ACT for Anxiety, When Exposure Isn't Enough

ACT for anxiety is an alternative proposal that doesn't seek the direct suppression of symptoms. It's rather about acceptance and decision-making, while respecting values. Indeed, there are many therapies for anxiety disorders. However, not all of them manage to overcome the difficulties that exposure with response prevention poses. 
ACT for Anxiety, When Exposure Isn't Enough

Last update: 21 June, 2021

ACT is a treatment for anxiety disorders. Although you may not be aware of it, these are increasingly prevalent in every stratum of society. As you can imagine, the growing demand requires a better solution for this type of condition.

The relapses in mood disorders and those included in the anxiety spectrum are many. What’s the most effective treatment for these? Continue reading, as today’s article will describe how ACT is a good option for anxiety when all else seems to be failing.

The goal of ACT (acceptance and commitment therapy) is to encourage a person to live fully, completely, and meaningfully. The suppression of the disorder, anxiety, ceases to be relevant here. This is because it’s about helping the person go beyond it.

“Anxiety is the dizziness of freedom.”

-Søren Kierkegaard-

ACT for anxiety

This type of therapy aims to help people change their approach to life. They achieve it by reducing their degree of pain while increasing their vitality and desire to move forward. It’s about helping them look forward to the future through those values they want to continue fighting for.

The patient and therapist discuss, evaluate, and work on what the first wants to do. What circumstances keep them from attaining it? There must be no dissonance with their values, though.

A woman sleeping.

The specific objectives of ACT for anxiety

  • To accept oneself and others – negative thoughts, memories, etc. The patient must accept what they’re experiencing if they want to act adaptively. For example, they’ll have to come to terms with their loss in order to move on to the grieving process. Also, they can take a big step forward if they can identify their weaknesses as opportunities, challenges. All as things, to improve instead of them being a source of bitterness.
  • Choose a direction consistent with the hierarchy of wants and needs. Regardless of the disorder, anxiety, in this case, the therapy work must respond to the client’s values. In this regard, following values that aren’t one’s own can lead to much discomfort.
  • Commit to carrying out actions so as to move on in an agreed direction. A person must take action after identifying their most relevant values (a child’s welfare, attaining a professional or academic goal, or self-enrichment). Therapy must work towards the stipulated values — whether these are part of the disorder or not.

The central problem of cognitive-behavioral therapies

Proposing ACT for anxiety arises from the inability of other therapeutic models to correct anxiety. The goal of therapy is for the person to be able to manage their moments of anxiety. It’s about giving them the tools to do so.

The therapist also establishes Socratic discussions along with cognitive restructuring so as to improve the automatisms with which the person relates to the world. This is because the relationship could be flawed due to dysfunctional cognitive schemas and irrational thoughts.

The ultimate goal of all these tools isn’t to end anxiety per se, but to work with the person who experiences it. Mainly so their relationship with events is different. These changes will lead to a reduction in anxiety.

The EPR or exposure with response prevention

There’s a technique specifically used for reducing anxiety levels and to set in motion habituation and reality testing processes. The technique is about exposure with response prevention which attempts to eliminate mental or factual behaviors that eliminate anxiety at first but increase it over time.

The problem with response prevention is that, even though it has a clinically significant impact on those who undergo it, it’s also a technique with high rejection and dropout rates. Indeed, approximately 25 percent drop out, and between five and 22 percent refuse to undergo exposure. This is because this technique can generate intense and unpleasant feelings that’ll demand energy from other pillars of the patient — motivation and social support.

Thus, ACT for anxiety and its approach to the disorder as an experiential avoidance disorder is a good option when anxiety suppression complicates due to more commonly applied interventions.

What does ACT contribute to the treatment of anxiety?

ACT proposes an intervention marked by specific elements. Furthermore, it’s important to remember that acceptance also involves assuming that one can’t change (immediately) and achieving an improvement in those facets of life where there’s room for action. Acceptance is synonymous with experiencing events without being defensive and without thinking and avoiding.

A woman dreaming.

These are the elements that Eifert and Forsyth (2014) expose as useful in ACT for anxiety:

  • Reframing the clinical context. The big problem with traditional therapy is it makes symptom reduction contingent on living fully. However, quality of life will hardly improve if the symptoms associated with anxiety don’t go away. The dynamic in the ACT isn’t the same and symptom suppression is irrelevant to achieving goals.
  • More flexible treatment goals and objectives. The objective is much broader when there are usually concrete objectives to induce sadness or impotence when not achieved. The purpose of ACT for anxiety is to put an end to those lifestyles that alienate a person from their values.
  • Recontextualizing exposure with nuances. The direct objective of exposure isn’t the reduction of anxiety, even though it’s certainly undertaken by the mechanisms that work in an exposure. There may not be a reduction in anxiety, but perhaps the therapy was successful.
  • Means of data collection. There’s advocacy for the use of unstructured, non-diagnostic clinical interviews. Labeling in one disorder or another is a double-edged sword that can fill the person with prejudice and stigma. Disorders aren’t the main thing to treat during therapy, but a pattern that doesn’t work at the time. In addition, ACT treats the essential and general processes of abnormal experiences of fear and anxiety. It doesn’t treat specific disorders.

Is ACT useful for anxiety?

ACT is a therapeutic variant that can be useful for the treatment of anxiety disorders. In turn, it’s a complicated type of work. This is because components such as the client’s creative hopelessness, their acceptance and disposition (one can use questionnaires such as the AAQ or the WBSI to measure these), and their degree of experimentation in relation to their need for control must be taken into account.

Studies on ACT for anxiety seem promising. Be that as it may, it’s a type of therapy that tries to solve the problems posed by exposure-response without dispensing with all its power. Therefore, it’s an example of how all therapeutic currents can add up to produce the desired result.

In this case, it’s about the improvement of the quality of life of a person without directly attacking their anxiety. Thus, it’s about decreasing as a consequence of any changes made.

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  • Eifert, G.H. y Forsyth, J. (2014). El equilibrio entre aceptación y cambio (cap. 5). En: La terapia de aceptación y compromiso para trastornos de ansiedad. Bilbao: Ed. Mensajero.