How ACT Therapy Works

Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral therapy approach that focuses on helping people accept difficult thoughts, feelings, sensations, and internal experiences while guiding them to commit to values-based actions, explains Avigail Lev, PsyD, a licensed clinical psychologist specializing in acceptance-based treatments.

The theory behind ACT suggests that by increasing acceptance, individuals can enhance their psychological flexibility. This flexibility allows them to better handle life's challenges and stressors without being overwhelmed by negative emotions or thoughts.

The Benefits of ACT

ACT offers a variety of benefits, including:

• Encouraging greater emotional acceptance

• Reducing avoidance of difficult thoughts or feelings

• Increasing commitment to meaningful actions aligned with personal values

By helping people stop habitually avoiding uncomfortable emotions or experiences, ACT can prevent further psychological or emotional problems from developing.

ACT Therapy Techniques

Acceptance and Commitment Therapy (ACT) differs from traditional Cognitive Behavioral Therapy (CBT) in its approach. Unlike CBT, the goal of ACT isn’t to reduce the frequency or severity of unpleasant internal experiences like cognitive distortions, emotions, or urges. Instead, ACT focuses on reducing the struggle to control or eliminate these experiences, while encouraging greater involvement in life activities that align with personal values.

As Avigail Lev, PsyD, explains, "ACT utilizes six processes to help people create psychological flexibility, meaning the freedom to choose our actions regardless of our internal experiences."

The Six Core Processes of ACT Therapy

1. Identifying Values
   This process involves recognizing the areas of life that are most important to you. It’s about understanding what you want to stand for and what guides your actions toward a fulfilling life.

2. Commitment to Action
   This involves changing your behavior to align with your values. This process emphasizes taking specific actions that either bring you closer to or move you further from living according to those values.

3. Self as Context (Self as Observer)
   Learn to observe your thoughts and feelings without becoming entangled in them. Lev uses the metaphor of seeing yourself as the sky and your thoughts and feelings as weather patterns—transient and not defining who you are.

4. Cognitive Defusion Skills
   Cognitive defusion involves separating yourself from your internal experiences. This allows you to see thoughts as simply thoughts, without attaching the importance your mind often adds to them.

Acceptance in ACT Therapy

Acceptance in ACT means allowing your inner thoughts and feelings to occur without trying to change, avoid, or ignore them. It’s an active process of embracing these experiences non-judgmentally.

Skills for Cultivating Acceptance

ACT therapy uses several techniques to help develop acceptance, including:

• Self-compassion meditations

• Emotion exposure

• Physicalizing emotions or thoughts

• Loving-kindness phrases

• Experiential exercises and metaphors

Present Moment Contact

ACT therapy emphasizes staying mindful of your surroundings, helping you shift attention away from internal thoughts and feelings. Focusing on the present moment builds greater awareness and prevents past experiences from negatively affecting current interactions.

What to Expect in ACT Therapy

In the initial sessions of ACT, the focus is on clarifying the client's values, explains Avigail Lev, PsyD. Subsequent sessions help clients connect to these values and apply them in meaningful ways.

A Typical ACT Therapy Session

A typical session may include:

• Reviewing the previous week and identifying behaviors aligned with the client's values

• Examining behaviors that weren’t aligned and understanding the barriers that led to those actions

• Using ACT processes to work through barriers and move closer to values

What ACT Can Help With

ACT has been shown to be effective in treating a variety of mental health conditions, including:

• Anxiety

• Depression

• Eating disorders

• Obsessive-compulsive disorder (OCD)

• Stress

• Substance use

• Psychosis

How Effective Is ACT Therapy?

ACT is part of the "third wave" of psychotherapies, which includes:

• Dialectical Behavioral Therapy (DBT)

• Schema Therapy

• Mindfulness-Based Cognitive Therapy (MBCT)

"Third-wave approaches emphasize acceptance and mindfulness-based strategies rather than cognitive restructuring," Lev explains. They focus on helping people accept difficult emotions and develop distance from troubling thoughts.

Initially, third-wave treatments like ACT were seen as options for individuals who didn’t benefit from traditional therapies like CBT. However, ACT is now considered a first-line treatment for some individuals.

Research shows that ACT is effective in treating a wide range of conditions and improving quality of life, especially in managing physical conditions and chronic pain.