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What is Acceptance Commitment Therapy and How Does it Work?

Keren Fisher

Keren Fisher

Tuesday, 15th January 2019

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"Acceptance?", you say. "Doesn’t that mean giving up and never getting any better?"

The answer is a big NO. Acceptance is an active process that involves learning new ways of coping with unhelpful thoughts and emotions.

"But I’ve tried Cognitive Behaviour Therapy (CBT) and learned about challenging unhelpful thoughts. It didn’t help me much", you say.

That is quite a common problem which is why some people use ACT techniques instead. You can think about thoughts as a stream of events in the mind, like cars on a motorway or leaves in a river.

CBT asks us to stop the stream and catch the thoughts that worry us, but ACT says that just observing the thoughts and working alongside them allows us to have more of the life we want.

A basic aim of ACT is to encourage people to be adaptable in their thinking rather than getting stuck in the same old habits with the same old words. Words get collected into thoughts that have a strange power to bully us – to make us believe them and to assume they know what’s best for us, so we stick with them for fear of experiencing something much worse.

Acceptance involves learning to live with thoughts, rather than change them.

One technique for this is Observing, being present, noticing how things are, rather than wishing they were somehow different. Mindfulness exercises are a good way to start learning this.

The stories we tell ourselves.

Stories - reasons for our actions - enable us to make sense of the life we are stuck in. They ‘allow’ us to continue avoiding what scares us because the thoughts about the situation are fused or glued to our sense of self. For example, you might have a thought, "I can’t go into a room full of people. I feel too anxious", and you avoid many social situations that might help you get more out of life.

So, another basic ACT technique involves Defusing – ungluing thoughts from reality and action. You could learn to unstick the glue between the ideas ‘room full of people’ and ‘self too anxious’, by just noticing the thought and labelling it, ‘There goes my anxious thought again’. There are different ways of achieving this.

Thoughts are not rules. You don’t have to obey them.

ACT likes metaphors. Another way of ungluing thoughts that get you stuck in an uncomfortable place, is to imagine you’re driving a bus in the direction of your most valued activity, but thought passengers keep coming up to you and telling you to stop and turn round. "You’re bound to fail", they say. You can learn to keep going in your valued direction while taking the passengers with you, still muttering but no longer influencing your journey.

Or you can imagine struggling with a problem as if it were a tug of war with a monster on the other side of a ditch. You have to keep pulling on the rope to try to get the monster into the ditch instead of you, but it takes all your time and effort and stops you living the life you want.

You could learn a new strategy – Let go of the rope.

ACT is about being open to experience.

The other side of the coin is COMMITMENT.

ACT is about Values. These are aspects of life that really matter to you, that give your life meaning and guide you like a compass to more of the life you want. Values are different from goals, though you might use goals along the way. Goals are specific achievements with an end point such as walking to the shops or joining a gym. Values can’t be completed as they are on-going and encourage you to grow into the best version of yourself.

You might want to improve relationships with your partner or children, or develop your career, improve your health and fitness or learn new skills.

So, to move in the direction of your values takes committed action. You may have been avoiding what you really want because you have been too influenced by your thoughts or unpleasant emotions. You may have been stuck in rigid thought pathways.

Commitment is not easy but it is rewarding. You can begin to realise that important parts of your life that you believed were unreachable, might be within your grasp after all.

For example, you really want to study a new course at college that will enable you to achieve your dream of designing new gadgets to improve other people’s lives. You think that you are not good/bright/creative enough and you believe the stories you tell yourself.

But what if you were to give it a try - to be open to the experience?

"Hmm, too scary", you say. Yes, that’s true. You might apply for your course and not succeed, but now you have more information and a chance to change the story.

You can learn to be more flexible.

Maybe that wasn’t the right course. One with a different emphasis might be nearer to what you want. There are a lot of potential outcomes from a behavioural experiment. The important thing is to learn to be a scientist, to experiment and be curious about the result which will
surely lead to more experiments, more results and better self knowledge – a value worth pursuing.

What happens in an ACT therapy session?

The main aim in an ACT session is to learn flexibility in thoughts and action – to give up the struggle for control of life’s problems and to be open to experience things as they actually are. Then you can change the stories that keep you avoiding the path towards your better life. It’s important to remain in the present, rather than regretting the past and fearing the future like a game of mind ping pong.

Trying to avoid situations is NOT YOUR FAULT – it is not because you’re weak.

The therapist will explain this to you. The evolution of the brain meant that it developed specific ways to keep you safe. A thought, "I must be careful to avoid this situation because it’s dangerous", might have been useful when the alternative was to be eaten by a lion. However, in modern life your early brain is still trying to keep you safe but the ‘I must avoid’ thought has become attached to all kinds of situations which are now keeping you stuck in a depressing loop.

Acceptance:

A mindfulness session helps. Mindfulness is frequently used in many different circumstances but may need to be focused on the problem of your particular ‘thought rules’. It also helps you to learn to tolerate the rise and fall of emotions. If they are observed rather than responded to, you can learn that they fade away over time and become less intrusive. It is the constant struggle to control or avoid them that has been keeping them on the boil.

Commitment:

If you didn’t have to struggle with emotional problems, how would your life be different?

This question helps you to identify your values – what’s really important to you that you want to get out of your life? You may be given a questionnaire to help you focus your ideas, especially if you have lost sight of your original life plans while dealing with your problems.

The session may then move on to investigating the question,

This week, have your footsteps taken you in the direction of your chosen value?

Assuming the response is not an overwhelming YES, then problem solving strategies will be discussed with you. What were the barriers to progress? A struggle with scary thoughts and feelings? A fear of failing? That’s OK. That’s the avoidance that’s probably been holding you up all along.

Following more information about the ‘stories’ that have been stopping you progress, new footsteps or goals will be discussed and a homework plan will be agreed for the next session. This will be a bit of a challenge - just enough to give you a sense of achievement, but not enough to frighten you off trying. You will probably have a phone number to ring so that any unforeseen problems between sessions can be ‘nipped in the bud’. You will be encouraged to practise mindfulness every day.

ACT therapy for depression

There is good evidence that ACT is a very helpful therapy for depression. The two main arms of the treatment - learning to accept sad emotion while defusing the power of unhelpful thoughts and commitment to becoming more active (known as behavioural activation) will help you get more of the life you want.

Constantly struggling with unpleasant emotions, regretting the past and fearing the future may have become such ‘mind habits’, that it seems impossible to imagine a life without them. Being present right here, right now can stop the ruminations about past failure and future disappointment. Then you can begin to achieve more of the things you value.

There will be mindfulness exercises to learn awareness of the breath, of physical sensations, of thoughts, and of emotions. These help with accepting yourself as the observer of the thoughts and sensations. They happen in your mind but they are not the whole you. They are passing events and they vary over time – changing from one thing to another.

There will be plenty of opportunity to practise these exercises and you will be encouraged to try them everyday between sessions.

Commitment to behavioural activation involves starting from the baseline of what you do in a day – stay in bed, get up occasionally for a drink but eat very little, or manage to go to work but feel isolated from your tasks and your colleagues. It’s important to identify what is maintaining you in this position and ‘helping’ you avoid your valued activities. Setting goals around your values will help to specify particular actions you can take to improve what you achieve.

You will be encouraged to continue at your agreed pace, using problem solving strategies to overcome barriers to progress.

It may take a good few sessions but with Acceptance and Commitment, it will change your life.

The best way to learn is by doing it rather than reading about it.

You can book a session with Keren by clicking on her bio below.


Keren Fisher

Keren Fisher

Dr. Keren Fisher uses Acceptance and Commitment Therapy and Mindfulness techniques where they are effective. She is particularly interested in the treatment of trauma, depression and chronic illness.

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