Kate had been diagnosed with a serious health condition that changed the course of her life. She was overcome with thoughts about the unfairness of the situation, the difficulties she would face, and her unknown future. As she became depressed, friends and family said she needed to “accept” her condition. Have you ever been told you needed to accept something that seemed so terrible that you wondered how anyone could accept it? Or have you been told that you can’t “let things go,” whether this is criticism, negative feelings about yourself, or daily stressors that replay in your mind? Part of being human is having the ability to think and plan. Although this is a good thing, excessive negative thinking can lead to depression and prevent us from reaching for our goals and desires.
Acceptance and Commitment Therapy (ACT) is a type of therapy that addresses these issues, with a focus on thoughts, emotions, and behaviors. One major goal of ACT is to help people remove the obstacles caused by problematic thoughts so that they may pursue goals they value. For example, a man may avoid socializing because he tends to be “awkward” in social settings. This feeling of awkwardness prevents him from developing meaningful friendships, which is something he greatly desires. In another situation, a woman may have a great desire to exercise, but believes that others at the gym will be judging her negatively because she is overweight.
ACT counselors do not try to directly change thoughts. Instead, the goal of ACT is to change a person’s reaction to these thoughts in order to remove the barriers that the thoughts create. In the case of the man who avoids socializing, the ACT therapist will not challenge his belief that he is socially awkward. Instead, the therapist will work with him to accept his awkwardness and find ways of connecting with others despite this feeling of awkwardness. In the case of the woman who is overweight, the ACT therapist will not challenge thoughts that others are viewing her negatively as a result of her weight. Instead, the therapist will work with the patient to help her accept her weight, accept that others may sometimes judge her, and learn ways to overcome the obstacle of feeling judged. The ACT therapist uses various treatment techniques to accomplish these goals.
A core part of ACT is mindfulness. Mindfulness refers to the process of being fully focused on the present moment, without thoughts and concerns about the past or future. When a person learns to be mindful and practices mindfulness regularly, thoughts lose their ability to sculpt that person’s emotions. Mindfulness is also used to help people cope with their painful internal experiences, including physical and emotional pain. Mindfulness means simply experiencing the pain without judgment or negative thoughts. For example, an ACT therapist will help someone with chronic pain be mindful of the sensations without allowing negative thoughts to dominate their mind. Negative thoughts may include “This pain will never get better,” “I can’t handle this,” or “Something bad is going to happen to my body.” Because research shows that emotions and thoughts increase the experience of physical pain, mindful acceptance is an important part of therapy with individuals who have chronic pain. Similarly, mindful acceptance of emotions such as anxiety, sadness, and anger is also taught in ACT. People with depression and anxiety often judge their emotions and criticize themselves harshly for having emotions, which only strengthens and maintains depression and anxiety. The ACT therapist teaches patients to be mindful and accepting of the ebb and flow of emotions. ACT has shown effectiveness in helping people cope with certain chronic illnesses as well as reducing depression and other mental health conditions.