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Running away from any problem only increases the distance from the solution. The easiest way to escape from the problem is to solve it.
At first glance, Acceptance and Commitment Therapy (ACT) may seem confusing. How does acceptance and commitment therapy paired with mindfulness-based therapy form an effective treatment? If you are aiming to be more accepting of your thoughts and feelings, how does commitment play a role?
What are you committing to?
Acceptance and Commitment Therapy, as well as Mindfulness-Based Cognitive Therapy, are used often in the medical community and by psychotherapists to help clients become more aware of their lives and their circumstances so they can better learn how to react to these circumstances.
Both have been found to be helpful in treating medical conditions such as anxiety, depression, and OCD, and even addictions and substance abuse. Mindfulness-Based Cognitive Therapy (MBCT) combines cognitive behavioral therapy and mindfulness therapy.
However, ACT promotes the development of greater psychological flexibility and is a form of behavioral therapy that combines these mindfulness skills with the practice of acceptance.
In the case of ACT, you are committing to facing the problem head-on. Instead of avoiding your problems, you commit to actions that will help you stop struggling against the inevitable and facilitate thriving instead.
As you will see later in this piece, ACT is effective for a wide range of psychological disorders, but it is also effective as a life-affirming and inspirational perspective on the world.
What if you could accept and allow yourself to feel what you feel, even if it’s negative? What would happen if you let yourself experience it all, instead of focusing all your effort on evading any potentially difficult problems?
ACT can show you exactly what happens, and how you can harness the power of acceptance to get the life you want.
This article contains:
- What is Acceptance and Commitment Therapy (ACT)? Definitions and Core Processes
- Steven C. Hayes and ACT
- The Role of ACT in Psychology and Mindfulness
- 10 Worksheets, PDF’s, Workbooks, PPT’s and More ACT Resources
- 7 Useful ACT Exercises, Techniques and Metaphors
- 8 ACT Training, Courses, and Workshops
- 4 Acceptance Therapy Books (+ ACT for Dummies)
- ACT for Treating Disorders
- Applying ACT in Group Therapy
- 4 Best YouTube Videos
- ACT Apps That Can Help
- A Take Home Message
What is Acceptance and Commitment Therapy (ACT)? Definitions and Core Processes
The website www.actmindfully.com.au explains ACT in simple terms: it is a type of therapy that aims to help patients accept what is out of their control and commit to actions that can improve and enrich their lives (Harris, 2013).
According to the Association for Contextual Behavioral Science, ACT is:
“a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.”
The ACBS views ACT as a therapy based on the idea that suffering is a natural and inevitable condition for humans, a result of the interface between human language and cognition, and the instinct to control our experiences.
The founder of ACT has also offered a definition of ACT in terms familiar to the psychology field:
“a psychological intervention based on modern behavioral psychology, including Relational Frame Theory, that applies mindfulness and acceptance processes, and commitment and behavior change processes, to the creation of psychological flexibility” (Hayes, “The Six Core Processes of ACT”).
To put it in less clinical terms and make it a bit easier to understand, Dr. Russell Harris (2011) has defined ACT as “a mindfulness-based behavioral therapy that challenges the ground rules of most Western psychology” with the goal of helping patients create a rich and meaningful life and develop mindfulness skills, even with the existence of pain and suffering.
Six core processes of ACT guide patients through therapy and provide a framework for developing psychological flexibility (Harris, 2011). These six core processes of ACT include the following:
- Cognitive Defusion
- Being Present
- Self as Context
- Committed Action
Acceptance is one process that should be familiar to any readers who have been following our posts on mindfulness. In this case, acceptance is an alternative to the instinct to avoid negative, or potentially negative, experiences. It is the active choice to be aware of and allow these types of experiences without trying to avoid or change them.
Acceptance is not a goal of ACT, but a method of encouraging action that will lead to positive results.
Cognitive Defusion refers to the defusion techniques that are intended to change how an individual reacts to or interacts with their thoughts and feelings rather than the nature of these thoughts and feelings. Acceptance and Commitment Therapy is not intended to limit our exposure to negative experiences, but to face them and come out the other side with a decreased fixation on these experiences.
Being Present is another familiar concept for practitioners of mindfulness-based therapy. It can be understood as the practice of being aware of the present moment while declining to attach judgment to the experience. In other words, being present involves actively experiencing what is happening without trying to predict, change, or make value judgments about the experience.
Self as Context is a simple idea that an individual is not his or her experiences, thoughts, or emotions. Instead of being one’s experiences, the “self as context” process rests on the idea that there is a self outside of the current experience.
In other words, we are not what happens to us. We are the ones experiencing what happens to us. This idea will be explored in more detail when we get to techniques.
Values in this context are defined as the qualities that we choose to work towards in any given moment. We all hold values, consciously or unconsciously, that direct our steps. In ACT, we apply processes and techniques that help us live our lives according to the values that we hold dear.
Finally, ACT aims to help patients commit to actions that will further their long-term goals and facilitate their attempt to live a life consistent with their values. All of the exercises, techniques, and practices of ACT are intended to assist individuals in reaching their goals through positive behavior changes.
These core processes show that ACT is not all that different from other behavioral-based therapies, but the emphasis on acceptance and allowing instead of avoiding is what separates ACT from many other forms of therapy. This departure from some of the most mainstream treatment regimens can be traced back to the research background of ACT’s founder.
Steven C. Hayes and ACT
Acceptance and Commitment Therapy was developed in 1986 by Steven C. Hayes, a professor in the psychology department at the University of Nevada (Harris, 2011). His work on how language and thought influence our internal experiences laid the foundation for ACT.
Hayes did not agree with the prevalent idea in mainstream psychology that suffering and pain are to be avoided, minimized, and buffered whenever possible. He saw suffering as an inevitable and essential part of being human, and his work on language and thought informed his belief that accepting this suffering is a more effective method to build a meaningful and fulfilling life than running from it.
To see Steven Hayes make the case for acceptance and self-compassion based on his own experiences with pain, check out his TED Talk “Psychological flexibility: How love turns pain into purpose.”
The Role of ACT in Psychology and Mindfulness
Acceptance and Commitment Therapy is built on the Relational Frame Theory, a theory that is well supported by psychological research. This theory is based on the idea that the human ability of “relating” is the foundation of language and cognition. This idea of relating is similar to associating but goes further in that relating involves noting the dimensions along which relation exists.
For example, we may associate an apple with an orange, but our ability of relating allows us to understand that they have a similar shape (round) and function (to be eaten) but have different colors and textures.
Humans, unlike most other animals, have an uncanny ability to relate even neutral events no matter what the order is, as well as seemingly unrelated words and ideas. While this is an advantageous ability, it can also facilitate negative thoughts and judgment about ourselves. If we can relate the word “cookie” to the experience of eating a cookie, then we can also relate the word “worthless” to how we feel about ourselves.
Our quite useful ability to form relational networks (e.g., I relate the words “orange”, “apple”, and “pear” to the concept of “fruit”) can be a destructive ability when it comes to anxiety or depression (e.g., I relate “worthless” to my ability to perform my job and, by extension, I can relate the word “worthless” to my life).
In this way, ACT is built on Relational Frame Theory. We often form relational networks that are not complimentary or life-giving, but we can also change those relations that we find problematic. We can apply mindfulness to accept our feelings and change how we react and relate to them instead of trying to avoid them.
10 Worksheets, PDF’s, Workbooks, PPT’s and More ACT Resources
Are you ready to jump in and learn about how to use ACT to improve your life or the life of your clients? If so, read on for some excellent resources to help you apply the science of Acceptance and Commitment Therapy!
Once again, ACT Mindfully provides tons of resources that can help you practice ACT techniques in your life or assist a client in practicing ACT techniques.
Getting Unstuck in ACT Worksheets
Follow this link for a PDF that includes several worksheets and lots of information on how to guide a client through them.
Triggers, Behaviors, and Payoffs (page 7)
One worksheet you’ll find here is a fillable matrix on page 6 with one column for writing down triggers (situations, thoughts, or feeling that immediately precede a certain behavior), behaviors (what you actually do), and payoffs (the immediate outcomes of the behavior that encourage the behavior to continue).
This worksheet can help you or your clients associate self-defeating behaviors with the motivation behind them, which can be a first step to identifying and modifying problematic behavior.
Bull’s Eye: Clarifying Your Values (page 9
Another worksheet presents the values bull’s eye, a set of concentric circles separated into four quadrants: work/education, leisure, personal growth/health, and relationships.
The exercise involves placing an “X” on the circle that most closely represents how you feel in the present moment.
The closer to the middle the X is, the more you feel you are behaving like the person you want to be. The further out the X is, the less you feel like the person you want to be. This worksheet can be found in the PDF above on page 11 or individually here.
The ‘Triflex’ Psychological Flexibility Assessment Tool (pages 14-15)
The final pages in the PDF from ACT Mindfully provides a way to estimate your current psychological flexibility based on three factors:
- Ability to open up
- Ability to be present
- Ability to do what matters
Here you will find a visual representation of psychological flexibility, an explanation of each of these three factors, and a method of estimating your abilities in these areas at this moment.
“The Happiness Trap” Worksheets
The Cost of Avoidance Worksheet (pages 4-5)
This worksheet present four sentences for you to complete:
- The thoughts I’d most like to get rid of are:
- The feelings I’d most like to get rid of are:
- The sensations I’d most like to get rid of are:
- The memories I’d most like to get rid of are:
Next, you are asked to write a list of everything you have done to try to avoid or get rid of these thoughts, feelings, sensations, and memories, including distractions; avoiding activities, places, or people; thinking strategies, and substances.
Finally, you are instructed to ask yourself these questions for each item:
- Did this get rid of my painful thoughts and feelings in the long term?
- Did it bring me closer to a rich, full, and meaningful life?
- If the answer to question 2 is “no”, then what did this cost me in terms of time, energy, money, health, relationships, and vitality?
This worksheet can help you learn about your own avoidance strategies and whether they are producing the results you want.
Informal Mindfulness Exercises (page 9)
This page introduces two simple mindfulness exercises you can try in a typical day:
- Mindfulness in Your Morning Routine: an exercise encouraging you to take notice of the sensations you experience when getting ready in the morning, such as the taste of your toothpaste, the smell of your face wash, or the feel of hot water on your body in the shower.
- Mindfulness of Domestic Chores: another exercise that you can practice by being aware of the sensations you experience as you sweep the floors, do a load of laundry, or make dinner.
This worksheet allows space for you to imagine some informal mindfulness exercises of your own, such as while waiting in traffic or while walking from your car to your door.
Values Assessment Rating Form (page 12)
The Values Assessment Rating Form provides a matrix with ten life domains (e.g., couples/intimate relationships, parenting, employment, etc.) and four columns to fill out:
- Valued direction (a brief summary of your goal for each domain)
- Importance of this value in your life
- Success in living this value
- Rank in order of importance you place on working on this domain right now
The Values Assessment Rating Form can help you identify where you are falling short of your goals and where you are meeting your goals, as well aiding the prioritization of meeting these goals going forward.
Goal Setting Worksheet (page 16)
This worksheet guides the reader through the values that underlie their goals, their immediate, short-term, and long-term goals, and how to make sure these goals are SMART goals. SMART goals are goals that are Specific, Meaningful, Adaptive, Realistic, and Time-bound.
This activity will help you understand how to set useful goals and identify which goals are important to you at this point in your life.
What To Do in a Crisis (page 20)
This informational page lays out a practical and useful response you can choose when you face a crisis.
This response is called STOP:
- Slow your breathing, and enter into a quick and simple mindfulness practice.
- Take note, by noticing what you are experiencing in the present moment.
- Open up, and allow yourself to feel without judgment or avoidance.
- Pursue your values, by deciding what the best course of action is based on your most important values.
Below the description of this response is a list of things to consider:
- Consider if you need assistance or support, and who could provide you with the assistance or support you need.
- Think about whether you have experienced anything similar before, and how you responded to it then.
- Consider ways to improve the situation, even in the smallest and simplest way, whether it’s in the next few minutes or the next few days.
- Be willing to practice acceptance if you cannot improve your situation, and commit to spending your time and energy in a constructive way.
- Ask yourself what the best way is to deal with this situation or, as the metaphor goes, how to play the game with the cards you have been dealt.
- Remember to practice self-compassion; if you need inspiration, imagine a friend or loved one was going through your experience right now, and tell yourself whatever you imagine telling them.
For therapists or other mental health professionals who wish to guide their clients through ACT practices, this PDF from The HappinessTrap may be a useful resource. It provides questions to ask your client(s) to assess their psychological Inflexibility or the extent to which they have trouble practicing the six core processes.
The questions map to the opposite of the six core processes as follows:
- The dominance of the conceptualized past or future; limited self-knowledge (vs. acceptance)
- Fusion (vs. defusion)
- Experiential avoidance (vs. being present)
- Attachment to the conceptualized self (vs. self as context)
- Lack of values clarity/contact (vs. values)
- Unworkable action (vs. committed action)
This set of questions can be a great tool to help your client(s) figure out where they can focus their energy in order to embrace their experiences and live their lives according to their values.
Applying Mindfulness to Your Therapeutic Practice
If you’re looking for a more visual resource for learning how to apply ACT in your practice, check out this slide presentation on acceptance and mindfulness as therapeutic tools.
This presentation includes information on how mindfulness and acceptance can benefit people who are struggling, the theories behind how it works, and suggestions for therapists who wish to introduce their clients to mindfulness.
7 Useful ACT Exercises, Techniques, and Metaphors
The section above includes some worksheets and workbooks that include several Acceptance and Commitment Therapy exercises, but we’ll describe some of the most popular exercises, techniques, and metaphors in more detail here.
For each exercise or metaphor, a link will be provided to the exercise for you to learn more.
ACT Exercises and Techniques
Writing Acceptance Exercise by Matthieu Villatte
This is a quick and easy exercise for therapists and other mental health professionals to help their clients understand why avoidance is often counterproductive. This exercise can be completed in the following steps:
- Give your client a sheet of paper and a pen and inform them that you are going to instruct them to write a sentence
- Before the client can write anything, the therapist introduces an obstacle that obstructs their ability to see the paper and pen (e.g., a piece of cardboard, a mask with severely limited vision, etc)
- Ask the client if this bothers them and if they’d rather be able to see as they write. Inform them that the obstacle will stay, but they should still attempt to work around the obstacle in order to write the sentence
- Let them struggle with seeing around the obstacle for 20 to 30 seconds. They probably will not have written anything readable at this point
- Ask the client about their experience (i.e., “How was it? Was it difficult? Were you able to write the sentence? Can we read it?”)
- Propose that the client stop trying to see around the obstacle, but just accept that it is there and write the sentence anyway
- The sentence they write when focusing on writing instead of avoiding will likely be readable. Point this out to them and help them make the connection between avoiding the physical obstacle and avoiding emotional pain, and the negative consequences of each
You can find this exercise in more detail here.
Two Sides of the Same Coin by Jenna LeJeune
This exercise can be guided by a therapist or completed on your own. Following these steps should help you or your client understand that suffering is an inevitable part of life, and if we eradicated suffering, we would also eliminate joy.
Follow these steps to give this exercise a try:
- Find an activity or relationship that you find deeply valuable, but that you may be pulling away from
- Take out an index card or piece of paper. On one side, write down what you value about that activity or relationship or what you hope to achieve or become through it
- On the other side, write down the difficult thoughts and feelings that may come up when you take action towards gaining the value or achievements written on the other side
- Put the card in your pocket, wallet, or purse. Over the next week, take it out, look at both sides, and ask yourself if you are willing to have that card, with both the good and bad. You can either avoid both the value and the pain, or you can embrace them both
Mindfulness of Emotions by Carol Vivyan
This is a mindfulness technique you can use to defuse a strong, negative emotion. Follow the steps below to renew your focus on acceptance and positive action toward your values:
- Sit comfortably in a quiet area and bring your attention to your breath, feeling the sensations of breathing without trying to manipulate your breath
- Notice the emotion(s) you are feeling, and what it feels like
- Name the emotion. Identify what it is, what word best describes how you are feeling
- Accept the emotion as a natural and normal reaction to the circumstances. Don’t condone it or judge it, just let it move through you
- Investigate the emotion by asking questions like:
1) How intensely am I feeling this emotion?
2) Has my breathing changed?
3) What are the accompanying sensations in my body?
4) How is my posture? Am I experiencing increased tension in my muscles?
5) What is my facial expression at this moment? How does my face feel?
- Notice the thoughts or judgments that arise, but let them pass. If you find yourself dwelling on any of them, gently bring your attention back to your breathing to re-center, then visit the emotion again. This technique may produce the best results when starting small and working your way up to the more intense emotions.
To read the entire technique description and try it for yourself, click here.
The Valued Directions Worksheet by John Forsyth and Georg Eifert
This exercise is a great first step for anyone looking to start engaging in ACT techniques. Values, as mentioned earlier, are a foundational piece of Acceptance and Commitment Therapy, so it makes sense to get an idea of your unique set of values early on.
The Valued Directions worksheet presents 10 value domains for the reader to consider:
- Intimate relationships
- Education/learning/personal growth
- Friends/social life
- Health/physical self-care
- Family of origin (relationships other than marriage or parenting)
- Spirituality Community life/environment/nature
The exercise then instructs the reader to rate the importance of each value domain on a scale of 0 (not at all important) to 2 (very important), noting that there is nothing wrong with valuing some areas more than others.
Next, readers rate their satisfaction with their lives in each area on a scale of 0 (not at all satisfied) to 2 (very satisfied).
Once the ratings have been completed, the exercise instructs readers to go back to any value rated as a 1 or 2 on the importance scale and write down their intentions for the foreseeable future.
In other words, write down what you want to achieve, maintain, or become in each important value area. These are not goals that can be completed and checked off the list but describe how you want to live your life each day.
This exercise can help you clarify what is important to you and what you need to prioritize in your life to become the person you want to be. It’s best if you have a therapist or other qualified professional to discuss the results of this exercise with, but it can be enlightening and inspiring whether you are currently attending therapy or not.
To give this exercise a try, follow this link.
For more ACT exercises, check out the exercises, techniques, and worksheets on the following sites:
Metaphors play a big role in Acceptance and Commitment Therapy, as they provide clients with a simple way to understand how their feelings and thoughts influence their actions, allowing them to see how adjusting the way they think can result in extremely positive outcomes.
The Sailing Boat Metaphor
This metaphor uses the setting of a small sailing boat with you as the sailor. Occasionally, waves send water over the side and into the boat, causing you the inconvenience of wet feet. The boat includes a bailer to bail out this water, and you know how to use it.
So, one day when a particularly big wave breaks over the side and leaves water in your boat, you start bailing. You may start bailing calmly or mindfully, but eventually, you might find yourself bailing desperately or wildly to get rid of all this water.
While you’ve been bailing, have you noticed what is happening to your boat? Where is it headed? Where has it drifted to? Would it be fair to say you’ve been bailing more than sailing?
Now imagine that you take a look at the bailer and see that it is really a sieve, full of holes? What would you do?
The implicit promise of bailing is that you can get your boat back on track once you rid the boat of the water, but if your tool is not suited to the task, you will find yourself struggling to meet this goal.
The real question in this metaphor is whether you would rather be on a boat that has only a little water in the bottom but is drifting without direction, or on a boat that may have quite a bit of water in the bottom but is heading in the direction you wish to go.
This metaphor can help you or your clients realize two things:
1) The techniques we use to deal with our problematic thoughts and feelings are tools like the bailer and the sieve, and some are better than others.
2) Sometimes working desperately to avoid wet feet (or other painful or uncomfortable feelings) gets us so off-track the life we want to live that wet feet are the least of our problems.
To read this metaphor in its entirety, see this link.
The Mind Bully
This metaphor is specifically meant for people struggling with a particular emotion or diagnosis, like anger, anxiety, or depression.
In this metaphor, the mind bully is our particular problem, and it is an extremely large and strong bully. We are on opposite sides of a pit, tugging back and forth on a rope as the Mind Bully tries to make us fall into the pit.
When we pull on the rope, when we listen and pay attention to or even believe the monster, we are actually feeding it. Like any petty bully, the Mind Bully can only harm us if we engage with it or believe the negative things it says.
Instead of pulling on the rope, what do you think would happen if we drop it?
If we let go of the rope, the Mind Bully will still be there, hurling its insults and meanness, but it would no longer be able to pull us towards the pit. The less that we feed the Mind Bully, the smaller and quieter it will get.
In dealing with difficult problems like anxiety or depression, we stop feeding the Mind Bully by noticing and acknowledging it but shifting our attention away from it instead of believing what it says. Engaging in a quick mindfulness exercise can be a great way to do this.
To learn more about the Mind Bully metaphor and read the alternate version of this metaphor, visit this website.
The Quicksand Metaphor
Quicksand is a loose, wet patch of sand that cannot support weight like dry sand can. When you step in quicksand, you start to sink instead of finding a solid footing.
As you probably already know, common knowledge is that struggling against quicksand only increases the rate at which it sucks you down into its depths. When you put more weight on one foot to try to lift the other, it just sinks deeper into the pit. The more you struggle, the deeper you sink!
The solution to surviving quicksand is to spread your body weight over a large surface area.
Instead of trying to stand and fight the quicksand, ignore your instincts to struggle and lie down on your back instead.
It’s counterintuitive, but the less you struggle and the more you accept your present situation, the easier it is to escape.
This same principle applies to the pain and suffering that is an inevitable part of being human. The more we struggle and fight against it, the more we drag ourselves down.
When we accept that the suffering is inevitable, we are more likely to survive and come out the other side more quickly and efficiently.
If you find metaphors to be useful tools in your own life or your clients’ lives, you can read more metaphors in The Big Book of Metaphors: A Practitioner’s Guide to Experiential Exercises and Metaphors in Acceptance and Commitment Therapy by Jill Stoddard, Niloofar Afari, and Steven C. Hayes, or check out these websites for quick and simple descriptions:
We also suggest a couple of videos on ACT metaphors in the YouTube videos section below.
Spoiler alert: they include some pretty cute animation!
8 ACT Training, Courses, and Workshops
- The Association for Contextual Behavioral Science again provides excellent resources for anyone who wishes to learn about Acceptance and Commitment Therapy. They divide their resources by method of learning: on your own, or with a community. Check out this page here, where they list books and articles by Steven Hayes, provide a link with information on the DVDs available to see ACT in action, and books that can help you learn how to apply ACT to different populations.
- The ACBS also offers occasional training workshops on working with ACT. You can check their events calendar here to see when there will be training in your area.
- If you happen to be in the Portland, Oregon area, Portland Psychotherapy offers several workshops on applying ACT to your practice. These workshops are conducted by Dr. Jason Luoma both on location in the Pacific Northwest and online and focus on a variety of topics within Acceptance and Commitment Therapy.
The next two upcoming workshops will be focused on applying ACT with highly self-critical and shame-prone clients. You can find more information about these workshops here.
- Dr. Russ Harris also offers training in ACT for a variety of purposes. His online course for beginners lasts 8 weeks and includes animation, video clips of real ACT sessions, audio clips, and more. If you’re interested in taking this course, more information can be found here.
- Another course through Dr. Harris focuses on ACT and mindfulness for clients who have experienced trauma. This course also runs for 8 weeks and offers a more intensive dive into ACT, complete with videos, online coursework, and multiple tools and techniques to apply in your practice. You can learn more about this course here.
- If you’re interested in applying ACT in your practice with adolescents, this course can help. It is a 6-week course intended to help you adapt ACT for your younger clients.
- Finally, Dr. Harris also offers a course for treating depression and anxiety disorders with ACT. This course is not active at the moment, but you can share your interest in the course through the website.
All of these courses can be found with more details on timing, course content, and cost at imlearningact.com.
4 Acceptance Therapy Books (+ ACT for Dummies)
- The most essential ACT book may be Hayes’ Get Out of Your Mind and Into Your Life, a book that was at one point the best-selling self-help book in America. This book struck a chord when it debuted, thanks to the emphasis on accepting and living with pain, a concept that is foreign to the predominant Western perspective on happiness and the avoidance of pain.
This book will walk you through the foundations of ACT and help you learn how to accept your emotions as something you are experiencing, rather than mandates to act in ways that are self-destructive or undermining to your mental health. To read reviews or see purchasing options, check it out here.
- If you’re a therapist or researcher who is interested in learning how to apply ACT in your practice or research, A Practical Guide to Acceptance and Commitment Therapy may be just what you are looking for. This book by Steven C. Hayes and Kirk D. Strosahl lays out the groundwork for integrating ACT into your work. According to the reviews, this is a great resource for any professional new to this form of therapy. If you’d like to learn more, you can find the book here.
- Another excellent guide for applying ACT to your work with clients can be found in Learning ACT: An Acceptance and Commitment Therapy Skills-Training Manual for Therapists by Jason Luoma, Steven C. Hayes, and Robyn D. Walser.
This book garnered numerous positive reviews on Amazon, and includes a DVD that features role plays of some of the main ACT processes and techniques. You can check out this book here.
- Finally, a list of books on any topic wouldn’t be complete without the “For Dummies” version. The always entertaining and easy to read “For Dummies” books are tongue-in-cheek with their titles, but there are anything but dumb for those who are new to the topic and hoping to learn more. This book is no different, with an excellent description of what ACT is, how it can be applied to everyday life, and why it works. To see reviews and other information on this book or to purchase it for yourself or your clients, follow this link.
ACT for Treating Disorders
While ACT, like the practice of mindfulness itself, can be applied in any individual’s life, it has also proved to be effective in treating many psychological disorders, including general anxiety disorders, chronic pain, depression, OCD, eating disorders, and social anxiety.
General and Social Anxiety Disorders
ACT may be most effectively applied to anxiety disorders, as there are a plethora of studies showcasing the positive effects of this form of therapy on patients struggling with anxiety.
For example, one study showed that college students who received ACT treatment enjoyed less stress, both generally and specifically in regards to academic concerns, decreased anxiety and depression symptoms, greater general mental health, and improved mindful acceptance (Levin, Haeger, Pierce, & Twohig, 2017).
Another study reiterated these positive impacts on anxiety and showed that ACT delivered via the internet could be as effective as therapist-delivered ACT (Ivanova et al., 2016).
The participants in this study reported reduced general and social anxiety, whether they were in the “treatment as usual” group or the online ACT group.
To learn more about how to apply Acceptance and Commitment Therapy to anxiety disorders, check out this website that is packed with information on how ACT can help treat anxiety and why it works. This site focuses on important points like mindfulness, commitment, and the control paradox, which arises from our expert ability to control our environment paired with our relative inability to control our thoughts and emotions.
If you want to dive deeper into treating anxiety with ACT, this book may be exactly what you are looking for. Acceptance and Commitment Therapy for Anxiety Disorders: A Practitioner’s Treatment Guide to Using Mindfulness, Acceptance, and Values-Based Behavior Change Strategies by Georg H. Eifert, John P. Forsyth, and Steven C. Hayes is an excellent resource for transferring your interest in ACT into real results for your patients.
This book can be found here.
Acceptance and Commitment Therapy has been applied in many studies of chronic pain and has been found to improve quality of life even without affecting the level of pain experienced. One study showed that cancer patients who receive ACT treatment reported significant improvements in acceptance of their circumstances and increased meaning in life, even while still experiencing pain (Datta, Aditya, Chakraborty, Das, & Mukhopadhyay, 2016).
Another study also found that ACT improves psychological flexibility and reduces depressive symptoms even when chronic pain remains (Scott, Hann, McCracken, 2016).
Another study verified this finding, showing that physical and emotional functioning improved with ACT, even with no concurrent reduction in pain (Vowles, Witkiewitz, Levell, Sowden, & Ashworth, 2017).
To learn how to treat chronic pain with ACT, check out this page packed with resources, including treatment manuals, handouts and worksheets, self-help books, and even Smartphone apps.
Similarly, ACT has been found to improve symptoms for people suffering from depression. One study found that ACT significantly decreased the severity of depressive symptoms for veterans with depression and suicidal thoughts (Walser, Garvert, Karlin, Trockel, Ryu, & Taylor, 2015).
ACT also reduced psychological inflexibility and distress related to depression and anxiety in older adults, even with only a brief course from a novice ACT therapist (Roberts, 2016).
If you’d like to learn more about using Acceptance and Commitment Therapy to treat depression, give this book a try: ACT for Depression: A Clinician’s Guide to Using Acceptance and Commitment Therapy in Treating Depression, by Robert Zettle. It describes how ACT can contribute to the successful treatment of depression by providing a session-by-session approach.
Obsessive-Compulsive Disorder (OCD)
ACT can also help patients suffering from Obsessive-Compulsive Disorder (OCD). An overview of the quantitative research conducted in this area showed that ACT treatment for OCD is as effective as the “treatment as usual” approach, including cognitive behavioral therapy (Bluett, Homan, Morrison, Levin, & Twohig, 2014).
For a great explanation of how to apply ACT in the treatment of patients with OCD, check out Michael Twohig’s piece on this subject.
He explains that ACT can be applied to OCD treatment through viewing behaviors as changeable rather than inherent biological responses and focusing on clients’ reactions to events instead of seeing them as facets of their personality.
Finally, ACT has also been successfully applied to patients with eating disorders. A case-series study on women with Binge Eating Disorder showed that participants improved with the application of ACT (Hill, Masuda, Melcher, Morgan, & Twohig, 2015).
One patient even reached a point where her symptoms no longer met the clinical definition of Binge Eating Disorder, while both displayed increases in their body image flexibility.
In a study on patients with anorexia, participants who received treatment that included ACT were more likely to reach positive outcomes at the end of the study (Parling, Cernvall, Ramklint, Holmgren, & Ghaderi, 2016).
If you’re interested in applying ACT to your treatment of patients suffering from eating disorders, this PowerPoint is an excellent resource. It outlines the importance of psychological flexibility and self-compassion for patients with eating disorders, provides several suggestions for books, workbooks for patients, and websites that can facilitate greater responses to treatment, and outlines some of the most important steps for treating patients with eating disorders.
Applying ACT in Group Therapy
Acceptance and Commitment Therapy can be applied on an individual level, but it is also effective when delivered via a treatment group. The Association for Contextual Behavioral Science acknowledges the effectiveness of group ACT treatments for anger, depression and general anxiety, social anxiety, chronic pain, and for struggling adolescents.
The Houston Group Psychotherapy Society reiterates the effectiveness of group ACT therapy, noting that the group setting can provide opportunities for clients to connect and learn from one another, receive the validation they may desperately need, and practice constructive vulnerability.
The HGPS also lays out some advice for applying ACT in a group:
Set rules for the group (show up to each group ready to make it work, don’t try to “solve” another group member’s feelings, etc.) and make sure group members know they must be followed.
Group Format and Structure
Decide on whether the group is more general or formed for a more specific topic like anxiety or depression. Consider starting the group with a mindfulness exercise or keeping a quick mindfulness exercise in your back pocket in case a group member gets off track.
Don’t be afraid to include experiential exercises but be on the lookout for judgment from group members after the exercise.
When conflict arises, which is likely to happen at some point, guide the group member to their inner experience first. Help them bring their thoughts back to making therapy work for them. Be ready to experience discomfort but avoid the urge to “rescue” group members from their pain.
For more information on applying ACT in groups, see the humorously named The Idiot’s Guide to ACT in Groups. This workbook provides a practical outline for setting up and conducting group ACT therapy and includes models, techniques, exercises, and basic protocols for group ACT.
4 Best YouTube Videos
If you learn more efficiently from videos than books, you’re in luck! There are some fantastic ACT videos on YouTube to learn about and practice ACT techniques.
For a great overview of ACT videos, check out Dr. Russ Harris’ YouTube channel here. He has several ACT videos for different audiences and techniques. For example, his latest upload is for adolescents who want to harness ACT to “stop struggling and start thriving.”
If you’re looking for a short and sweet introduction to Acceptance and Commitment Therapy, the video below is under 2 minutes and comes from the Veterans Health Administration. It features simple language and showcases important points in text on the screen.
If you’d like to learn more about the metaphors applied in Acceptance and Commitment Therapy, this video from Joe Oliver explains the ACT metaphor of passengers on a bus. In this metaphor, we are asked to place ourselves in the role of the bus driver, the person who has control over the speed and direction of the bus, but not the passengers.
Just as we cannot control the passengers who board the bus, we cannot control our own internal experiences, but we can allow them to say their piece while maintaining control over the bus. It’s only 5 minutes long and features some engaging animation to keep you interested.
Another great video from Joe Oliver outlines the unwelcome party guest metaphor. This video is just over 4 minutes and shows how trying to avoid things can backfire. Instead of avoiding the negative experiences that cause us stress or emotional discomfort, allowing ourselves to experience them and learn from them can produce far better results.
Our final metaphor video from Joe Oliver is that of the demons on the boat. In this metaphor, we are steering the boat with a horde of angry, aggressive, and intrusive demons in the water below us. If you’re wondering how this translates to helpful ACT tactics, watch the video below!
It clocks in at just under 5 minutes and explains the metaphor with the same engaging animation.
ACT Apps That Can Help
As technology flourishes, so too does the set of treatment options available to us. As with so many other problems, issues, or opportunities, there’s an app for that! The two most popular apps are described below.
The Happiness Trap App
The most popular ACT app seems to be the ACT companion App, or the Happiness Trap App, from Dr. Russ Harris and psychologist Anthony Berrick. This app helps individuals keep their commitment to positive action through mindfulness exercises, a tool to measure how well you applied ACT skills to a real-life situation, a system for prompting quick mindful acts, a crisis tool to help you deal with a sudden and difficult situation, and much more.
This app is available through Google Play for $9.99 and the Apple App Store for $14.99. It’s not free, but it is a relatively inexpensive investment for an app that can help you dramatically improve your quality of life! If you are interested in downloading this app, click here to learn more.
This app is offered through the US Department of Veterans Affairs, and includes tabs such as “Learn”, “Practice Mindfulness”, “Live Your Values”, and “Track Your ACT Moments.” This app is designed to help veterans live their values in their daily life, even when faced with unpleasant situations. This app is available at no cost through iTunes. Learn more about this app here.
A Take Home Message
Acceptance and Commitment Therapy has the potential to produce extremely positive results, not only for those suffering from psychological disorders but also for those suffering from the pain inherent in everyday life. With so many resources available online, it’s easier than ever to give ACT a try.
Whether you want to try it yourself or guide your clients through ACT, I hope this piece has provided you with the information and resources you need to get started.
Thanks for reading!
Have you ever tried Acceptance and Commitment Therapy, for yourself or your clients? How has your experience with ACT been? Leave us a comment and let us know how it went!
- Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of Anxiety Disorders, 28, 612-624. doi:10.1016/j.janxdis.2014.06.008
- Datta, A., Aditya, C., Chakraborty, A., Das, P., & Mukhopadhyay, A. (2016). The potential utility of acceptance and commitment therapy (ACT) for reducing stress and improving wellbeing in cancer patients in Kolkata. Journal of Cancer Education, 31, 721-729. doi:10.1007/s13187-015-0935-8
- Harris, R. (2011). Embracing your demons: An overview of Acceptance and Commitment Therapy. Psychotherapy. Retrieved from https://www.psychotherapy.net/article/Acceptance-and-Commitment-Therapy-ACT#section-the-goal-of-act
- Harris, R. (2013). Acceptance and commitment therapy training. Retrieved from https://www.actmindfully.com.au/acceptance_&_commitment_therapy Hill, M. L., Masuda, A., Melcher, H., Morgan, J. R., & Twohig, M. P. (2015). Acceptance and Commitment Therapy for women diagnosed with Binge Eating Disorder: A case-series study. Cognitive and Behavioral Practice, 22, 367-378.
- Ivanova, E., Lindner, P., Ly, K. H., Dahlin, M., Vernmark, K., Andersson, G., & Carlbring, P. (2016). Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial. Journal of Anxiety Disorders, 44, 27-35. doi:10.1016/j.janxdis.2016.09.012
- Levin, M. E., Haeger, J. A., Pierce, B. G., & Twohig, M. P. (2017). Web-based acceptance and commitment therapy for mental health problems in college students: A randomized controlled trial. Behavior Modification, 41, 141-162. doi:10.1177/0145445516659645
- Markaway, B. (2013, May 25). The ACT approach to self-acceptance: Three surprising, simple ways to increase self-acceptance. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/living-the-questions/201305/the-act-approach-self-acceptance
- Parling, T., Cernvall, M., Ramklint, M., Holmgren, S., & Ghaderi, A. (2016). A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up. BMC Psychiatry, 16. 272-284 doi:10.1186/s12888-016-0975-6
- Roberts, S. L. (2016). Acceptance and Commitment Therapy with older adults: Rationale and case study of an 89-year-old with depression and generalized anxiety disorder. Clinical Case Studies, 15, 53-67. doi:10.1177/1534650115589754
- Scott, W., Hann, K. E. J., & McCracken, L. M. (2016). A comprehensive examination of changes in psychological flexibility following acceptance and commitment therapy for chronic pain. Journal of Contemporary Psychotherapy, 46, 139-148. doi:10.1007/s10879-016-9328-5
- Serani, D. (2011, Feb 22). Acceptance and commitment therapy: A mindful way to treat disorders. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/two-takes-depression/201102/acceptance-and-commitment-therapy
- Vowles, K. E., Witkiewitz, K., Levell, J., Sowden, G., & Ashworth, J. (2017). Are reductions in pain intensity and pain-related distress necessary? An analysis of within-treatment change trajectories in relation to improved functioning following interdisciplinary acceptance and commitment therapy for adults with chronic pain. Journal of Consulting and Clinical Psychology, 85, 87-98. doi:10.1037/ccp0000159