Acceptance and Commitment Therapy (ACT) is an approach that views human suffering, including problems associated with anxiety, as stemming from normal psychological processes rather than seeing them as diseases. Instead of trying to eliminate or control anxiety, ACT focuses on changing how one relates to difficult internal experiences and taking action towards living a life based on personal values.
The Foundations of ACT for Anxiety
Acceptance and Commitment Therapy for anxiety is a process-based approach. This means it targets the underlying processes that can turn normal anxiety into life-limiting problems. It is not simply a collection of techniques, but an approach to understanding and treating challenges. The central idea is that struggling against unwanted internal experiences can make things worse, and a different path involves willingness and acceptance.
ACT involves several core, interconnected processes:
Acceptance
Acceptance, in the context of ACT, is about learning to willingly experience difficult thoughts, feelings, memories, and physical sensations rather than fighting against them or trying to make them go away. This is a core component, as control efforts applied to unwanted internal experiences are seen as often unworkable and even counterproductive in the long run. Trying harder to control internal states can actually make the anxiety and the client’s life worse.
Acceptance does not mean liking or wanting the anxiety, nor does it mean resignation. It is a choice to experience what is already present. This willingness is the opposite of control. Experiential exercises, like the “Acceptance of Anxiety” exercise, are used to help clients practise making space for these experiences. Metaphors, such as the “feeding-the-anxiety-tiger” metaphor, illustrate how attempts to appease or manage anxiety by giving in to avoidance and escape behaviours can lead to increasing loss of resources and life space.
Mindfulness
Within ACT, mindfulness refers to paying attention in the present moment without judgment. It’s a specific type of meditation focusing on present awareness. Clients are encouraged to observe their anxiety-related thoughts, feelings, and bodily sensations as they are, without evaluation or attempting to change them. This is different from using mindfulness as a control strategy to feel better. The goal is to create space for experiences and open up a different way of relating to anxiety.
Cognitive Defusion
This process involves learning to step back from thoughts and see them as just thoughts, rather than literal truths or commands that must be followed. It’s about changing one’s relationship with thoughts, not changing the thoughts themselves. Unworkable strategies clients often use include arguing with thoughts or trying to talk themselves out of anxiety. ACT encourages observing thoughts without getting entangled in their content. Shifting from focusing on the content of thoughts to the process of thinking itself is a key skill.
Values
Identifying and clarifying personal values is a central part of ACT. Values are chosen life directions – what is important to a person and what they want their life to stand for. They provide an alternative agenda to the endless struggle of managing anxiety. Values are distinct from goals; goals can be achieved, while values are ongoing directions. Clarifying values helps clients understand what truly matters to them beyond their anxiety.
Committed Action
ACT encourages clients to take action that is consistent with their chosen values, even in the presence of anxiety or other difficult internal experiences. This involves setting goals based on values and taking specific, measurable steps. Exposure exercises, traditionally used in cognitive behavioural therapies for anxiety reduction, are often reframed within ACT to be in the service of moving towards valued life goals, rather than solely focused on reducing anxiety levels. Progress is measured by living a richer, more meaningful life, not necessarily by anxiety reduction.
Applying ACT to Anxiety
ACT for anxiety involves helping clients understand how their past attempts to control or avoid anxiety have been unworkable and have often led to their problems persisting. The approach is active and experiential, guiding clients to directly experience their fears, worries, and anxiety differently. Therapists adopting an ACT approach aim to create a context of acceptance and willingness. They work collaboratively with the client, helping them discover what works for them. The focus is on building a more flexible repertoire of behaviours when experiencing anxiety, allowing clients to pursue a life they value.
ACT is considered a transdiagnostic approach, meaning its principles can be applied across various challenges. It shares principles with other therapies like Cognitive Behavioural Therapy (CBT) variants and Dialectical Behaviour Therapy (DBT), particularly in encouraging behavioural change. However, its emphasis on acceptance and changing the relationship with internal experiences sets it apart from traditional approaches primarily focused on disputing or changing thought content or reducing symptoms as the primary goal.
Summary:
Acceptance and Commitment Therapy (ACT) for anxiety is a process-based approach that helps individuals live a full and meaningful life while learning to coexist with anxiety. It does not view anxiety as a disease but as a normal human experience that can become problematic when one attempts to control or avoid it excessively. Key principles include acceptance (willingness to experience difficult thoughts and feelings without struggle), mindfulness (paying attention to the present moment nonjudgmentally), cognitive defusion (changing one’s relationship with thoughts), clarifying personal values (chosen life directions), and taking committed action (steps towards values, even with anxiety). The goal is not necessarily anxiety reduction itself, but building psychological flexibility to engage in a rich and meaningful life, guided by values.