What Is Acceptance and Commitment Therapy?


Acceptance and commitment therapy (ACT) is a relatively new depression treatment. Depression often manifests with a preoccupation with past and/or current emotions, such as guilt and shame, or past events, such as loss and trauma. Because dealing with chronic pain often involves grieving the loss of a previous chronic-pain-free life, many people facing chronic pain also suffer from depression and benefit from ACT therapy.

Acceptance and commitment therapy is an action-oriented therapy that originated from behavior therapy and cognitive behavioral therapy. In ACT, patients learn to cease denying, avoiding, and/or struggling with their emotions and to accept that strong feelings are a normal response to certain situations. Individuals learn that suppressing painful emotions ultimately leads to more pain and trying to change distressing thoughts and feelings is almost impossible. Acceptance and mindfulness are valuable alternatives to suppressing and fighting thoughts and emotions. ACT teaches people how to change the way they mentally view difficult experiences. Individuals positively impact their emotional well-being by accepting present and/or past issues and adapting their behavior. They also learn how to determine if the inevitable problems and issues in their lives can be immediately remedied or if they simply need to be acknowledged and accepted. ACT then teaches individuals how to make the necessary behavioral changes to make positive changes in their lives.

Any type of behavior therapy should start with an assessment. ACT helps patients manage anxiety disorders, psychosis, stress, depression, substance abuse, and chronic pain conditions. In ACT, health care professionals work with patients to discover how they talk to themselves (self-talk) about various life situations, such as relationships, chronic pain issues, physical limitations, and traumatic events. Therapists help people identify how they negatively talk to themselves, and over time, people learn positive self-talk and self-affirmations. Additionally, individuals learn how to decide if immediate action is required to remedy a problematic situation or if acceptance of the situation and the strong emotions surrounding it is needed. People learn to be confident in their decisions and more accepting of their situations.

Acceptance and commitment therapy incorporates six core processes: acceptance, cognitive defusion, being present, self as context, values, and committed actions.

  • Accepting is the opposite of avoiding, fighting, and/or denying. ACT therapists provide people with cognitive tools to help them stop struggling to change their situation and to simply accept that a pain condition is present.
  • Cognitive defusion helps change the way that individuals interact with their thoughts. For instance, people may think that their chronic pain is going to get worse, and instead of recognizing it as a fleeting thought, they truly believe it. Cognitive defusion teaches people to not be fooled by a thought and realize it is simply a thought.
  • Being present is being nonjudgmental of the current situation. ACT therapy teaches individuals to exhibit flexible behavior and ultimately use language to describe (rather than judge) situations and emotions.
  • Self as context is the use of "I versus you." The human tendency is to focus on the self. By using mindfulness exercises to become aware of experiences, people learn to not completely attach themselves to those experiences.
  • In ACT, values are used to determine an individual's life priorities (career, family, etc.). Therapists teach people how to prioritize their values and to not use negative self-talk to avoid them. Individuals learn to focus on their priorities even during inevitable hardships.
  • Committed action is similar to behavioral therapy as it includes exposure and goal setting. Exposure therapy involves setting goals that require people to face their fears. Exposure leads to breaking the limitations that individuals have inadvertently set on themselves. To achieve short-term and long-term benefits from exposure exercises, people complete "homework" in order to alter their behavior patterns.

A health care professional properly trained in ACT is a valuable asset for those facing depression and chronic pain. Individuals should be very comfortable with their ACT therapist in order to obtain the best results.

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