ACT for anxiety

Acceptance and Commitment Therapy, or ACT, is an approach to understanding and treating anxiety that focuses on changing your relationship with internal experiences like thoughts, feelings, and sensations, rather than trying to control or eliminate them. It is pronounced as one word, like the verb “act”, which highlights the importance of taking action.

ACT for anxiety is not primarily about getting rid of anxiety. Instead, the goal is to help you create a life worth living, even when anxiety is present. This involves undermining unworkable emotion regulation efforts like control, suppression, avoidance, and escape, which are seen as contributing to and perpetuating anxiety problems.

ACT for anxiety views excessive control efforts as having an insidious side effect: they can actually make anxiety and your life worse. When you are unwilling to experience anxiety, it cannot turn into “sweet butter”. Many individuals struggling with anxiety disorders engage in rigid and inflexible avoidance patterns, which exacerbate their problems regardless of the specific diagnosis. ACT for anxiety encourages clients to take a hard look at their lives and identify their values, committing to put those values into freely chosen action. This focus on living a valued life, even in the face of anxiety, is a central tenet of ACT for anxiety.

The core processes of ACT for anxiety are designed to increase psychological flexibility and experiential willingness. These processes are not just techniques but are based on underlying principles and a conceptual framework.

Key Processes of ACT for Anxiety:

• Acceptance: This involves being open and willing to experience emotions, sensations, or thoughts, including anxiety. It means making a choice to experience what is there to be experienced without trying to change it. Acceptance is not about liking anxiety or seeing it as a “clever fix” to reduce it; it is about experiencing it fully. This is often framed as developing willingness to have anxiety and fear.
• Cognitive Defusion: This process aims to loosen the hold that thoughts, particularly verbally derived constructions and evaluations, have over behaviour. Mindfulness exercises in ACT for anxiety function as defusion strategies, helping you make contact with experience as it is, without getting caught up in evaluative language or verbal rules. The goal is to observe thoughts and feelings without getting involved in trying to change them. This questions the dominance of language and rules, especially when they are not working for you.
• Contacting the Present Moment / Mindfulness: This involves paying attention to your experience in the present moment. Mindfulness in ACT for anxiety is a specific type of meditation that focuses on present moment attention. It is not intended as a relaxation or anxiety control strategy. The aim is to foster the ability to pay attention in the present, helping clients wake up to their own experiences.
• The Observing Self: This refers to the perspective from which you can notice your thoughts, feelings, and sensations without being identified with them. It is the part of you that is aware of your experiences.
• Values: Identifying and clarifying what is most important in your life is a crucial component of ACT for anxiety. Values provide a sense of purpose and meaning, which is necessary for clients to engage in the difficult work of therapy. They act as a guide for behaviour, rather than letting anxiety dictate actions. ACT for anxiety helps clients become clearer about personal values and commit to action consistent with them.
• Committed Action: This involves taking action towards what matters to you, guided by your values. This action is taken even when anxiety is present. Committed action predicts future drops in suffering. It is an all-or-nothing action; you either do it or you don’t.

These processes are considered more beneficial than simply targeting symptom reduction because they address the underlying processes that turn normal anxiety into disordered, life-shattering problems. ACT for anxiety aims to help clients live fully and richly, even with anxiety, rather than focusing solely on alleviating the disorder. It questions the control agenda, showing how efforts to control anxiety have often backfired and restricted clients’ lives.

How Clients Can Better Use ACT for Anxiety as a Self-Help Tool:

ACT for anxiety is often presented in workbook formats designed for clients to work through on their own or with a therapist. For self-help, it is recommended to first understand the underlying framework and rationale, not just jump directly to techniques. The approach itself is as important as the technology.

Clients can use self-help ACT for anxiety resources to:

• Understand what anxiety is and how it can become problematic.
• Analyse past strategies used to cope with anxiety and evaluate their workability and costs. This helps build “creative hopelessness” regarding control efforts.
• Identify and clarify personal values. Exercises like the Valued Directions worksheet or creating a Life Compass can help.
• Learn techniques for cognitive defusion and acceptance, such as mindful attention to thoughts and feelings. Specific exercises like Acceptance of Thoughts and Feelings or the Acceptance of Anxiety exercise can be practised daily.
• Practise contacting the present moment through mindfulness exercises.
• Engage in committed action steps aligned with values, even when experiencing anxiety. This often involves exposure-like exercises reframed as taking action towards a valued life, sometimes called FEEL (Feeling Experiences Enriches Living) exercises.
• Monitor experiences and progress using tools like the Living in Full Experience (LIFE) form or Daily ACT Ratings.
• Use techniques like Conscious Questioning to work skillfully with situational anxiety by identifying tasks and organising concerns.
• Understand that taking action despite anxiety is key to transforming the experience and rewiring the brain. Willingness is a choice and a commitment that requires action.
• Identify protective factors and coping skills they can rely on.

Consistency and willingness to practise the skills are important for clients using ACT for anxiety as a self-help tool. While anxiety reduction may occur as a byproduct of living a valued life and engaging in feared activities, it is not the explicit focus or a prerequisite for living fully.

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Summary: ACT for anxiety is an approach focused on changing your relationship with anxiety rather than trying to control or eliminate it. It posits that control efforts often exacerbate the problem. The goal is to help clients live a rich and meaningful life aligned with their values, even when anxiety is present. This is achieved through core processes: Acceptance (willingness to experience anxiety), Cognitive Defusion (changing the relationship with thoughts), Contacting the Present Moment (mindfulness), The Observing Self (perspective taking), Values (clarifying what matters), and Committed Action (taking steps towards values despite anxiety). These processes are seen as more beneficial than symptom control because they target underlying issues and foster psychological flexibility. Clients can use ACT for anxiety as a self-help tool by working through principles and exercises presented in workbooks, focusing on understanding the rationale, practising the core skills, identifying values, and taking committed action, using tools like monitoring forms and specific exercises like Conscious Questioning and FEEL exercises. The emphasis is on taking action with anxiety towards a valued life.