Acceptance and commitment therapy (ACT) is a type of cognitive behavioral therapy (CBT) which proposes that many of the strategies we use to control unwanted thoughts and emotions are ineffective and can lead to problematic behaviors.¹ Classical CBT generally involves learning more effective strategies to actively modify maladaptive thought and behavior patterns to elicit desirable change.² Alternatively, ACT submits that our attempts to control distress can often interfere with our willingness to accept it.³ In this view, it is often our struggle to control unwanted experiences that perpetuates them.

Instead, ACT aims to help clients learn strategies and techniques for perceiving and relating to unwanted experiences in ways that increase cognitive flexibility.⁴ Specifically, ACT encourages the strengthening of six (6) core skills:⁵

Defusion — Learning to non-judgmentally view thoughts as a transient stream of private experiences rather than literal ones.

Acceptance — Allowing unwanted thoughts and feelings to exist without struggling against them or avoiding them.

Contact with the present moment — Bringing total awareness to the here-and-now with openness, interest, and receptiveness.

The observing self — Assuming the persepctive of a conscious observer, transcendent and utterly distinct from thoughts, feelings, memories, urges, sensations, images, roles, and the physical body.

Values — Clarifying what is most important, significant, and meaningful to you.

Committed action — Setting value-aligned goals and taking effective action to achieve them.

The basis for these skills as an antitode to distress is rooted in relational frame theory (RFT) which posits that humans "learn to relate events mutually and in combination, without being limited by their form."⁶ To simplify, this means that we learn to associate certain things with other things through categorical relationships (i.e. relational frames), and that these associations can extend far beyond their literal forms.

For example, imagine two things: a sunset, and a memory of a dear friend who passed away. Sunsets are generally beautiful sights to behold, while memories of our deceased love ones can tear at our heartstrings. Yet because of the way associations form through human language, it's entirely possible that a beautiful sunset may remind us of our long lost friend, thereby triggering feelings of sadness rather than evoking only the positive sensations that may have been felt had it been experienced in isolation. Relational frame theory argues that it is this entanglement within cognitive networks created by human language that creates suffering.⁶ By developing the six (6) core skills presented by ACT, we can help 'detangle' these associations and reduce their emotional impact on us. The cognitive flexibility obtained through freedom from harmful or destructive associations enables us to shift our focus, time, and energy onto strengthening constructive ones by aligning our behaviors with core personal values.⁷

Research supports the effectiveness of ACT in therapeutic settings. Meta-analyses have found that ACT is more effective than placebo and standard "treatment as usual" procedures, and may be as effective as other established psychotherapeutic interventions in treating anxiety disorders, depression, addiction, substance use disorders, and somatic health problems.^8,9,10 Some studies suggest ACT is comparable with a combination of CBT and interpersonal psychotherapy (IPT) for treatment of depression,¹¹ while others further support its effectiveness as treatment for both depression and anxiety.¹² Literature reviews have discovered support for ACT's efficacy in symptom management and reducing rehospitalization rates in clients with psychosis.⁶ Importantly, research also supports the notion that applications of ACT-specific mindfulness-based interventions within ACT treatment protocols influence treatment outcomes, providing validitation for their use in therapuetic settings.⁶

Classical CBT is well-established as the most-researched form of psychotherapy and considered by some to be the "gold standard" of psychotherapeutic treatment.¹³ ACT and CBT overlap heavily in both technique and strategy, but differ theoretically with respect to the role of cognitions in human experience, and in their approaches to developing effective emotion regulation strategies.¹⁴ We believe ACT can provide a strong alternative approach to symptom management for clients who may otherwise struggle with classical CBT approaches to actively modify undesirable cognitive and behavioral patterns.