and typical treatment for anxiety disorders, depression, and addiction.
Does ACT follow a specific course of treatment?
Though it is an empirically-based psychological intervention, ACT is an orientation to psychotherapy rather than a specific set of protocols or techniques.
Isn’t it considered negative to dwell in pain and discomfort?
Pain and discomfort are inevitable parts of life. The denial of these ‘negative’ experiences on one sensory level often leads to their amplification in another (for example, emotional to physical). ACT contends that moving through pain without subjective judgements of good or bad makes it easier to manage. It frees up energy that is otherwise tangled in resistance. The ability to ‘sit with’ pain and discomfort and to ‘choose’ our response to it, often has the added benefit of clarifying our values.
How Kai uses ACT to help you feel better
Acceptance and Commitment Therapy is rooted in most areas of Kai’s service. You’ll notice it in the values-based approach to our daily One Thing focusing questions, or the mindfulness practices we offer, through journaling, breathing and reflection.
If you reach out to Kai seeking advice, you are also likely to receive one of several ACT-based guided interventions, including journaling, self-compassion and self-reflection.
- Nature: The neuroscience of mindfulness meditation
- Journal of Contextual Behavioral Science: Neurological evidence of ACT efficacy in college-age gamblers
- Frontiers in Human Neuroscience: Neural mechanisms of ACT for chronic pain
- Association for Contextual Behavioral Science: ACT treatment protocols and manuals
- Clinical Psychology Review: A meta-analytic review of the efficacy of ACT in treating anxiety
- European Journal of Cancer Care: Psychological interventions for patients with cancer
- Journal of American College Health: Web-based ACT prevention program for college students
- Psychotherapy and Psychosomatics: A meta-analytic review of the efficacy of ACT in mental health
- Cognitive Behavior Therapy: A meta-analytic review of the efficacy of ACT in treating chronic pain