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Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that is an offshoot of Cognitive Behavioral Therapy (CBT), and is considered by some as a "third wave" or "third generation" cognitive behavioral therapy, following in the steps of Behavioral Therapy and CBT. It shares with CBT the idea that psychological distress and mental health conditions are rooted in problematic or maladaptive thoughts, attitudes and behaviors.

However, ACT tends to differ from CBT in at least one important way. Whereas CBT tries to alter problematic thoughts and attitudes by questioning them and challenging them head-on, ACT tries instead to help people distance themselves from their firmly held beliefs and take a more dispassionate and objective view of all of their thoughts and attitudes. In this regard, ACT invokes many principles that are reminiscent of Eastern meditative philosophies, like Zen Buddhism, where the goal is to become less attached to and invested in one's typical ways of experiencing and reacting to events, and to live more fully in the present moment without prejudgments.

The Process of Acceptance and Commitment Therapy

In a course of ACT, a client (ie. patient) will meet with the therapist for a number of sessions, usually on a weekly basis, to address a specific set of mental health symptoms and issues. The therapist will help the client to divest themselves from their usual ways of thinking and reacting to events, and to develop the ability to behave differently and more flexibly, in keeping with their values and goals. To achieve this end, the client and therapist focus on the following tasks [ref]:

Acceptance: clients learn to allow uncomfortable experiences to occur without trying to fight them, control them or alter them. For example, if a person struggles with panic attacks, the goal would be to allow these feelings of anxiety and tension to happen and to run their course at their own speed. This can help the client to become more accustomed to these symptoms and to tolerate them better, and thus to experience less anxiety about having the symptoms, which in turn can actually help to decrease the intensity of the symptoms.

Cognitive diffusion: clients learn to become aware and observant of their thoughts as phenomena in their own right, without assuming that these thoughts are necessarily true or that they are to be taken seriously. This can help to free the person from feeling oppressed or distressed by certain habitual ways of thinking about things. For example, a person who often thinks, "I'm not interesting to other people," can learn to see this sort of thought as simply an object passing in their mind that need not be true or important. Certain exercises can be used to help the client with this skill, such as repeating the words of the thought over and over until only the sound remains, or treating the thought as an externally observed event by giving it a particular shape and color.

Being present: this involves trying to experience the present moment - including one's inner thoughts and feelings as well as what is happening in one's surroundings - in a way that is as direct and non-judgmental as possible. The idea is that by being more aware of the present moment and all the possibilities it offers, one can begin to act in a more flexible manner that is more in tune with their chosen values.

Self as context: the goal here is to become aware of the fact that the self is the context for all of one's thoughts and experiences, but is not defined by these experiences. The client is taught to become aware of their experiences without becoming overly attached to them or invested in how they will or ought to occur.

Values: the client is encouraged to develop goals and directions in life that are not based on social scripts and expectations, but on what seems truly important and necessary for them.

Committed action: this involves learning new ways of behaving that better reflect one's values and goals without leading to situations that increase one's distress. The techniques used are the same as in other behavioral therapies.

Applications of Acceptance and Commitment Therapy

ACT has not be examined as thoroughly as CBT, and does not have the same amount of research studies supporting its effectiveness. However, there is a small and growing body of research suggesting that ACT shows promise as a treatment for Obsessive-Compulsive Disorder, Social Phobia, PTSD, Depression, Substance Use Disorders, psychosis, and medical conditions including chronic pain and diabetes [ref].