Acceptance and Commitment Therapy

Dr. David L. Kupfer, Ph.D.

Based on the work of psychologist Steven Hayes, Acceptance and Commitment Therapy (ACT) is an adaptation of Cognitive Behavioral Therapy (CBT) that fits well with the Serenity prayer; it helps people accept what they cannot control, control what they can, and develop the wisdom to know the difference. While CBT aims to help people control and change their thoughts, ACT guides them to accept and embrace even their negative thoughts. In ACT, people learn skills to control their behavior so that they can live meaningful lives consistent with their deepest values.

Hayes rejects the “control agenda” that has led many people to feel that if they could just control their internal thoughts and feelings, then they could overcome the symptoms that render them abnormal or sick. In his view, good therapy begins by accepting negative thoughts and feelings as normal. Symptoms of anxiety and depression are also normal, inevitable, and tolerable. In contrast to the CBT goal of “feeling BETTER”, ACT aims to help clients “FEEL better.” In other words, clients are taught to accept sad feelings and embrace a life enriched by experiencing a wide spectrum of normal emotions.

In ACT, clients learn to accept and deal with unpleasant internal thoughts and feelings. Experiential avoidance, the misguided attempt to distract yourself or get away from scary or depressing experiences, is seen as the core problem. The solution is learning a willingness to deal with the pain of presence, the pain or anxiety that naturally occurs when you life a full life. Hayes sees too many of us suffering from the pain of absence, the emptiness felt when you have over-utilized avoidance and escape to deal with normal life problems.

Clients in ACT learn the difference between thoughts and reality. Thoughts are seen as natural mental events that are not necessarily “THE TRUTH.” Clients learn to observe their thoughts with interest, but also see that they do not have to base their life choices on their thoughts. With the “Cognitive Defusion “ technique, clients learn specific methods of noticing their thoughts without getting anxious or depressed by them. This might involve watching their thoughts pass by as if they were leaves floating down a stream. Cognitive Defusion is different from the Cognitive Restructuring method in CBT. In CBT, clients learn to change the content of their thoughts in order to change their mood. In ACT, they learn that they can allow their thought to contain inevitable negative content; they just don’t have to become anxious or depressed because of these thoughts. They learn a detached skepticism about their thoughts, shifting from “I CAN’T go to the mall because I will panic and pass out” to “I am having the thought that I will panic if I go to the mall.”