How Acceptance and Commitment Therapy (ACT) Can Help You Overcome Anxiety

Have you spent a lot of time and money on psychotherapy or self-help books, yet you still feel stuck in negative thinking, avoidance, debilitating anxiety or depression? Learning to de-fuse from unhelpful thoughts, accept your current reality, rather than struggling against it, and taking specific, deliberate, manageable actions to achieve your life goals can make you happier, healthier, and less distressed. Acceptance and Commitment Therapy (or ACT) is an intervention approach used in psychotherapy and workplace settings that is based on these principles.

ACT can help you to:

  • break out of negative thought cycles,
  • accept what you can’t control
  • stop running away from pain
  • tolerate risk, failure, and uncertainty
  • reap the rewards of living a meaningful, engaged life.

Some core principles of ACT are:

(1) Experiencing the present moment
Similar to Mindfulness practitioners, ACT therapists use exercises to help clients remain present and focused on the breath or their moment-to-moment thoughts and feelings, rather than trying to avoid or judging internal experiences. Feelings themselves are momentary, changing experiences in your body and mind. However, because of childhood learning experiences, you may develop negative judgments about feelings and what it means to have them – like “You’re depressed again – You’re such a loser!” When you pay attention to the feelings and describe them in language (e.g., my chest feels tight – seems like anxiety), they become less threatening. You realize that feelings will not make you die or fall apart, that you can tolerate them, and that they will pass. Watching feelings rise and fall in your body helps you see them for what they are – as transient experiences, rather than parts of who you are in essence.

(2) Being willing to be where you are
Acceptance is a term that is often confused with passivity. In ACT terms, acceptance means “being willing to experience the present moment, even if it’s not what you would have chosen.” Acceptance means accepting your life for what it is, including trauma or suffering. ACT helps you realize that you can never completely obliterate or make up for negative experiences. At the same time, you have a choice about what to do with your life now. You do not have to let your views of ourself and your actions be determined by old, automatic habits.

Changing habits takes time and effort. Therefore, you need to be willing to be uncomfortable You need to commit and persist even when your efforts aren’t bringing any concrete rewards, you don’t see major change, or you have a relapse. It takes time to change your brain pathways, or to have other people notice you are different and behave differently towards you.

Being willing means you no longer avoid uncomfortable thoughts, feelings, or situations by zoning out, not showing up, turning to addictions, using anger to hide hurt feelings, or procrastinating. If you want to be healthier, you first need to be able to look at and experience how unhealthy you are right now. At the same time, commit to doing what you need to do in small daily actions that move you towards health. Lifting the veil of self-deception or avoidance can go a long way towards getting you on the right track.

(3) Defining your core values
Core values are the things in life that are most meaningful to you and that enrich your life. They include such things as “Being healthy,” “Taking care of your family,” “Being honest and accountable,” or “Contributing to society.” When people come to therapy, they are often so overwhelmed with distress, anger, or struggles with pain or addiction, that they have lost touch with what really fulfills them. Even if they know “I want to be a good parent,” their day-to-day behavior may not reflect this because they are preoccupied with seeking escape from daily stress or worrying about the future. ACT therapists use imagery and writing exercises to help clients define their individual core values and proactively seek out activities and people that enhance these values in their lives.

(4) Committing to motivated action
ACT therapists educate clients that, to live according to your values and live a meaningful life, you need to take reasonable risks, get out into the world, and tolerate uncertainty and anxiety. Exercises focus on setting manageable, attainable, meaningful goals – commitment to taking specific, small steps that help you live according to your values. The focus is on taking action, not expecting a particular result, since outcomes may be at least partially out of your control. To be successful is not necessarily to always feel happy or pain-free, but to live a full life despite the anxiety or pain. By facing what you fear, the fear will eventually lessen, and, even if it doesn’t, you will know you have done the best you can. This takes you out of the cycle of self-doubt, regret, and second-guessing.

(5) De-fusing from your thoughts
A fundamental principle of ACT is that your thoughts, feelings, and sensations are not entirely who you are. ACT includes mindfulness, imagery, and language-based exercises to help you connect with your “observing ego” that can observe your thoughts and feelings, and can deliberately choose how much attention to pay them. Although your thoughts may feel true, they are not necessarily the truth, because they are biased by your expectations from past experiences. A major ACT principle is that you do not need to let your thoughts and feelings determine your behavior. You can choose how to behave, based on your direct experience (what you see, hear, feel, observe – independent of thoughts or judgments) and your core values. You can evaluate a thought: “Is it kind? Is it truthful?,..” and so on. Based on the answer, you may take the thought seriously or let it pass on by. Rather than changing the content of your thoughts, you can choose to change how much you let them influence you. Thinking you are stupid or fat does not make you stupid or fat – it’s just a thought, even if it feels like reality.

Issues and populations addressed

ACT Therapy has been used with substance abusers, people suffering from chronic pain or illness, or patients with obsessive thoughts, anxiety, or depression. ACT works well with clients who are tired of letting uncontrollable symptoms rule their lives and are willing to take a more active role.

According to SAMHSA’s Registry of Effective Programs,

“ACT has been shown to increase effective action; reduce dysfunctional thoughts, feelings, and behaviors; and alleviate psychological distress for individuals with a broad range of mental health issues (including DSM diagnoses, coping with chronic illness, and workplace stress).”

I use aspects of ACT in my practice. De-fusing from thoughts and acceptance have been particularly helpful in helping clients cope with anxiety, depression, and self-esteem issues.

Comments 4

  1. Donna
    August 14, 2017

    Thank you, Melanie, for posting this information. I have periods of depression and have been through multiple therapy sessions over the last 10 years. I do feel so bad when the depression returns and I do tell myself I’m a loser, there’s no real reason to be depressed, and I find all the negative thoughts coming back to haunt me as if they never left. I hate feeling this way and it hurts all of my family, not just me.

  2. Julie Bull
    October 23, 2017

    I agree with everything that you have said .how do I get this help please

  3. Cathy
    October 23, 2017

    Very helpful Melanie!
    I’d like to know how to handle what feels like extreme stress in my body(from many different things because I’m a Highly Sensitive person and have GAD). What can I do to physically and mentally feel better when I feel burned out? Alcohol helps initially, but I dont like how I feel afterwards, and I dont think it is healthy

    1. melanieg
      January 15, 2018

      Dear Cathy,

      Thanks for your comment. Alcohol may make you feel relaxed initially, but too much alcohol or regularly drinking more than 7-10 drinks a week (women) can act as a depressant and make you feel worse later on.Try nature walking, listening to music, going to the movies, doing art or something creative.

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