Acceptance and Commitment Therapy: Move through Unwanted Thoughts

If you've ever tried to fall asleep only to lie awake with worrisome thoughts nagging you along an endless loop, you know how frustrating it can be to feel powerless over your own mind. What if, instead of obsessing over what happened in the past or stressing about what could happen in the future, you accepted those thoughts as just thoughts and turned your focus to the present moment?

This is the idea behind Acceptance and Commitment Therapy (ACT), a form of behavior-change psychotherapy that can help you accept certain unpleasant thoughts, emotions or feelings as okay in certain situations—and then move on.

According to the Association for Contextual Behavioral Science, Acceptance and Commitment Therapy involves "taking the view that trying to change difficult thoughts and feelings as a means of coping can be counter-productive, but new, powerful alternatives are available, including acceptance, mindfulness, cognitive defusion, values, and committed action."

How Does Acceptance and Commitment Therapy Work?

As a psychological intervention, Acceptance and Commitment Therapy is used by therapists to help patients acknowledge that—while the experience of sadness, fear, anxiety or anger is very real and very challenging—these thoughts and feelings don't have to run the whole show. Therapy guides patients in developing acceptance-based skills, mindfulness techniques and self-compassion in order to respond and move through unwanted thoughts and feelings (rather than ignore them, obsess over them or simply check out).

According to Aisling Curtin, registered counseling psychologist and founding director of ACT Now Ireland, this therapy "aims to increase our psychological flexibility. When we are more psychologically flexible, we are more connected in the present moment and to what matters to us, open to our experiences as they are, rather than what they say they are, and engaging in actions that help bring us closer toward who and where we want to be. Unwanted emotions are part of life," she says, "but with ACT, we learn strategies to relate to our emotions in more compassionate ways that allow us to learn from our emotions, rather than see them as something that needs to be feared."

Therapy can help you build "psychological flexibility" by connecting to the present moment, refusing to buy into thoughts that prevent you from leading the life you deserve, maintaining an open viewpoint, and acting on your personal values.

Research in Psychology Today shows that Acceptance and Commitment Therapy has been particularly beneficial in helping those struggling with anxiety disorders (particularly related to social anxiety or workplace anxiety), depression, obsessive-compulsive disorder, substance abuse issues and substance use disorders.

Is Acceptance and Commitment Therapy Different from Cognitive Behavioral Therapy (CBT)?

Traditional cognitive-behavioral approaches to psychotherapy place a greater emphasis on thinking and behavior changes to cope with symptoms. Acceptance and Commitment Therapy works to change the patient's concept of what's causing the symptoms and to better accept life on life's terms.

"Useful pessimism" is how The Art of Wellbeing describes the ACT approach. "Instead of challenging distressing thoughts by looking for evidence and coming up with a more rational response like in CBT, in ACT you accept the thought, and then defuse it like a bomb. ACT is all about accepting that negative thoughts and emotions are a part of life, and ending the struggle that things can—or should—be any other way. It is pessimism at its most useful."

For example, if you are having trouble sleeping, a Cognitive Behavioral Therapy approach would have you identify irrational thoughts related to your inability to sleep, explore the rationality behind those beliefs and examine times when you were able to sleep. The psychological goal is getting to you to see it's not that you "never" sleep, but instead you "sometimes" have difficulty sleeping. By contrast, an ACT approach looks at how you process the idea of not being able to sleep. Instead of focusing your energy on thinking "I can't sleep"—which can actually cause anxiety and make sleeping more difficult­—the idea of acceptance is introduced. In this way, you acknowledge that sometimes you sleep well and other times you don't. This acceptance process decreases the amount of stress and worry associated with the symptom. This, in turn, can reduce the frequency of the symptom.

When Does Acceptance and Commitment Therapy Seem to Be Most Effective? Why?

Therapists commonly use ACT techniques with individuals who want to develop coping skills to manage persistent or reoccurring symptoms. Especially for people with a chronic disease, persistent mental or behavioral health issues, or chronic pain, ACT provides a path for working toward a mindset of acceptance—yes, your symptoms are indeed real, and you will need to manage them over time.

Why Is ACT Classified as a "Third Wave" of Psychotherapy?

In the field of psychology and psychotherapy, the first wave of "behavioralist interventions" focused largely on the unwanted or unhealthy behaviors themselves rather than analysis of the thoughts that influenced those behaviors. The second wave of behavioral interventions included approaches such as CBT and Rational Emotive Behavior Therapy (REBT), which looked at how irrational thoughts influence the thinking process and, in turn, impact emotions and behaviors. The third wave of behavioral interventions includes ACT and Dialectal Behavior Therapy (DBT), forms of psychotherapy that incorporate acceptance and mindfulness techniques to defuse unpleasant thoughts or feelings and, instead, support behavior that aligns with personal values and goals. ACT was developed by clinical psychologist Steven C. Hayes, PhD, who has written extensively about the various applications and benefits of this therapy.

What Would an ACT Session Involve?

With ACT, therapists work with patients to develop mindfulness techniques and acceptance strategies that build greater psychological flexibility. ACT interventions are also designed to help patients clarify personal values and life goals, such as having meaningful relationships or doing purposeful work, so they can take action in that direction. Therapists employ ACT methods to help patients focus on the current moment rather than become fixated on an idea of what life might look like at a certain point in the future. Typically, ACT techniques are combined with other evidence-based therapy such as CBT or Motivational Interviewing.

While licensed therapists are generally well-versed in multiple psychotherapy modalities, your mental health care should be individualized to meet your specific psychological needs and goals. That starts with a comprehensive mental health assessment conducted by a credentialed provider. Acceptance and Commitment Therapy can help you move through unwanted thoughts and feelings that keep you stuck—and move toward living your best, most meaningful life.