Here are a few words about Acceptance and Commitment Therapy, (called “act” not Aay See Tea), prompted by Teg’s “Positivity”, 10 Sep 2022.
ACT is a brief therapy. It comes from the labs with a solid body of research evidence to show you can achieve rapid and lasting clinical gains with brief therapy. Many years ago I was training to become the world’s worst CBT therapist. With time I realised I’d really misjudged CBT; we’re friends now. So what did I like about ACT?
Well, I liked the research. While many of my patients and clients just want the relief I liked the theory behind ACT. Unfortunately this can’t be explained in a 508 word blog but here’s a single idea which I feel ACT clarified for me:
Human suffering and distress is almost inevitable because of the way we learn behaviour. We often avoid distress and danger in the physical world by following rules, e.g. obey the Don’t Walk sign so you don’t walk in front of a bus. We tend to use similar rule-based avoidance behaviour with distress and danger in the internal, mental world. ACT showed me how avoidance behaviour was often making my distress worse. This was radically counter to what I felt — I just wanted to avoid pain and be happy. How does avoidance make problems worse?
For me it was primarily through using alcohol and eating to manage mood, but it was also through other control strategies. This is massive:
Most of my clients want me to help them control their behaviour. “I want to be able to control my eating; my stage fright; my anger; my chronic pain.” I don’t work much with depression but my colleagues have patients who want to control their depression. The effort of controlling behaviour frequently becomes a large component of a problem. Imagine trying to go for a swim but you’ve got an annoying beach ball to manage. You can spend all your time holding it down, forcing it below the water and yes, you can do that — but how much swimming are you doing? What was the actual point of being in the water?
Life is more engaging when we stop trying to constantly manage and control stuff we don’t like — e.g. like the impact of persisting pain. The very nature of that stuff is to keep bobbing up. ACT suggests we’ll get more from life if we use control strategies when they’re useful and not just as a reactive way of avoiding distress. I see people panic if they sense they can’t cope without their control strategies. Thankfully ACT suggests ways to cope differently.
I’ll finish with four questions I often use to focus an ACT session:
1) What are you seeking? — (I want to know what the solution looks like).
2) What have you tried? — (I want to clarify the links between what people want and what they do).
3) How’s it working out? — (I want people to see the connections).
4) What has it cost you? — I’ll leave this with you.
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