How Psychotherapy Works: An Introduction to Acceptance and Commitment Therapy

By Whitney Graff, Licensed Clinical Psychologist and Psychotherapist at Wildflower Center for Emotional Health

At Wildflower Center for Emotional Health, we use a certain set of therapeutic techniques based on a common foundation of assumptions and ideas about mental health. One of these in particular is called Acceptance and Commitment Therapy. Widely considered to be an effective and accessible treatment, Acceptance and Commitment Therapy (or “ACT,” said like the word act) combines psychological tools for dealing with thoughts and feelings with an overall goal of helping patients live rich, meaningful lives. 

Imagine this scenario: you have an interview for your dream job. Good for you! However, you learn that getting the job hinges on you not feeling anxiety during the interview. How do you think you would feel? Most likely, you would actually feel anxious about whether or not you would feel anxious. But you decide to give it your best shot. Knowing that you should try not to feel anxiety and given the importance of the interview, you might take deep breaths and repeat positive phrases in your head. These might work to a certain extent. However, you will need to put some effort toward them and focus on keeping the signs of your anxiety to a minimum. Plus, working to control your anxiety is likely adding to it. While you are busy doing that, what was the interviewer just asking you? Wait, you were not paying attention because you were busy taking deep breaths! 

While you might be successful masking your shaking hands or calming yourself for the duration of an interview, imagine having to do this day in and day out. It would be exhausting. Part of the reason these common techniques can fail us is that they are control strategies, which require us to be in an active, problem-solving mode. Unfortunately, this problem-solving mode is the same system activated during times of anxiety. The mind is busy, there are tasks to complete, and the nervous system engages. The driving force behind control strategies stems from the same agenda involved with anxiety: try to anticipate every possibility, plan for every contingency, or protect us from threat.

In ACT, we assume that control is part of the problem. However, do not think we mean that since we cannot control everything we should simply give up and take it. Rather, ACT gives us new ways of relating to our internal experiences (thoughts, feelings, bodily sensations, memories, images…) that don’t ask us to take on the impossible task of controlling them. If you have ever tried not to think of certain image or not to remember a certain song lyric, you know the futility of trying to control these mental experiences. In fact, in ACT we assume that trying to push away a certain experience increases our overall suffering, and through psychological research we have found that struggling against a thought makes it more likely to pop into our heads. 

Instead, we can tap into different ways of relating to our thoughts and feelings, letting go of our struggle with them, and set our sights ahead. We use acceptance techniques which have been shown to be effective in changing our relationship with thoughts and feelings, and we focus on moving in the direction of a meaningful life. What do we want our days, our lives, our relationships to be about? What is most important? What qualities do we want to embody? By setting these out in front, and allowing our feelings and thoughts to come along for the ride, rather than seeing them as standing in the way, we can begin forging a rich, purposeful life. What energy is freed up to engage with life when it is no longer put toward an unwinnable battle with feelings? 

ACT is not just for anxiety. ACT is an overall framework for letting go of tiring, futile struggles with many different internal experiences and refocusing on building meaning and purpose. This makes it a good fit for patients suffering from mood disorders, trauma and PTSD, reproductive issues like infertility or perinatal/postpartum mental health concerns, grief and loss, eating disorders, and many others. Rather than being a specific protocol for one disorder, ACT is a way of approaching human suffering that aims to help with getting back on track when difficult thoughts or feelings have derailed us. 

A common reaction to these ideas is that they sound simple enough but perhaps “easier said than done.” Indeed, while these might not be complicated in principle, they can be difficult to put into practice. That is why working with a trained therapist can be invaluable. Through an authentic and empathic therapeutic relationship, new ways of being are explored and practiced. In ACT it is assumed that every human struggles in one way or another, therapists included, so the therapist acts as a guide and source of another perspective, someone who can see what may be getting in the way when we ourselves cannot. 
Here at Wildflower Center, many of our therapists embrace ACT as a highly effective, engaging, and affirming treatment option for our patients. We know that ACT is considered an empirically-validated treatment, having been tested with a wide range of populations and clinical issues. We hope that with this approach and similar other techniques we can open up new possibilities for our patients and help them build the full, rich lives they deserve.