Acceptance and Commitment Therapy

ACT Therapists Chicago

Acceptance and Commitment Therapy (ACT), founded by Steven Hayes and widely taught by Russ Harris, is a fascinating & newer treatment approach that permeates most therapy sessions at Cityscape Counseling.

​ACT utilizes metaphors, mindfulness, and defusion techniques (tricks for interacting with thoughts and feelings) to help individuals understand how to respond to their internal experience (thoughts, feelings, memories, bodily sensations) in such a way that they can still live a meaningful and present-based life in spite of past and current pain.

​Identifying the values you want your life to be driven by is a very important component of ACT work. We explore what you want to stand for in the face of hardship, how you want your life to look in the future, and what steps we can take to get you there.

Acceptance and commitment Therapy is fun, fascinating & enlightening.

Cityscape Counseling’s therapists are well trained in providing ACT therapy in Chicago and are highly passionate about teaching their clients about how ACT can change their lives. In November 2016, Chelsea Hudson, Cityscape’s founder, presented about ACT at the National Renfrew Center Foundation Conference in Philadelphia.

Acceptance and Commitment Therapy (ACT) provides patients with an alternative to attempting to “get rid of their thoughts and feelings.” The alternative involves a shift in attention from what is often largely out of their control to what is in their control. Patients are usually not in control of the rate and intensity at which distressing thoughts pop into their minds. However, patients are in control of their actions as well as how they choose to respond to their thoughts. ACT, an offshoot of Cognitive Behavioral Therapy, uses a series of metaphors to teach patients acceptance-based strategies that will help disempower the influence of their distressing thoughts over their behaviors. ACT also emphasizes a focus on identifying one’s values and committing to act in ways that are in line with one’s chosen values.

Passengers on the Bus Metaphor

In this popular ACT metaphor, patients are taught that navigating through life with anxiety provoking thoughts is like being the driver of a bus full of noisy passengers that you can’t throw off the bus. The passengers on the bus represent different thoughts. One passenger might be the “you’re ugly” thought, another passenger might be the “you’re never going to amount to anything” thought, and another passenger might be the “it’s all your fault thought.” The metaphor is used to demonstrate that the driver can still arrive at his destination in spite of the noisy and cruel passengers, provided that he stops engaging with the passengers and continues driving towards his destination. Likewise, patients do not need to get rid of their thoughts to be able to attain a life of recovery. Watch a short video of the metaphor here.

History & Research

Acceptance and Commitment Therapy (ACT) was developed in the early 1980s by Dr. Steven Hayes, a psychology professor at the University of Nevada. His research has focused on the connection between language and the experience of human suffering. The ACT model was developed throughout the 1980s and 1990s and the first ACT book was published in 1999.

Russ Harris, an Australian physician and therapist, has emerged as an expert ACT trainer and author. His books and training make the process of learning ACT fun and simple, and his popular book “The Happiness Trap” has sold more than half a million copies.

To date, empirical support for ACT as a treatment mode for patients struggling with eating disorders has been promising. Research studies have revealed some significant findings such as:

• overall improved functioning for patients treated with ACT
• a reduction in mental health symptoms for various disorders

The Six Processes of ACT and their Application to Eating Disorders

ACT theory proposes that maladaptive coping mechanisms (such as harmful behaviors) arise in response to psychological rigidity, a key trait of patients struggling with mental health issues. ACT teaches patients to move from psychological RIGIDITY to psychological FLEXIBILITY through 6 different processes outlined below:

1.  Learning to “defuse” from unhelpful thoughts that one has become “fused” with

In a state of fusion, anxious or depressed thoughts seem like the absolute truth or commands that have to be followed. For example, when the thought “I am worthless” pops into one’s head, instead of viewing the thought simply as a string of words randomly produced by one’s mind, the thought is immediately believed as if it were a fact.

ACT provides alternative ways to interact with difficult thoughts so that the thoughts will have less impact on one’s behavior. Defusion involves stepping back and observing one’s thoughts without getting caught up in them. Thoughts are simply seen as constantly changing “streams of words, sounds, and images”. Defusion techniques involve playing around with these words, sounds, and images so that the content of the thoughts start to seem less relevant in influencing one’s behavior. For example, defusing from the thought “I am worthless” might include saying the thought aloud in a funny accent, singing the thought to a popular tune, or repeating the thought rapidly. There are hundreds of different defusion techniques in ACT literature that can be utilized to disempower the significance of the thoughts. The aim is not to get rid of the thought, but rather to learn to respond more flexibly to the thought. While not a goal of defusion, laughter frequently occurs during practice and patients often realize “how ridiculous” their thoughts sound when they bring their thoughts to life and start to play around with them. This is obviously a radically different approach to strategies that involve engaging in efforts to rationalize or change thoughts.

2.  Moving from experiential avoidance to acceptance

ACT proposes that maladaptive and avoidance behaviors are maintained by experiential avoidance which occurs when one is not willing to remain in contact with difficult emotions and thoughts and as a result, harmful behaviors are used in an attempt to escape difficult thoughts and numb unwanted emotions. Examples include: restricting food intake or over-exercising in the hopes that one will experience fewer “I’m fat” thoughts or using drugs to numb the thoughts of “I am worthless”.

ACT uses a series of metaphors to demonstrate how experiential avoidance is not a long-term solution. Once the patient understands that avoidance is unworkable, acceptance is provided as an alternative and the patient learns that fostering acceptance of their unpleasant internal reality will provide them with more energy and space to engage in other things that are important to them. The ACT therapist will frequently create in-session opportunities that expose patients to difficult thoughts and emotions so that the patient can practice acceptance and tolerance. Once the patient becomes more comfortable with and less reactive to their internal experience, there is less of a reason to engage in harmful behaviors as a way of coping.

3.  Practicing mindfulness to return one to the present moment

Engaging with distressing thoughts takes one out of the present moment because the mind is either engaged in mental planning involving future efforts to alter one’s body or the mind is caught up in the past ruminating about past failures or tracking mistakes to help one better compensate in the future. ACT is a mindfulness-based therapy. Patients learn to pay attention, with intention, to the present moment, without judgment. When one notices obsessive future weight-related fears, mindfulness tools can be used to return one’s attention to the present moment.

4.  Detaching from unhelpful self-narratives

Patients with mental health issues often become attached to unhelpful narratives or stories about who they are. For example, patients might strongly identify with narratives such as “I’ll always be alone” and “I’ll never be good enough.” These self-stories usually develop over time in response to how other people treat them and how they interpret those experiences. Mental Health Disorders are strengthened when patients become overly attached to the unhelpful stories their minds have created.

ACT uses the concept of an “observing-self” to teach patients that they are not actually their thoughts. While their minds are creators and containers of these self-stories, they do not have to be defined by them. For example, patients can learn to view their internal experiences from an observer’s perspective “I’m noticing that the story entitled I’ll always be alone just popped into my mind, and I can recognize that my mind made up this story because when I was younger, I was bullied and rejected by many of my peers, but I don’t have to buy into this story anymore because it doesn’t serve me.” Taking an observer’s perspective to one’s own mind helps to create distance between who the mind says the patient is and who they actually are at their core. ACT helps patients create new narratives for their lives that will provide stronger foundations for recovery.

5.  Clarification of values

Patients often remain stuck in their disorder because they feel as if their mental health struggles are the core of their identity. Values work in ACT targets one’s over-reliance on what society or others have deemed important. Clarification of values helps patients identify what kinds of people they want to be, what’s truly important to them and what they want to stand for. Once some values have been identified, patients are taught how their harmful behaviors act as a barrier to living a valued-based life.

6.  Committed action in service of values

If a patient’s values are unclear and their time and energy are being consumed by engaging in harmful behaviors, it’s likely that patients will stop working towards creating a meaningful life. For example, patients might drop out of school, isolate from their friends and stop volunteering which will move them further away from a life worth living.

This final process of ACT focuses on empowering patients to take committed actions (specific steps) in service of their values. For example, patients might commit to contacting their college advisor to begin the process of re-enrolling in classes to work on the value of education which they would have identified in the “values” process of their ACT therapy work.