Acceptance and Commitment Therapy Helps You Thrive After Difficult Times

This form of psychotherapy focuses on mindfulness and goalsetting, while acknowledging life’s most challenging experiences.

When you must deal with upsetting situations or carry around painful memories, your first instinct might be to do whatever you can to escape or erase them. You may try to find a way to think about them differently to ease the pain. But there is a type of psychotherapy that suggests in some situations, a more productive approach is to acknowledge and “own” those difficult feelings, and then move on with a more goal-oriented and positive outlook.

It’s called acceptance and commitment therapy (ACT), and it’s similar in some ways to the more well-known cognitive behavioral therapy (CBT). Both types of therapy are often short-term treatments, very goal-oriented and emphasize a deep awareness of your thoughts. However, CBT approaches treatment with the idea that your thoughts are what drive your feelings and behaviors, so changing how you think about a situation can lead to different feelings and actions.

“With ACT, the practice is not about challenging or changing thoughts or even seeing them as ‘irrational’ or ‘distorted,’ but rather labeling thoughts in a nonjudgmental, non-reactive way, and allowing them to come and go like cars on the highway,” explains Sarah Gray, PsyD, a clinical psychologist with Massachusetts General Hospital. “This practice allows one to be connected with the ‘observer self,’ or that sense of a core self that is separate from thoughts and feelings, and therefore does not need to react or be controlled by them.”

ACT Fundamentals

The “acceptance” part of acceptance and commitment therapy means that there is no running from the troubles of your past. Instead of denying your feelings or trying to minimize things that you know deep down are important, ACT teaches you how to embrace all the chapters in your life—good, bad, and in-between. They led you to this moment. With ACT you understand them, rather than allow them to dictate your outlook and behaviors.

“ACT is a type of psychotherapy that incorporates mindfulness and acceptance skills to help people live a vital and meaningful life, guided by personal values, despite the elements of unpleasantness and suffering that are part of life’s experiences,” Dr. Gray says. She quotes noted ACT practitioner Russ Harris, MD, who sums up the therapy quite simply: “Embrace your demon and follow your heart.”

Embracing your “demon” or upsetting thought doesn’t mean that you let it rule you, however.

“ACT practitioners provide guidance and practice in using mindfulness-based skills to help detach from unhelpful thoughts that may be interfering with behaviors and experiences that align with one’s values,” Dr. Gray says. “These skills promote an increase in ‘psychological flexibility’ and may include practices such as ‘defusion’ or detaching oneself from one’s thoughts. In other words, I have a thought but I am not the thought, so instead of thinking ‘I’m a loser,’ one could practice noticing ‘I’m having a thought that I’m a loser,’ which often feels very different and produces different reactions.”

In addition to defusion, ACT includes several mindfulness practices. One of the most important is being fully aware in the present, paying attention to where you are, what you’re doing, who you’re with, and so on. Be mindful of the moment and not stuck in thoughts of the past or future.

Through ACT, you are also taught to watch thoughts or feelings or sensations as a curious, but nonjudgmental, observer, who isn’t trying to change or avoid or control them, Dr. Gray says. This gets to that “acceptance” concept.

The “commitment” part of ACT requires you to identify your values or “chosen life directions that lead to a meaningful, rich life, and taking committed, effective action, while guided by one’s values,” Dr. Gray explains.

ACT Sessions and Homework

The duration of acceptance and commitment therapy may be a few months in some cases, but could last longer if necessary.

ACT patients usually receive “homework,” which includes the practice of skills such as mindfulness and cognitive defusion techniques, says Dr. Gray.

While ACT can be a relatively short-term process, it doesn’t always produce immediate change and symptom reduction, Dr. Gray says.

ACT is especially useful if your troubles stem from a long-term illness, the loss of a loved one, or some other specific event or circumstance.

“The body of research on ACT is significant, and shows benefits in multiple populations and for a wide range of presenting concerns, including depression, anxiety, chronic pain, stress, addiction, and schizophrenia,” Dr. Gray says. “So ACT can be utilized with a wide range of people. With its focus on acceptance and coping, it offers practice and guidance in skills and mindset shifts that can be helpful for anyone navigating the ups and downs at any stage of life.”

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