What is ACT?

Acceptance and Commitment Therapy (ACT – pronounced ‘act’, rather than ‘ay cee tee’) is a widely practised psychotherapeutic approach. Evidence about its efficacy is rapidly accumulating. ACT aims to help you build a rich and meaningful life in two ways:

Teaching you the psychological skills that help handle painful thoughts and feelings.
Helping you clarify what is truly important and meaningful to you and motivating you to make changes in your life.

How does it work?

The main goal of ACT is to increase psychological flexibility. This happens through six processes shown in the picture:

ACT uses metaphors and experiential exercises to aid you in gaining distance from persistent thoughts and emotions, and in experiencing awareness of the present moment. ACT involves mindfulness exercises and emphasizes values clarification and living life according to one’s values.

“Passengers on a Bus” is one of the metaphors used in ACT. Negative thoughts are often a significant cause of low mood, anxiety, and similar issues. They may manifest themselves like annoying passengers on a bus, like in the video below.

You can find more videos at the website of Association for Contextual Behavioral Science.

Benefits of ACT

Positive: aims to create a rich and fulfilling life, not to get rid of negative feelings

Transferable: builds basic skills to deal with any negative feelings, thoughts and experiences

Flexible: can be used individually, in pairs or groups, and with varying timespans

Easy-to-use: focuses on reflecting and experiencing rather than self-tracking

Progressive: develops along with research on underlying processes

ACT in a Nutshell

The acronym ACT can be used as a shortcut for the core ideas of the approach:

Accept your reactions and be present
Commit to your values
Take action

Avoidance of negative thoughts and feelings is the core cause of many problems. ACT offers a healthy alternative to it.

ACT and Anxiety

When you experience anxiety, it is natural to try to avoid unpleasant body sensations, feelings, thoughts and situations. However, usually the harder you try to get rid of or try not to experience the anxiety, the worse the anxiety becomes.

ACT questions the workability of avoidance and teaches mindfulness and acceptance. You learn to distance yourself from unpleasant thoughts, feelings and actions, and live a vital and meaningful life.

ACT and Low Mood

ACT sees depression as the result of unsuccessful attempts to escape from difficult thoughts, feelings and memories.

First, ACT develops psychological skills (mindfulness) to deal with painful thoughts and feelings, and to defuse unhelpful thoughts. Second, ACT helps you to clarify what is truly important to you and what motivates you to create a rich, full and meaningful life. It is essential to come in contact with the present moment, rather than stay stuck in the past.

Acceptance and Commitment Therapy (ACT) belongs to the family of third-wave cognitive behavioural therapies, and its roots are in research on human language and cognition. The aim of ACT is to learn to resist experiential avoidance: the unwillingness to experience negative emotions, feelings and thoughts. This skill, which allows a person to accept discomfort and commit valued actions, is called psychological flexibility.

ACT and CBT

ACT is a form of cognitive behavioural therapy (CBT) but it has three distinctive characteristics.

ACT does not attempt to change the content of thoughts and beliefs, because the role of the context of a behaviour is more important in determining how to influence it.
ACT’s model of psychopathology emphasizes the importance of cognitive defusion skills, that is, the ability to distance oneself from thoughts that are not beneficial.
ACT focuses on the person’s relationship to experiences instead of the content of the experiences. This allows people to free themselves from the grip of their painful memories and assumptions.

Evidence of ACT

ACT has been shown to have positive effects on a wide range of conditions and behaviours, including depression, anxiety disorders, work stress, chronic pain, substance abuse, weight maintenance and general well-being. Psychological flexibility has been found to be related to good job performance and it has even been proposed to be a fundamental aspect of health. Studies on work stress interventions utilizing ACT (in the occupational context, “Acceptance and Commitment Training”) have resulted in reduced work stress and increased well-being and job performance.

ACT appears to be effective in reducing anxiety, also in social situations (Bluett et al., 2014; Swain et al., 2013; Sharp, 2012). ACT encourages the person to confront one’s fears to do valued actions and accept unwanted feelings and thoughts.

ACT lends itself well to implementation on online and mobile platforms thanks to its structured approach and reliance on experiential exercises. Our online programmes are based on the studies by the department of psychology at University of Jyväskylä (Lappalainen et al., 2015; Lappalainen et al., 2014; Lappalainen et al., 2013), in addition to drawing from the growing body of evidence in ACT and web-based interventions.

References

Räsänen et al. (2016) An online guided ACT intervention for enhancing the psychological wellbeing of university students: A randomized controlled clinical trial. Behaviour Research and Therapy 78, 30-42.
Lappalainen et al. (2015) Web-based Acceptance and Commitment Therapy for depressive symptoms with minimal support: A randomized controlled trial. Behavior Modification 39(6), 805-834.
Bluett et al. (2014) Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of Anxiety Disorders, 28, 612-624.
Lappalainen et al. (2014) ACT Internet-based vs face-to-face? A randomized controlled trial of two ways to deliver Acceptance and Commitment Therapy for depressive symptoms: An 18-month follow-up. Behaviour Research and Therapy 61, 43-54.
Hayes et al. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180-198.
Lappalainen et al. (2013) Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: Randomized controlled pilot trial. JMIR Research Protocols 2(1), e1.
Swain et al. (2013) Acceptance and Commitment Therapy in the treatment of anxiety: A systematic review. Clinical Psychology Review, 33, 965-978.
Ruiz (2012). Acceptance and commitment therapy versus traditional cognitive behavioral therapy: A systematic review and meta-analysis of current empirical evidence. International Journal of Psychology and Psychological Therapy 12(3), 333-357.
Sharp (2012) A review of acceptance and commitment therapy with anxiety disorders. International Journal of Psychology & Psychological Therapy, 12(3), 359-372.
Kashdan and Rottenberg (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review 30(7), 865-878.
Biglan et al. (2008) Acceptance and commitment: Implications for prevention science. Prevention Science, 9, 139-152.
Lappalainen et al. (2007) The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification 31, 488-511.
Hayes et al. (2006) Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25.

How to learn and apply ACT? Association for Contextual Behavioral Science has a wealth of information and resources especially for practitioners.

Other online resources

Working with ACT – blog for people interested in using ACT to improve work wellbeing, resilience and performance
Free audio exercises – mindfulness exercises and ACT walkthroughs in audio

Self-help books

Orsillo, Susan & Roemer, Lizabeth (2011). The Mindful Way Through Anxiety: Break Free from Chronic Worry and Reclaim Your Life. Guilford Press.
Harris, Russ (2008). The Happiness Trap: Stop Struggling, Start Living. Robinson.
McKay, Matthew (2007). Leave Your Mind Behind: The Everyday Practice of Finding Stillness Amid Rushing Thoughts. New Harbinger.

Books About ACT

Harris, Russ (2009). ACT made simple. New Harbinger Publications, Inc.
Batten, Sonja V. (2011) Essentials of Acceptance and Commitment Therapy. SAGE Publications Ltd.
Hayes, Steven C. & Lillis, Jason (2012) Acceptance and Commitment Therapy. Theories of Psychotherapy Series. American Psychological Association.