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Treating Anxiety with Acceptance Commitment Therapy (ACT)

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What makes ACT different?

Psychologists have multiple approaches to treating anxiety at their disposal - using a thorough understanding of your childhood to address anxiety, examining thought and behavior patterns to look for possible changes, developing solutions to practical problems, and many more methods. Acceptance and Commitment Therapy (ACT) expands on these by introducing a novel way of looking at the treatment of anxiety - what if we don’t need to get rid of it in the first place?

What is ACT?

ACT is a psychotherapeutic modality for helping people with a variety of mental health difficulties. It includes a number of ways of understanding people’s emotional experiences, the way they interact with these, and the possibilities for changes in how they think about their experiences. It helps to put ACT in the context of other psychotherapy approaches to treating anxiety, to best understand how it can be helpful.

Cognitive behavioral therapy, or CBT, is perhaps the most widely utilized and researched approach to treating anxiety. The premise of the therapy is that our emotions, thoughts and behaviors all impact each other, and so we can use control of one of these to impact the others. From a CBT practitioner’s perspective, anxiety is the result of faulty or unhealthy patterns of thinking and behaving, and so the way to eliminate anxiety is through developing healthier patterns of thinking and behaving. There is a lot of research that supports the efficacy of CBT in treating anxiety, and it helps many clients to overcome anxiety and its associated symptoms. CBT is particularly good for treating very specific symptoms in a very direct way.

Psychodynamic therapy looks at how anxiety develops from our earliest interactions with our families as young children, and how we learnt to think of ourselves, significant others, and the world around us, based on those experiences. In analyzing significant moments in our past, they hope to help make our unconscious thought processes more easily accessible. This then helps us to make changes to these beliefs, which in turn change the way we are impacted by the world around us. Psychodynamic therapy is great for people looking to develop insight into the way their minds work.

One feature that both of these (and many other)forms of psychotherapy have in common is that they both in some way seek to reduce the intensity and frequency of the anxiety. In contrast to these, ACT looks at the “problem” of anxiety differently - how can we live a more fulfilling life with that anxiety still there?

A useful metaphor for understanding ACT

Imagine struggling in a tug-of-war. Picture yourself as one participant, and your anxiety as the other. For added drama, imagine that between the opposite ends of the tug-of-war is a bottomless pit, that you are fighting to pull your anxiety into.

Victory sounds like a wonderful idea - you put all your effort into the struggle, you uproot the anxiety from its spot, it falls into the abyss below, and you are finally freed of your awful anxiety!

Defeat sounds like a dreadful thought - it catches you off guard, yanks the rope just hard enough to pull you in, and you are lost to the horrible void of anxiety…

If you take a moment to think of this fight, you’ll likely realize it’s a fight you’ve fought many times with many different emotions - fear, anxiety, jealousy, anger, sadness, hurt, frustration… But if you think a little further, you will also likely realize that you’ve never actually won that fight. Sometimes you reach a point where it feels like you’ve won, but the next time something happens to cause a similar emotion, it taps into all the emotion that’s still there from the last time you felt the same way. But maybe this time if I just -

And we fall into that line of thinking over and over again, continuously focusing so much of our attention and so much effort into fighting this never-ending struggle with our emotions which we never win.

How does ACT impact our anxiety?

ACT presents a third option for our tried-and-not-so-trusty tug-of-war - why not let go of the rope? When we let go of the rope, we make a few decisions:

  • We enact a “hopeless'' situation - I may never defeat my anxiety!
  • We free up our attention - while I was struggling in the tug-of-war to defeat my anxiety, I felt compelled to focus much of my attention on the fight. Now that I am no longer struggling, I am free to focus that attention elsewhere.
  • As I move forwards with other things that I choose to focus on, I know that anxiety is going to stay with me and follow me, even competing for my attention at times. I accept that I cannot stop it from existing and trying to draw my attention, but I know that I can choose if it's worth giving it my attention.

Engaging in this process frees us from a life where anxiety controls our lives by virtue of controlling our attention, and grants us a life where we choose what is important to us, and work consistently with those values to create meaning and purpose for ourselves. Ironically, making the decision to let go of the rope typically frees us from secondary anxiety - anxiety about becoming anxious - which is often the most distressing part of people’s experience with anxiety. Many clients report that their anxiety fades away much faster in this new approach to living with it (but unfortunately we can’t cheat the process and skip ahead to this reduction).

ACT teaches us the tools to engage in the process successfully - how to accept emotions, engage mindfully in the present, distance ourselves from the impact of those feelings, discover what values we choose to focus on instead, and learn to commit to action around those values.

How do I do ACT?

Connecting with a therapist that is trained in ACT may be your best approach to learning to use ACT effectively. They can use their knowledge of the model to explain how it can be applied to your particular situation, and answer whatever questions you may have along the way. They can also help you decide if ACT is the right fit for you - you may also benefit from other approaches to managing and treating anxiety, and a good psychologist can help you explore these processes effectively.

If you would like to read more about ACT in the meantime, websites such as the Association for Contextual and Behavioral Science, and books by authors such as Steven Hayes (the founder of ACT) or Russell Harris might be good starting points too, and can absolutely compliment your therapy process with a therapist who uses ACT.

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