ACT Concepts and Clinical Strategies

August 7, 2019
In this article, we discuss the primary clinical resources and concepts of acceptance and commitment therapy.

Acceptance and commitment therapy (ACT) belongs to a category called “third-generation therapies“. These therapies are a departure from conventional psychological treatments because they put more emphasis on certain aspects of mental health. In ACT, things such as acceptance, mindfulness, cognitive deactivation, dialectics, values, spirituality, and relationships are significant. Today, we’re going to discuss ACT concepts and clinical strategies.

At the heart of third-generation therapies is the idea that the disorder isn’t part of the individual. Rather, the individual finds themselves in a difficult situation or problematic circumstances.

Thus, the conflicts aren’t a part of the individual but come from their interactions with their current context (which is influenced by historical context as well). The two main principles that guide third-generation therapeutic interventions such as acceptance and commitment therapy are:

  • Acceptance. This strategy consists of radically letting go of the search for happiness or immediate well-being. The key is to normalize unease and discomfort as part of normal life experience.
  • Activation. The idea is to pursue your goals and values in spite of your discomfort and unhappiness. In this kind of therapy, your success is measured by your personal achievements instead of what symptoms you have or don’t have.

Steve Hayes, a professor at the University of Nevada, started acceptance and commitment therapy in the 1980s.

Experts define ACT as a type of experiential, behavioral, and cognitive psychotherapy based on relational frame theory (RFT), language theory, and human cognition that’s part of radical behaviorism. It encompasses a wide range of clinical resources that help therapists guide their patients to achieve acceptance and activation.

A worried woman sitting on a couch.

Important ACT concepts

As we mentioned above, acceptance and commitment therapy is a big departure from earlier therapies, especially with respect to the way you relate to the content of your mind. Another departure is the rejection of a concrete diagnostic classification. Instead, the only element that the therapist considers and analyzes is the individual’s behavior and function in context. With that as a foundation, we can talk about some key ACT concepts:

  • Experiential avoidance. This is the avoidance of any symptom, emotion, or thought that makes an individual feel bad. The goal of this avoidance is to control private events, feelings, and sensations as well as the circumstances that cause them. Experiential avoidance stems from living in a culture that places well-being and happiness above everything else, even your own values. It’s important to note that experiential avoidance isn’t always pathological. It becomes pathological when it’s limiting the way the individual wants to live their life.
  • Personal values. These are the things that you value most in your life. They’re the goals that you want to reach because you believe that they’ll make you happy.

These two ACT concepts put you in a vicious cycle. Since you aren’t willing to suffer (experiential avoidance), you’re stuck in a situation that doesn’t fit with your personal values. Nevertheless, staying in this situation keeps you in your comfort zone.

Clinical strategies for ACT

Although acceptance and commitment therapy isn’t highly structured, the first step is usually a functional analysis of the patient seeking treatment. 

This analysis allows the therapist to get to know the patient’s values and commitment to those values. From there, the therapist can set the therapeutic goals. The most representative ACT clinical resources are:

  • Creative hopelessness. Before patients come to therapy, they’ve usually already tried other alternatives. The problem is that their attempts have been unsuccessful. In fact, sometimes these solutions turn into part of the problem.

Creative hopelessness teaches you that your attempted solutions to your problems (rumination, drinking, trying to control everything) aren’t working and you have to consider alternatives.

To help patients question these fruitless endeavors, therapists use the quicksand metaphor. The more you try to get out of the sand, the further down you sink. Thus, the logical thing to do is stretch your body and make contact with the sand. 

  • Value orientation. Help the patient clarify what their values are, and what direction or paths will help them live out those values. Values guide behavior.
  • Control is the problem. Trying to control your life in order to avoid suffering often makes things worse. If you tell yourself not to think about pink elephants, what happens? The more you try not to think about something, the harder it is to get pink elephants off your mind. As such, you have to realize that it’s better to stop trying to control the uncontrollable.
  • Acceptance. When you accept, you open yourself to the experience of feeling. Facing your demons might not be pleasant, but it’s necessary. It’s important, of course, not to pass judgment on them or assign any kind of meaning. Just let them be what they are: emotions, sensations, thoughts. Nothing else.

More clinical strategies…

  • Cognitive diffusion. This means learning how to disconnect from your thoughts and your emotions. No one gets attached to their blood, feces, or other bodily fluids, although they’re technically “part” of you. So why would you get attached to your thoughts and emotions? The idea is to arrive at the conclusion that your thoughts are products of the mind that come from your living brain. Consequently, they’re perfectly normal.
  • The self as context. This strategy involves realizing that your thoughts and feelings don’t define who you are. One thing is to think “I need to be perfect at work” and another thing is to let this thought define you completely. You’re much more than your thoughts.
  • Committed action. Defining goals and committing yourself to carrying out those goals in spite of the obstacles that you face along the way.
  • Exposure. Being completely open to your most painful thoughts and feelings. Exposing yourself means being willing to experience your emotions, knowing that they’ll eventually pass.
  • Mindfulness. Lastly, the practice of mindfulness is a relevant practice in acceptance and commitment therapy. It enables you to change the relationship between your thoughts, feelings, memories, and verbal regulation patterns that you tend to judge as problematic and try to control.
A woman learning about ACT concepts.

Effectiveness of ACT

Acceptance and commitment therapy has been shown to be effective in different case studies and can be applied in group or individual settings. One advantage of ACT is that the results continue during follow-up. With ACT, problems are less likely to become chronic.

The only downside to ACT is how difficult it is to accept your negative thoughts and emotions in a context that only values happiness and satisfaction.

In conclusion, we live in a culture where the number one goal is happiness. We see this message everywhere. Who hasn’t had a moment when they’re depressed and someone says “Come on, snap out of it! Life is too short!”

This culture of well-being makes it really difficult not to reject the negative. The key is to be consistent with your therapy. You also have to stick to the clinical strategies that your therapist recommends for you. Little by little, you’ll get used to the habit of radical acceptance and you’ll understand that all emotions are valid, necessary, and normal.

  • Ruiz, M.A., Díaz, M. I., Villalobos, A. (2012). Manual de Técnicas de Intervención Cognitivo Conductuales. Desclée De Brouwer, S.A