What is Acceptance and Commitment Therapy (ACT)?
Acceptance and Commitment Therapy (ACT) is based on a pretty radical idea: maybe the problem isn't that you have anxiety, or that you overthink, or that you're not 'confident enough.' Maybe the problem is that you've spent so much time trying to ‘fix’ these 'problems' that it’s become your main pastime (hello journaling, affirmations, thinking positively, faking it until you… didn’t make it), hoping that you’ll finally feel calm, less frazzled, and like a million bucks, before you can do anything differently.
Instead of trying to get rid of negative thoughts or control your emotions (spoiler alert: that rarely/never works), ACT helps you build a different relationship with your internal experiences. It's about learning to move forward with what really matters to you even when your mind is shouting 'but what if?' - because let's face it, it probably will be (mine definitely is). And that's okay. Because maybe the goal isn't to feel confident all the time, but to do what matters even when you don't.
ACT isn't a 'think positively and everything will be fine' therapy. It's more like a practical guide for dealing with your mind when it's doing... well, what minds do.
You know, like when it wakes you up at 3am to remind you of everything that needs doing from your endless to-do list, so you can finally become like everyone else who has life figured out (I promise you, they don’t!!).
“Having negative thoughts and feelings means I’m a normal human being.”
— Russ Harris
ACT is an evidence-based transdiagnostic therapy model, part of the "third wave" of cognitive behavioural therapy (CBT).
ACT aims to cultivate psychological flexibility - that is, being able to relate to our private experiences (thoughts, beliefs, emotions, memories, physical sensations, urges) in a more helpful way, such that they don’t hold us back from doing the things that really matter to us.
“ACT proposes that the normal thinking processes of a healthy human mind will naturally lead to psychological suffering. You’re not defective – your mind’s just doing its job; the thing it evolved to do.”
— Russ Harris
Dancing around the hexaflex
ACT is often illustrated using this diagram, called the Hexaflex.
At the centre, we find psychological flexibility (the “flex” part) - the ultimate purpose of ACT. To cultivate this, we “dance” around the hexaflex, addressing each of the six processes (the “hexa” part):
Defusion (or unhooking) is about recognising and understanding our thoughts, beliefs, memories, as impermanent mental events - and being able to choose not to engage with them if they’re not helpful
Acceptance is about being able to have, hold, and make space for emotions without being thrown around by them - even if we don’t want them or like them
Be here now (present moment awareness) is about paying attention, on purpose, without judgement, to what is happening in our experience moment by moment
Values are about knowing what matters to us, at our core - what we want our lives to be about, what we want to stand for
Committed action is about doing what it takes to live in line with our values
Self-as-context is about recognising that there’s a part of us that observes our experiences moment by moment - as though these experiences are on a stage, and the observing self is in the audience, watching them
Evidence base - aka this is not BS
ACT has been rigorously studied by scientists, who have found evidence that supports its effectiveness for all sorts of difficulties that people can go through.
As of mid-2023, there are over 440 meta-analyses, systematic reviews, and narrative reviews of the ACT evidence base, and nearly 1,050 ACT randomised controlled trials (RCTs), considered the gold standard level of evidence where treatments or therapies are investigated. Basically, there’s lots of good research out there about it!
A wide range of organisations describe ACT, or areas of ACT, as evidence-based, including:
The World Health Organisation (WHO)
The American Psychological Association (APA)
The UK National Institute for Health and Care Excellence (NICE)
The Australian Psychological Society (APS)
Some conditions or difficulties for which there is a strong ACT evidence base are:
Chronic pain
Depression, mixed anxiety, OCD, stress
If you’re interested in reading more, I suggest the following website, which provides the best overview of the state of ACT research I know of: State of the ACT Evidence - Association for Contextual Behavioural Science (ACBS)
Now, a lot of how we think about mental health is in terms of diagnoses - both when looking for support and in research. This doesn’t always align to how ACT is what we call ‘transdiagnostic’ - that is, you can use it for pretty much any difficulty (because the same difficulties can come up in several diagnoses, or people can have difficulties without there being a specific diagnosis in place).
So, the following people may make the best use of ACT, given its approach, and based on clinical experience:
People who are stuck:
in a life situation – job, relationship, living situation etc. - which millennials often are
in thought processes (rumination, overthinking, worrying)
in avoidance (situations or their own internal experiences)
in "emotional storms" (where emotions are overhwelming)
People who have tried “classic”, 2nd wave CBT where you’re encouraged to challenge how you think and change how you feel, and it didn't “click”.