When our anxious thoughts interfere with our ability to engage with the world around us, we quickly become overwhelmed, driven by fear of what might happen instead of a desire and willingness to experience each moment as it unfolds. Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults, or 18.1% of the population every year. While anxiety disorders are highly treatable, estimates suggest that only 36.9% of those suffering receive treatment.

Several therapies have proven to be particularly effective in addressing anxiety, including, acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), exposure therapy, and dialectical behavior therapy (DBT). Acceptance and commitment therapy, or ACT, helps individuals create a rich, full, and meaningful life, while accepting the pain that inevitably accompanies it. Through the utilization of mindfulness techniques and goal-directed or values-based behavior, clients can learn to reduce the influence and impact of painful thoughts and feelings and take steps that enrich their quality of life rather than diminish it.

In this post, we’ll explore what often leads us to feel stuck; the six core therapeutic processes of ACT; who ACT is most helpful for; and how you can begin implementing strategies from ACT in your own life. Without further ado, let’s get started!

Why Do We Suffer?

ACT proposes that the cause of most suffering is a result of two psychological processes: cognitive fusion and experiential avoidance.

Cognitive Fusion

Have you ever felt like you can’t shut off your mind, or that instead of controlling your thoughts, they control you? Cognitive fusion refers to getting entangled in our thoughts or holding on to them too tightly. When we fuse with our thoughts, they dominate our behavior. We become so caught up with our mind’s stories, we’re not even aware that we’re thinking.

As humans, we dwell in two different worlds. When we’re born, we take in the world through our five senses: the world that we can see, hear, touch, taste, and smell. As we grow older, we learn to think, and spend more and more time in the world of language. Fusion means we’re stuck in the world of language and become so preoccupied by the words and pictures running through our mind that we lose contact with the world of direct experience.

In a state of fusion, a thought can seem like:

· The absolute truth

· A command you have to obey or a rule you have to follow

· A threat you need to get rid of as soon as possible

· Something that’s happening right here and now even though it’s about the past or future

· Something very important that requires all your attention

· Something you won’t let go of even if it worsens your life

In a state of defusion, you recognize that a thought:

· May or may not be true

· Is not a command you have to obey or a rule you have to follow

· Is not a threat to you

· Is not something happening in the physical world

· May or may not be important – you have a choice as to how much attention you pay it

· Can be allowed to come and go on its own without any need for you to hold on to it or push it away

Experiential Avoidance

Experiential avoidance means trying to avoid, get rid of, suppress, or escape from unwanted “private experiences”, or thoughts, feelings, memories, images, urges, and sensations. While doing things to avoid troubling thoughts and feelings may initially provide temporary relief, the long-term result is often more pain and suffering.

For instance, if you become anxious in social situations, you may try to avoid those feelings by not going out. While this is certain to alleviate your anxiety in the short-term, the future consequences, such as isolation and limited interaction with others, can be harmful.

The greater value we place on avoiding what makes us uncomfortable, the more we develop anxiety about our anxiety. A large body of research shows that higher experiential avoidance is associated with anxiety disorders, excessive worrying, depression, poorer work performance, higher levels of substance abuse, lower quality of life, high-risk sexual behavior, borderline personality disorder, greater severity of PTSD, long-term disability, and higher degrees of overall psychopathology.

Now that we’ve talked about the two primary causes of suffering, let’s take a look at how ACT can help us be more mindful and live by our values.

Key Terms in ACT therapy

Mindfulness

Mindfulness means paying attention with flexibility, curiosity, and openness. It involves bringing awareness or paying attention to your experience in this moment. Even if your experience is difficult or painful, you can be open to it and curious about it instead of running from or fighting with it. Mindfulness also involves flexibility of attention: the ability to consciously direct, broaden, or focus your attention on different aspects of your experience.

Valued Living

Valued living means taking action, on an ongoing basis, that is guided by and aligned with core values.

Six Core Therapeutic Processes

The six core therapeutic processes in ACT are:

1. Contacting the present moment

2. Defusion

3. Acceptance

4. The observing self

5. Values

6. Committed action

As we go through them, I’ll also note in parentheses the problem areas each one addresses.

Contacting the Present Moment – Be Here Now (Dwelling on a conceptualized past and future)

When we’re out of touch with our here-and-now experience, we cling to a conceptualized past and future: we dwell on painful memories and ruminate about why things turned out the way they did; we fantasize about the future, worry about things that haven’t happened yet, and concentrate on all the things we have to do next.

Contacting the present moment means being psychologically present: consciously connecting with and engaging in whatever is happening in this moment. We bring our awareness to either the physical world around us or the psychological world within us, or to both simultaneously, without becoming consumed by our thoughts or operating on automatic pilot.

Defusion – Watch Your Thinking (Cognitive fusion)

Defusion refers to learning to step back and separate or detach from our thoughts, mental images, and memories. Instead of getting tangled up in our thoughts, we step back and observe them. We see them for what they are – nothing more or less than words or pictures.

Acceptance – Open Up (Experiential avoidance)

Earlier we learned that experiential avoidance often has negative long-term consequences, even though in the moment, it can provide a tremendous sense of relief. Acceptance means opening up and making room for painful feelings, sensations, urges, and emotions. Instead of fighting them, resisting them, running from them, or getting overwhelmed by them, we give them some breathing room and allow them to be as they are. This doesn’t mean liking them or wanting them, but simply creating space for them.

The Observing Self – Pure Awareness (Attachment to the conceptualized self)

We all have a narrative about who we are – it includes our name, age, sex, and cultural background, in addition to descriptions and evaluations of our roles, our relationships, our strengths and weaknesses, our likes and dislikes, and our hopes, dreams, and aspirations. When we hold this story lightly, it can give us a sense of who we are and what we want in life. But if we cling to this story too tightly, and start to believe that we are the story, it becomes problematic. For instance, we might begin to believe that we’re bad, worthless, hopeless, unlovable, ugly, or incompetent, instead of recognizing that we’re separate from our self-description.

Most of us are well-acquainted with the part of us which is always thinking – churning out thoughts, beliefs, memories, judgments, fantasies, plans, and so on. But few of us are familiar with the observing self, the part of us which is aware of whatever we’re thinking, feeling, sensing, or doing in any given moment. As you go through life, your body, thoughts, feelings, and roles change. But the “you” that’s able to notice or observe all those things remains constant.

Values – Know What Matters (Lack of values clarity/contact)

As our behavior becomes increasingly driven by fusion with negative thoughts or attempts to escape unpleasant experiences, we often lose touch with our values. When we’re not clear about our values, we can’t rely on them to effectively guide our behavior.

Through ACT, we learn to clarify our values so we can create a meaningful life. We ask ourselves, “What do you want your life to be about?”, “What do you want to stand for?”, and “What really matters to you in the big picture?”

Committed Action – Do What it Takes (Unworkable action)

Unworkable action means patterns of behavior that pull us away from mindful, values-based living; patterns of that action that instead of making our lives richer and fuller, leave us feeling stuck or increase our struggles. This includes action that’s impulsive, reactive, or automatic as opposed to mindful, considered, and purposeful. Common examples of unworkable action may include, using drugs or alcohol excessively, withdrawing socially, being physically inactive, avoiding work or household tasks, or sleeping too much.

Committed action, on the other hand, means taking effective action guided by our values. Values-guided action evokes a wide range of thoughts and feelings, both pleasant and unpleasant. So committed action means “doing what it takes” to live by our values even if it brings up pain and discomfort.

Putting it All Together

Let’s summarize what we’ve learned so far: ACT speculates that the two primary drivers of suffering are cognitive fusion and experiential avoidance. To overcome these tendencies, there are six core processes in which we can engage to live more mindfully and integrate our values into our ongoing actions. The overall goal of ACT is to help us create a rich, full, and meaningful life, while accepting the pain that life inevitably brings. This is accomplished by:

Mindfulness: Teaching us psychological skills to handle painful thoughts and feelings effectively, in such a way that they have much less impact and influence.

Values clarification: Helping us to understand what’s truly important and meaningful to us so we can set goals and take action that enriches our life.

Who Can Benefit From ACT?

In short, everyone! We all can benefit from learning to be more present; more in touch with our values; more able to make room for the inevitable difficulties of life; more able to distance ourselves from unhelpful thoughts, beliefs, and memories; and more able to take effective action in the face of emotional discomfort. Psychological flexibility brings all of these advantages, and more.

Specifically, ACT has been scientifically studied and shown to be effective with a wide range of conditions, including:

· Workplace stress

· Chronic pain

· Drug use

· Psychological adjustment to cancer

· Epilepsy

· Weight control

· Smoking cessation

· Self-management of diabetes

· Anxiety

· Depression

· Obsessive-compulsive disorder

· Social phobia

· Generalized anxiety disorder

· Schizophrenia

· Borderline personality disorder

Now let’s explore some practical exercises you can use to begin implementing ACT strategies into your own life.

Defusion

I’m having the thought that…

Put your negative self-judgment into a short sentence – in the form “I am X.” For example, “I’m not lovable,” or “I’m not smart enough.” Now fuse with this thought for ten seconds. In other words, get caught up in it and believe it as much as you can. Now silently replay the thought with this phrase in front of it: “I’m having the thought that…” For example, “I’m having the thought that I’m not lovable.” Now replay it one more time, but this time add the phrase, “I notice I’m having the thought that…” For example, “I notice I’m having the thought that I’m not lovable.”

What happened? Did you experience a sense of separation or distance from the thought? If not, try the exercise again with a different thought.

Letting go metaphors

The next time you experience difficult thoughts, use one of these metaphors to allow them to come and go like:

· Passing cars, driving past outside your house

· Clouds drifting across the sky

· People walking by on the other side of the street

· Suitcases on a conveyor belt

· Bubbles rising to the surface of a pond

· Waves washing gently onto the beach

· Birds flying across the sky

· Trains pulling in and out of the station

· Leaves blowing gently in the wind or floating down a stream

Acceptance

The struggle switch

Remember that acceptance means allowing our thoughts and feelings to be as they are, regardless of whether they are pleasant or painful; opening up and making room for them; dropping the struggle with them; and letting them come and go as they naturally do.

The next time you find yourself struggling with a difficult thought or feeling, imagine that at the back of your mind is a “struggle switch.” When it’s turned on, it means you’re going to struggle against any physical or emotional pain that comes your way. When the switch is turned off, it means whatever feeling shows up, no matter how unpleasant, you don’t struggle with it. Instead you put your energy into doing something that’s meaningful and life enhancing.

Ask yourself if your struggle switch is on, off, or at the halfway point of “tolerating.” If the switch was like a dial with a scale of 0 to 10, and 10 is full struggle and 0 is no struggle at all, then right now, what level are you? Practice observing your difficult feeling and noticing where it is in your body. Where is it most intense? Breathe into the feeling and see if you can just open up around it a little – give it some space. See if you can let it sit there for a moment. You don’t have to like it – just allow it to be present. Continue in this way until you are able to bring your struggle switch down a few notches.

Contacting the present moment

Notice five things

Here’s a simple exercise to center yourself and engage with your environment. Practice it throughout the day, especially when you find yourself getting caught up in your thoughts and feelings:

Look around and notice five things you can see. Listen carefully and notice five things that you can hear. Notice five things that you can feel in contact with your body. (For example, the air on your face, your back against the chair, your feet on the floor.) Finally, do all of the above simultaneously.

The Observing Self

The sky and the weather metaphor

Your observing self is like the sky. Thoughts and feelings are like the weather. The weather changes continually, but no matter how extreme it gets, it cannot harm the sky. The mightiest thunderstorm, the most turbulent hurricane, the most severe winter blizzard – these events cannot harm the sky. No matter how bad the weather, the sky always has room for it, and eventually the weather changes.

Sometimes we forget the sky is there or we can’t see it because it’s obscured by clouds – but it’s still there. If we rise high enough above these clouds, no matter how thick or dark they may be, we’ll reach clear sky, stretching in all directions, boundless and pure. With practice, you can learn to access this part of you: a safe space inside you from which to notice and make room for difficult thoughts and feelings.

Values

Imagine your eightieth birthday

Imagine it’s your eightieth birthday (or twenty-first, fiftieth, or retirement party.) Three people who matter to you make speeches about what you stand for, what you mean to them, and the role you played in their life. In an IDEAL world, where you have lived your life as the person you want to be, what would you hear them saying? Reflect on what this tells you about what matters to you, what you want to stand for, and what sort of person you want to be. What feelings showed up for you? Did you make room for them or struggle against them?

Exploring your pain

Consider your painful thoughts, feelings, and experiences from the following perspectives:

Pain as your ally: What does this pain tell you about what really matters, what you truly care about?
Pain as your teacher: How can this pain help you to grow, learn, or develop new skills and strengths? How can you use it to help you better relate to others?
From worrying to caring: What do your fears, worries, and anxieties show you that you care about? What do they remind you is very important?

Committed Action

Setting values-based goals

When it comes to setting goals, make sure you set a SMART goal:

Specific: Specify the actions you will take. Consider when and where you will do so, and who or what is involved.

Meaningful: Is your goal driven by following a rigid rule, trying to please others, or trying to avoid pain or discomfort? If it lacks a sense of meaning and purpose, check in to see if it’s really guided by your values.

Adaptive: Does your goal help lead you in a direction that is likely to improve, enrich, or enhance your quality of life?

Realistic: Your goal should be realistically achievable. Consider your health, competing demands on your time, financial status, and skills required to achieve it.

Time-framed: To increase the specificity of your goal, set a day, date, and time for it, or as accurate a time frame as you possibly can.

So there you have it! That’s ACT, in a nutshell. What most resonates with you about this approach? How do you see it fitting into your journey? Whether you struggle with anxiety, depression, or are simply looking to gain clarity around your direction and values, I encourage you to try out some of the strategies discussed above and adapt them to fit your own needs and lifestyle. I hope this introduction gives you a glimpse of how ACT can help you pursue a rich and meaningful life no matter the challenges that may come your way.

Meet the Author : Emily Rose Barr, LGPC

Emily specializes in working with women struggling with depression, anxiety, life transitions, low self-esteem, social anxiety, and healthy identity formation. Her approach draws from ACT, CBT, mindfulness-based, and person-centered theories, with an emphasis on enabling each of her clients to feel empowered by their strengths instead of weighed down by feelings of inadequacy. Her favorite part of ACT is helping clients discover what matters to them and experiment with new ways of integrating their values into daily living.

Emily is also a freelance writer and publishes a monthly wellness and self-care column for Baltimore STYLE Magazine. Outside of the office, she can be found satisfying her sweet tooth, listening to audiobooks and podcasts, chasing that runner’s high, and swooning over her adorable pup, Lyla. Emily is currently accepting new clients on Monday mornings and Saturday afternoons and evenings in the Mount Washington office.

Acceptance and Commitment Therapy for Beginners