What is Acceptance and Commitment Therapy (ACT)?

ACT has its roots in applied behaviour analysis (ABA; Baer, Wolf, & Risley, 1968), Relational Frame Theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001), and the philosophy of Functional Contextualism (Biglan & Hayes, 1996; Hayes, 1993; Hayes, Hayes, & Reese, 1988). Both ACT and CBT use behavioural techniques. However, there are differences in theoretical approach, change processes, and clinical translation, specifically around how the two therapies address various aspects of human language and cognition. There is much less focus in ACT on the content of thoughts, emotions, memories or sensations, rather the clinician using ACT helps the person form a detached, non-reactive relationship to these private events. CBT approaches tend to view the content of distressing unwanted thoughts, emotions or memories as something that should be cognitively evaluated and restructured to be more consistent with logical analysis of the situation. An easy to read article about ACT can be found here.

What does therapy using ACT involve?

The psychologist using ACT focuses on how a person’s behavioural responses work for them in terms of identified values or life ends. ACT emphasises openness and acceptance of all psychological events (such as thoughts, feelings and behaviours), despite their type and label given, whereas CBT emphasises changing thoughts and behaviour with the goal of reducing symptoms (Coyne, McHugh, & Martinez, 2011). ACT focuses on identifying what really matters to you, and how you want to live your life. Important components of ACT are whether the way that you behave and respond to particular events, people and situations are working for you, and how you can change your behaviour (rather than your thoughts) to start to move towards what really matters to you. ACT emphasizes acceptance of all thoughts, feelings, behaviours, and memories, letting go of thoughts, feelings, and memories that are unhelpful, and being present in the here and now (this is known as mindfulness) while accepting our thoughts, feelings and bodily sensations. Mindfulness can be practiced in many different ways, and does not have to include formal meditation exercises. Practicing mindfulness can include your regular daily activities, like exercising, traveling by public transport, eating, listening to music, or even brushing your teeth. There are many more ways to practice mindfulness, and the more we practice it and incorporate it into our daily routine, the more skilled in it we become.

ACT shares many similarities with CBT in its’ approach to treatment, particularly in the use of exposure by both these therapies. The main difference is that ACT emphasizes changing the way that you view your thoughts and feelings, instead of having to do something to try distract yourself from them, avoid them, or get rid of them. ACT has a large, scientifically measured evidence base, which supports its’ effectiveness for a wide range of issues. ACT has been used successfully with children, adolescents, and adults. I use ACT in my own life, and with my family and children, and I’m so passionate about it that I completed my Doctor of Philosophy (Ph.D) investigating the effectiveness of ACT versus CBT as a compulsory part of school curricula for year nine students. My study is the first study to compare ACT to CBT in schools.

How is ACT different from CBT?

CBT differs from ACT in its focus on changing thoughts, and replacing thoughts we don’t want to have with positive thoughts. This can be really hard for some people to do (particularly if you do not actually believe the positive thought), especially if you have been thinking a certain way for a long time. This way of coping might get rid of your thoughts temporarily, but the thoughts might return again and again, and you may feel that your thoughts stop you from doing things that you want to do, or need to do (for example: speaking in public or attending social functions). Our thoughts tend to occur automatically, and are not necessarily rational, or reflective of what is actually true, and don’t always make sense. Difficulties coping often arise when we believe everything our minds tell us, which can occur because our thoughts can be pretty powerful, and we can allow them to control our lives. Instead of focusing on changing our thoughts, ACT emphasizes changing the way that you respond to your thoughts and feelings, and changing your behaviours with ones that work better for you. Important components of ACT are accepting what is out of your control, not letting difficult thoughts and feelings stop you from doing things that are important to you, and committing to actions (behaviours) that improve and enrich your life, so that you don’t have to miss out on things that matter to you.