Acceptance and Commitment Therapy

Think for a moment about a time when you had a workout scheduled that you just didn’t want to do. You felt tired. Your mind was pushing you around so much so that you thought of just giving in to it, laying on the couch and watching some Netflix. But… you didn’t, you went out for the workout and executed it perfectly, you were focused and engaged. The noise in your headed quieted down a bit and sometimes it was non-existent. This is a great example of acceptance and commitment in action. You committed to doing action in spite the stuff coming up for you and pushing you around.

I fell in love with Acceptance Commitment Therapy (ACT) years ago when I noticed that clients responded well when they were present and engaged in what they valued. I started digging into it and found a modality of therapy had already existed for a few years and was starting to gain traction – ACT.

Developed in the 1980’s by psychologist Stephen Hayes, Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral therapy (CBT) that focuses on psychological flexibility and living a values-driven life. This article will summarize some of the key aspects of ACT, dig into some of the research and even some of the neuro-underpinnings of ACT – a modality that I continue to integrate into both my therapy and mental performance practice. (As well as my training!)

Core Principles of ACT

ACT is built on six core processes aimed at fostering psychological flexibility:

1. Cognitive Defusion (watch your thinking): Learning to see thoughts as mere words or images, reducing their power over behavior.

2. Acceptance (open up): Embracing emotions and sensations rather than avoiding or suppressing them.

3. Present Moment Awareness (be here now): Maintaining contact with the present moment, promoting mindfulness.

4. Self-as-Context (the noticing self): Recognizing a sense of self that is consistent and distinct from fleeting thoughts, emotions, or experiences.

5. Values (know what matters): Clarifying what matters most in life.

6. Committed Action (do what it takes): Taking value-based actions, even in the presence of difficult emotions or thoughts.

Mechanisms of Change

• Psychological Flexibility: The ability to adapt behavior to align with values, even when faced with challenging thoughts and emotions. Studies identify this as the primary mechanism of change in ACT.

• Experiential Avoidance: ACT targets the avoidance of internal and external experiences.

Research Evidence

The research on the effectiveness for ACT is sturdy. Multiple meta-analyses (A-Tjak et al., 2015; Gloster et al., 2020) confirm the effectiveness for a wide range of psychological problems. In addition, research is starting to demonstrate changes in the brain that affect focus and cognition as well as emotional regulation (Hölzel et al., 2011; McCracken & Vowles, 2014).

Compared with CBT (Cognitive Behavioral Therapy)  

While traditional CBT focuses on changing thoughts, ACT emphasizes accepting them and taking value-based action. Both are effective, though ACT may have unique benefits in chronic conditions and populations resistant to thought-focused interventions.

ACT in Sport Psychology

ACT has been gaining tremendous traction in sports psychology as it:

• Enhances psychological flexibility, enabling athletes to focus on performance rather than being derailed by self-doubt or anxiety.

• Encourages mindfulness and present-moment focus, which are critical for optimal performance including flow and clutch state.

• Helps athletes build resilience by aligning training and competition with personal values.

Summary

While no therapeutic modality is perfect for everyone, ACT can be used ‘flexibly’ for a wide variety of persons and situations. It’s a modality I subscribe to both professionally and personally integrating it into both my therapy and mental performance practices. It’s a modality that’s often easy to grasp and is very experiential, something I like especially when working with athletes.

If you’re curious and would like to learn more do not hesitate to reach out to me or schedule an introductory call. Over the next coming weeks, I’ll dive into ACT a little bit more covering each of the six core processes and how they can help you on your journey.

A-Tjak, JG., Davis, ML., Morina, N., Powers, MB., Smits, J. & Emmelkamp PM. (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):30-6. doi: 10.1159/000365764.

Gloster, A., Walder, N., Levin, E., Twohig, M., &  Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181-192. doi.org/10.1016/j.jcbs.2020.09.009.

Hölzel, BK., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, SM., Gard, T., & Lazar, SW. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging Jan 30;191(1):36-43. doi: 10.1016/j.pscychresns.2010.08.006.

McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178–187. https://doi.org/10.1037/a0035623