ACT is a very active and dynamic approach to therapy…
…it fits into the broad category of behavioural therapies, and involves much more than just ‘sitting and talking’, often including activates for clients to engage in outside their therapy sessions.Since its initial development in the 1980s ACT (pronounced as the word ‘act’ rather than as initials) has established itself as a well-researched* therapy, able to help people with a wide range of difficulties, including anxiety and depression. Western psychology has largely assumed psychological distress to be the result of a deviation from a ‘healthy normality’, and as a result, it has sought to relieve the symptoms of mental ‘illness’.In a radical departure, ACT considers that normal psychological processes can be painful and damaging, and thus lead to distress and suffering. In addition, the attempts to be symptom free often result in deepening this pain and suffering in the long-term. In fact, ACT considers ‘experiential avoidance’ (attempting to avoid unwanted inner experiences) to frequently be the major cause of psychological suffering. A simple example of this can be found in addictions; where the behaviour (taking drugs, gambling, etc.) replaces an unwanted pattern of thoughts and feelings (e.g. feeling unloved or a loser) in a way that works in the short term, but causes more pain and suffering in the longer term. As a result, ACT does not have symptom reduction as a primary goal. But paradoxically, symptom reduction usually occurs through the development of ‘psychological flexibility’ arising through the combination of the six core ACT processes (described below).
As a therapist, I love the flexibility that ACT offers; sessions can be very fluid, moving through any or all of the ACT processes. It’s also very active, with experiential exercises that can often be practiced in-between sessions; in fact most sessions will end with something to take home and work with, or some positive action to take.
ACT seeks to use creative yet practical ways to help you to focus on what you’re doing, engage constructively with the things that matter to you, and take effective action guided by your values. This involves developing psychological skills to cultivate a different relationship with your thoughts and feelings; stopping the struggle with them and ultimately feeling less pushed around by them. In addition, becoming clearer about who you want to be and how you want to behave in the world, i.e. knowing your values, and using them to guide the actions you take; doing what matters to you, changing things for the better and living a meaningful life.
In more technical terms ACT could be described as helping people to develop greater psychological flexibility through three broad processes; being present, opening up and doing what matters. These can be broken down into four mindfulness processes of defusion, acceptance, self-as-context, and contacting the present moment, along with two further processes of engaging with values and committed action in line with those values. Don’t worry if this seems to leave you none the wiser; you don’t have to learn about how ACT works, that’s the therapists job!
*Research studies from around the world have shown ACT to be helpful with a wide range of clinical conditions, either on its own, or as part of a larger treatment program, these conditions include anxiety, depression, OCD, stress, chronic pain, PTSD, anorexia, addictions (to substances such as marijuana and heroin) and schizophrenia. As of 2019 the evidence base includes around 250 randomised controlled trials and about 30 systematic reviews and meta-analyses.
Frequently Asked Questions:
ACT and mindfulness seem to be connected, does that mean I will have to meditate?
The short answer is no. But certain types of meditation practices, known as mindfulness meditations, can be very helpful and effective ways to develop:
- Awareness of where your attention is, and more ability to direct and maintain your attention when you wish to.
- A new relationship with thoughts, feelings and body sensations.
- Increased self-acceptance and self-compassion.
- full contact with the present moment, and many other potential benefits.
Will I have to spend lots of time doing things between sessions? I’d rather just have the weekly sessions and forget about it in between!
There are many variables involved, so it’s not easy to give a definitive answer, however it’s almost guaranteed that engaging with activities or practicing things between sessions will dramatically reduce the number of sessions required to produce similar results. A good analogy would be learning to play a musical instrument; consider how much progress might be made with an hour–a-day of practice as opposed to a single weekly lesson. However, ACT will adapt to the needs of the client, so any between session activities are more in the nature of suggestions, rather than requirements.
Please note that, as with any talking therapy, results may vary from person to person.
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