What is Acceptance and Commitment Therapy (ACT)?
Acceptance and Commitment Therapy (often referred to as “ACT”, pronounced as “act” rather than “A-C-T”) is an evidence-based form of psychotherapy. Evidence-based means that ACT is a therapy that has been scientifically shown, through rigorous studies and meta analyses, to be an effective treatment for many mental health conditions. ACT has also been examined for individuals with chronic medical conditions.
ACT involves building skills to alter the experience of certain thoughts, feelings, and behaviors. Specific targets of ACT are increasing psychological flexibility and working to make sure your behavior aligns with what is valued to you.
Are you thinking that ACT sounds familiar to CBT, with this talk of thoughts and feelings and behaviors? You’re not wrong! ACT is a third-wave therapy, meaning that it builds on previous waves of psychotherapy, including foundational aspects of CBT. But ACT is different – it focuses more on therapeutic process and the specific context of an individual. So, ACT is poised to ask (and try to answer!) the question: “in the face of pain and suffering, how can you still lead a life that is full of value for you?”
The Building Blocks of ACT
Block 1: Contacting the present moment
This is just what it sounds like! ACT emphasizes the importance of “paying attention on purpose” as an important skill.
Block 2: Defusion
Have you ever had the experience of feeling like your thoughts and feelings are in charge of you rather than the other way around? ACT focuses on helping you notice thoughts and feelings without having them be in the drivers’ seat!
Block 3: Acceptance
ACT helps build skills to make room for acceptance of the painful, the uncomfortable, and the difficult. After all, suffering is a part of the human experience!
Block 4: Self as Context
ACT helps to strengthen seeing yourself in your own context – how can you take a moment and keep perspective on your own thoughts, experiences, and emotions?
Block 5: Values
Helping to identify what is important, meaningful, and worthwhile to you is an essential piece of ACT.
Block 6: Committed Action
And once these values are identified, you have to learn to act on it! How can you take actionable steps to live a life in line with your values?
What does an ACT session look like?
ACT sessions are a combination of discussion and concrete skill-building. In particular, ACT often teaches skills aimed at increasing psychological flexibility and reducing avoidance of emotions and experiences. These skills range from things like thought defusion or learning certain mindfulness skills to implement throughout your day-to-day.
ACT therapists also often use metaphors, like this Passengers on the Bus one to help you get started thinking about how your thoughts and emotions, and how you deal with those thoughts and emotions, can sometimes get you off the road you’d like to be on.
ACT for Chronic Medical Conditions
Because ACT is transdiagnostic (not specific to treating a certain condition), flexible in its delivery, and aimed at leading a valued life in the face of challenges, researchers have hypothesized that ACT may be particularly useful for treating chronic medical conditions.
ACT has been preliminarily shown to be a potentially efficacious treatment for aspects of cardiovascular disease and Type 2 Diabetes (glycemic control and diabetes self-management), and has been shown to reduce psychological distress for individuals with cancer. ACT has also been examined as a treatment for pain. While not consistently shown to reduce pain itself, ACT has been shown to be helpful in altering pain acceptance and psychological symptoms such as depression and anxiety.
A recent systematic review with meta-analysis showed that even a single session of ACT had some effect on functioning and well-being in individuals with chronic health conditions (although the results from this study are preliminary and need to be interpreted with caution!).
ACT for IBD and IBS
For people with IBD, ACT has largely been examined as an intervention that can help with psychosocial outcomes such as depression, anxiety, quality of life, and stress. Both patients and providers have described the specific potential for ACT to be a useful psychosocial intervention for people with IBD, and ACT has been shown to be associated with reduced depression and stress in individuals with IBD. However, relatively few studies have been done looking at ACT’s utility for people with IBD, so the literature in this field is new and growing!
ACT has also been researched as a potential useful intervention for people with IBS. Although the studies are again few and far between (with more research growing in this area), one study has shown that ACT was helpful in increasing disease acceptance and quality of life, and reducing anxiety as well as symptom severity itself. However, another study showed benefits from ACT on psychosocial outcomes but no effect on disease severity.
ACT is a third-wave approach with an increasing research-base and particular potential for individuals with chronic illness! If you think ACT might be useful for you, reach out to your provider or a member of your Care Team to discuss and learn more!
A-tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., & Emmelkamp, P. M. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30-36.
Dimidjian, S., Arch, J. J., Schneider, R. L., Desormeau, P., Felder, J. N., & Segal, Z. V. (2016). Considering meta-analysis, meaning, and metaphor: A systematic review and critical examination of “third wave” cognitive and behavioral therapies. Behavior therapy, 47(6), 886-905.
Dindo, L., Van Liew, J. R., & Arch, J. J. (2017). Acceptance and commitment therapy: a transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics, 14(3), 546-553.
Dober, M., Mikocka-Walus, A., Evans, S., Beswick, L., Emerson, C., & Olive, L. (2021). Perspectives on an Acceptance and Commitment Therapy (ACT) based program for patients with inflammatory bowel disease and comorbid anxiety and/or depressive symptoms. Psychotherapy Research, 31(5), 668-681.
Dochat, C., Wooldridge, J. S., Herbert, M. S., Lee, M. W., & Afari, N. (2021). Single-Session Acceptance and Commitment Therapy (ACT) Interventions for Patients with Chronic Health Conditions: A Systematic Review and Meta-Analysis. Journal of Contextual Behavioral Science.
Ferreira, N. B., Gillanders, D., Morris, P. G., & Eugenicos, M. (2018). Pilot study of acceptance and commitment therapy for irritable bowel syndrome: A preliminary analysis of treatment outcomes and processes of change. Clinical Psychologist, Jo, M., & Son, C. (2018).
Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and commitment therapy (ACT) for chronic pain. The Clinical journal of pain, 33(6), 552-568.
Ito, M., & Muto, T. (2020). Effectiveness of acceptance and commitment therapy for irritable bowel syndrome non-patients: A pilot randomized waiting list controlled trial. Journal of Contextual Behavioral Science, 15, 85-91.
Mohabbat-Bahar, S., Maleki-Rizi, F., Akbari, M. E., & Moradi-Joo, M. (2015). Effectiveness of group training based on acceptance and commitment therapy on anxiety and depression of women with breast cancer. Iranian journal of cancer prevention, 8(2), 71.
Rashidi, A., Whitehead, L., Newson, L., Astin, F., Gill, P., Lane, D. A., … & Jones, I. D. (2021). The Role of Acceptance and Commitment Therapy in Cardiovascular and Diabetes Healthcare: A Scoping Review. International Journal of Environmental Research and Public Health, 18(15), 8126.
Wynne, B., McHugh, L., Gao, W., Keegan, D., Byrne, K., Rowan, C., … & Mulcahy, H. E. (2019). Acceptance and commitment therapy reduces psychological stress in patients with inflammatory bowel diseases. Gastroenterology, 156(4), 935-945.