ACT (Acceptance and Commitment Therapy) represents a significant shift from older therapeutic techniques in treating anxiety disorders. Unlike traditional methods that focus on controlling or reducing anxiety symptoms, ACT aims to change an individual’s relationship with their thoughts and feelings, fostering psychological flexibility and a values-driven life.
Key Differences from Older Therapeutic Techniques
- Focus on Acceptance vs. Control: Older therapies often emphasise controlling or eliminating anxious thoughts and feelings. ACT, however, accepts the ubiquity of human suffering and does not seek to reduce pain or produce a particular positive feeling. It helps clients “relax with their anxiety” rather than “relax away fear and anxiety”.
- Values-Driven Action: Traditional CBT (Cognitive Behavioural Therapy) often targets symptom alleviation, while ACT focuses on broadband outcomes, helping clients move in directions they truly care about. ACT prioritises living fully and consistently with one’s values, even in the presence of anxiety.
- Process-Oriented Approach: ACT is more concerned with the processes that turn normal anxiety into life-shattering problems, rather than merely targeting symptoms. It addresses the agenda of emotion regulation itself, rather than just the emotions.
- De-emphasis on Thought Challenging: While traditional cognitive therapy seeks to identify and challenge maladaptive thoughts, ACT de-emphasises disputation. ACT recognises that challenging thoughts can inadvertently give them more power.
- Experiential Avoidance: ACT identifies experiential avoidance i.e. rigid and inflexible patterns of emotional and experiential avoidance as a core toxic process driving disordered anxiety.
Advantages of ACT for Clients
- Empowerment: ACT empowers clients to reclaim their lives by focusing on what they truly care about, rather than getting caught in a cycle of anxiety management.
- Increased Psychological Flexibility: ACT increases psychological flexibility, which includes being open to present experiences, voluntarily shifting attention, and developing habits aligned with values.
- Longer-Lasting Results: By addressing the underlying processes that maintain anxiety, ACT aims for more sustainable change compared to symptom-focused approaches that may lead to relapse.
- Reduced Struggle: ACT offers relief from the struggle against one’s own mind, enabling individuals to act even when feelings of self-doubt, fear and anxiety are present.
- Unified Approach: ACT provides a unified approach to treating anxiety problems, emphasising emotional acceptance, experiential mindfulness, and actions consistent with client values.
- Addresses a Range of Issues: ACT principles can be applied, with some modification, to several other clinical problems and to those comorbid problems faced by patients.
- Mindfulness as Defusion: ACT uses mindfulness as a cognitive defusion strategy, rather than as an anxiety control strategy.
- Flexibility in Application: ACT is not a set of techniques, but rather an approach to therapy, allowing for great flexibility in how it is used with clients.
Easier Sessions and Reduced Focus on Symptoms
- Less Emphasis on Content: ACT shifts the focus from the content of anxious thoughts to the client’s response to those thoughts. This can make sessions easier, as clients are not required to analyse or dispute their thoughts, but rather observe them with acceptance.
- Experiential Exercises: ACT employs experiential exercises, metaphors, and paradox to help clients make contact with feared thoughts, feelings, and memories. These can be less confrontational than traditional exposure techniques, promoting a sense of safety and willingness.
- Focus on Values: A therapist for anxiety using the ACT approach focuses on values and goals and encourages the client to make value guided commitments.
Anxiety Therapist Adoption of ACT
- Growing Popularity: Acceptance and mindfulness-based approaches are becoming increasingly popular in clinical science and practice.
- Growing Empirical Base: While the empirical base of ACT is growing rapidly, it is still in its infancy compared with well-established CBT for anxiety disorders.
- Integration with Existing Procedures: ACT can be combined with elements of existing procedures for anxiety, such as exposure-based methods.
- ACT is not a technology: A therapist needs to individualise and tweak techniques based on the specific circumstances and responses of each patient and understanding of the core processes involved in maintaining your client’s behaviour.
- New Wave Behaviour Therapies: Newer-generation behaviour therapies, by contrast, tend to focus on domains of human experience that go well beyond symptom alleviation and control as therapeutic goals and emphasize topics such as acceptance, mindfulness, values, spirituality, meaning and purpose, relationships, and quality of life.
Cautions
- Not a Quick Fix: ACT is not about producing quick fixes or using culturally sanctioned feel-good formulas. It requires a commitment to rethinking assumptions about psychopathology and psychotherapy.
- Counterintuitive Nature: The counterintuitive nature of ACT can be an obstacle for both therapists and clients, requiring a shift away from control and symptom-focused approaches.
Summary
ACT for anxiety differs significantly from older therapeutic techniques by focusing on acceptance, values-driven action, and process-oriented approaches. The advantages of ACT for clients include empowerment, increased psychological flexibility, longer-lasting results, and a reduced struggle with their own minds. ACT sessions can be easier due to less emphasis on thought content and the use of experiential exercises. While the adoption of ACT by anxiety therapists is growing, it requires a commitment to rethinking traditional assumptions and an understanding of the counterintuitive nature of the treatment.