Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy helps people acknowledge and overcome destructive thoughts and behaviors.

Recovery from an addiction or a mental health condition requires patients to examine the thinking patterns, experiences, actions and habits that have created problems. Acceptance and commitment therapy, or ACT, is designed to help patients see their thoughts and experiences in a less judgmental and more supportive way.

What Is Acceptance and Commitment Therapy?

It has an easy name to remember, and it forms a convenient, fitting acronym. But what is acceptance and commitment therapy? How does ACT work, and why is it effective?

Perhaps the most reliable acceptance and commitment therapy definition comes from its inventor, clinical psychologist Steven Hayes. According to Dr. Hayes, ACT is a psychological intervention that helps patients become more accepting and less judgmental of their thoughts and experiences. This allows patients to develop a more balanced view of themselves.

ACT identifies when patients think or act in a way they consider to be negative, such as avoidant or fearful. By reframing the language of a patient’s experiences, this helps them be less “at war” with the thoughts they have about themselves. Research and academic literature for ACT call these internal experiences “private events.” For example:

Patient: “I know I want to act differently, but I just keep doing the things that I know I shouldn’t do.”

Therapist: “You know you want to change, and you’ve been in a pattern that doesn’t create that change.

Such clients may judge themselves harshly for their thoughts about themselves and their lack of change. According to the principles of acceptance and commitment therapy, a therapist can make a subtle shift when reflecting back a client’s feelings to help the client feel less antagonistic about their negative behavior.

In this case, the therapist replaced “but” (which signals conflict) with “and” (which signals agreement), reframing the rigid tone of the client’s experience with a gentler one. These shifts show clients that they don’t have to change their feelings in order to take action, and they don’t have to fight their feelings to create a healthier life.  

History and Origins of ACT

The history of acceptance and commitment therapy is rooted in the work of the famous psychologist B. F. Skinner, who described “radical behaviorism.” He stated that private events like thoughts and feelings could be analyzed along with more observable, measurable events. He believed these events had “reinforcers” that made an event more or less likely to be repeated in the future.

In the 1980s, Dr. Hayes expanded upon Dr. Skinner’s idea that language can reinforce behaviors. From this, Dr. Hayes developed relational frame theory, which describes how language helps people relate to their world.

Relating to the world through language is a process that begins early in childhood. This process gives us, for example, the words and the ability to describe the way we can relate a bagel to a tire: a bagel has the same shape, a different size, a different color and is edible. The words “same,” “different” or “is/is not” create the relation, and the concepts of shape, size, color and edibility create the frame.

So how does that relate to acceptance and commitment therapy? In the earlier example, the “but” in the client’s statement and the “and” in the therapist’s statement demonstrate a difference in the relationship a client can have with a thought or behavior. Instead of frantically trying to control them, the patient can accept that a thought or behavior may indeed be destructive or harmful. This can allow the patient to be more flexible and commit to positive changes more readily.

Six Core Processes

There are six core principles of ACT that allow patients to develop better flexibility and balance in the way they think about themselves and their behaviors.

1. Acceptance: Rather than fighting against your feelings about distressing experiences, the principle of acceptance asks you to live with those feelings without judging them or judging yourself for having them. This is a similar concept used in mindfulness-based therapies such as dialectical behavioral therapy. With ACT, the act of acceptance is an important step toward creating a more helpful action.
2. Cognitive Defusion: Cognitive defusion has the same goal as a diffusing a bomb. The goal is to deactivate or neutralize the potentially negative impact of a thought. With cognitive defusion, rather than try to stop thinking about a destructive thought (“I’ve got to stop hurting myself like this”), patients try to defuse the power of the thought (“I’m in the thought pattern that makes me feel like I’m creating problems for myself. I can let that thought pass through.”).
3. Being Present: In ACT and other areas of psychotherapy, it is important to learn how to be in touch with and nonjudgmental about what is going on in your body and mind as it is happening. Doing so allows for your behaviors and your values to be in relative harmony.
4. Self as Context: Being present allows a patient to create a healthy detachment from thoughts and experiences and let them flow freely — a person can observe these reactions without affecting their core being. That detachment can help form a more permanent sense of self, creating the idea that “I am not simply what I am thinking, feeling, craving, etc.”
5. Values: What you believe, honor, stand for and commit to has a major impact on your actions and experience. In ACT, you may be asked if you are willing to tolerate uncomfortable feelings if they help you live up to your values. If so, your therapist will work with you to help you keep your values and actions in closer alignment.
6. Committed Action: In the final step of ACT, patients use their values to guide them in setting goals and taking active steps toward meeting those goals.

Acceptance and Commitment Therapy in Addiction and Mental Health Treatment

The use of acceptance and commitment therapy for addiction treatment can be extremely restorative. Likewise, the use of acceptance and commitment therapy for mental health conditions can relieve long-held suffering and psychological pain.

Among other benefits, ACT helps patients to:

• Develop mindful, nonjudgmental relationships with their thoughts and experiences.
• Feel less trapped by their own thoughts.
• Learn how to be present with their current thoughts and feelings rather than excessively worry about the past or future.
• Understand what their values are.
• Set meaningful goals to help them act on their values.
• Identify discrepancies between their value systems and their behaviors.

By guiding you to evaluate and forge new relationships with your thoughts, ACT can help you make sure that your behavior and your values are in line with each other.

If you feel overwhelmed with worry or consumed with nagging thoughts as a result of addiction or a substance use disorder, The Recovery Village can help. Our experienced therapists can help you be more at peace with your thoughts and increase patience, self-awareness and discipline. As you begin understanding and adhering to your core principles, The Recovery Village can help you live in a way that matches your values. Call today.

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Kevin Wandler, MD

Kevin Wandler holds multiple positions at Advanced Recovery Systems. In addition to being the founding and chief medical director at Advanced Recovery Systems, he is also the medical director at The Recovery Village Ridgefield and at The Recovery Village Palmer Lake. Read more