Acceptance & Commitment Therapy (ACT)

The goal of ACT is “psychological flexibility.” Psychological flexibility has been defined as follows: “the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends.” (Steven Hayes)

Over the last few years, I’ve come to embrace a style of psychotherapy called “Acceptance and Commitment Therapy (ACT).” Though this was not the therapeutic style in which I was trained during graduate school, I’ve come to feel that it best suits my unique integration of science and spirituality. Most psychotherapies have “symptom reduction” as a primary therapeutic goal. This is certainly what’s on the mind of almost every client that chooses to come to see a therapist. “Doctor, I’m in pain, I’d like you to make it stop hurting.” Symptoms are the way healthcare system measures the presence of psychological or physical disorders. Who could be opposed to reducing pain? It makes sense, it’s exactly how we were taught to engage with life in the physical world. If something is unpleasant, reduce it, avoid it, or control it. But there is another choice, one that may be particularly useful when circumstances or symptoms cannot be controlled.

ACT takes a somewhat different perspective, one that I think is particularly helpful in dealing with conditions that result from traumatic and life-altering events, or diseases like FSHD, that worsen over time. The purpose of ACT is not to reduce symptoms. The purpose of ACT is to help an individual to live a personally meaningful and values-driven life, in the midst of everything that life brings – whether joy or sadness, health or disease, or more likely all of the above.

ACT also resonates well with my faith background and experience in ministry. ACT is a behavioral therapy, that is – it’s about doing. Behavior therapy sees psychological change (and quality of life more broadly) as arising from the behaviors that we engage in. ACT takes the particular perspective that behavior should be driven by one’s personal values. Doing the things that matter most to us personally contributes greatly to the quality of our lives. For me, that focus on values, and purpose for living is highly consistent with, and integrates well with my own faith background and tradition.

ACT has been described as being like a three-legged stool. Just as a three-legged stool requires all legs to support weight, there are three necessary and interdependent processes that are part of ACT. Each of these processes has two elements. The first process has been described as “Opening up.” The two elements of opening up are called 1) acceptance (willingness); and 2) defusion. Both willingness and diffusion are about creating some distance from our thoughts and feelings, making space within our awareness for them, but also seeing them for what they truly are. Opening up is about allowing our thoughts and emotions to come and go within our awareness as they will. The second process is called “Being present.” The two elements that make up being present are called 1) mindfulness; and 2) self as context. Mindfulness has been defined by Jon Kabat-Zinn as “awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.” Through mindfulness we can develop a practiced skill as observers of our immediate inner experience. We can notice thoughts and emotions that are present without having our actions controlled or determined by them. The second element “self as context,” can be thought of as the ability to step back from oneself, and to see a larger context, a broader perspective on our immediate experience. I can see the “me” who was a child, an adolescent, and the continuity between those experiences of me and the me that is present. The third process is called “Doing what matters.” The first element of that process is 1) values; the second is 2) committed action. So the first part of doing what matters, is knowing what matters. Identifying one’s deepest values provides guidance for living. Values are like a compass in that they guide our way forward through life. Committed actions are the forward steps we take in the direction of our values. Life takes on meaning and purpose when our feet are actively moving toward those things we most value.

ACT has a hopeful, optimistic perspective on life, one that is reflected in most religious traditions as well. ACT assumes that even in the midst of pain and suffering there is opportunity for meaning, and for thriving. Victor Frankl is a survivor of the death camps in World War II. He was imprisoned in Auschwitz during WWII, and lost many family members and friends. He once wrote: “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” For me, ACT is about recovering the ability to choose, in the present moment, to live in a way that brings meaning and purpose, and that reflects my highest values. That act of choosing is done both in the midst of the pain and the joy of life.