I’m a long way from being anything other than a novice when it comes to Acceptance and Commitment Therapy (ACT). It’s a new-but-old approach, and like most therapies, seems to work best if the therapist actually uses it personally.
There’s no doubt that bad things happen to good people. That’s challenging, and people who are seen to be ‘resilient’ seem to cope better with these events than those who are less resilient. Resilience means being able to bounce back from impact, being flexible – and that’s the aspect that ACT addresses. The ability to be psychologically flexible, or to adjust your actions to help achieve the direction you really value in life is the main target of therapy.
Maybe it’s my occupational therapy heritage, but it took me a while for ACT to click in place for me – and it wasn’t until I read about the committed action part of the therapy that it all made sense. Actions that satisfy important values in a person is an integral part of occupational therapy.
Values, or what a person believes is important in life, are not goals. Goals are able to be ticked off and achieved – or not achieved, depending on many factors. Values are the underlying reasons for choosing those specific goals – values provide direction, and shape the range of goals a person accepts. Values don’t finish – we never ‘complete’ things like having a satisfying family life, being open to new experiences, or appreciating beauty.
Actions are behaviours we do. They can be seen, counted and measured. Added up, a series of actions provide momentum in a direction – sometimes they lead to completing goals, sometimes they don’t because of intervening events. Actions are about what individuals actually do, not the results of those actions which can vary.
When life happens, actions often change – the person becomes unable to keep lifting heavy boxes, doesn’t get off to sleep well, finds it hard to keep driving. As a result, often the momentum in their lives is lost. And if the person isn’t flexible about the goals he or she is aiming for, negative emotions usually arise. It’s hard not to feel frustrated and angry when the goal of ‘getting to work on time every day’ is stymied by being unable to sit for long enough to drive there! Then a lot of the work of therapy is about helping the person deal with these emotions while trying to help them regain the ability to continue with their previous actions. Most of the time in Western health anyway, the focus is on trying not to feel the negative feelings, or trying hard to control them.
Acceptance and mindfulness are processes that help people recognise that they are not equivalent to the thoughts and feelings that come and go (even though we have all probably learned that we are). There is a ‘me’ that these thoughts and feelings are recognised by, but they are not the complete ‘me’. And thoughts and feelings don’t remain at the same intensity – they come in waves, gradually peaking and ebbing away.
The only times when they don’t ebb away are when we try hard to either avoid having them (ignore them or pretend they’re not there), or try to control them. The effect of trying to ignore or somehow control them is that they remain in our attention for longer, and can then influence the actions we take.
Once actions are influenced by thoughts and feelings, it can be quite a rapid process for these actions to move away from the reason they were being done!
An example might help to illustrate this: if the original reason for having a clean and tidy home was so that the family feel comfortable there, but the actions to achieve that are restricted by thoughts that pain is horrible and it’s important not to have pain, then it’s tempting for the person to strive to keep the house to the same standard. This can make it harder to actually be present emotionally so that the family feel comfortable being there!
So a big part of ACT is to help the person take action to move towards those valued things in their life at the same time as experiencing negative emotions.
Some of the tools to help people start to do this are ‘acceptance’ and ‘mindfulness’. Acceptance involves moving from a battle to a dance with the negative experiences. Instead of trying to defeat the pain, being ready to be a partner to it instead.
Mindfulness is about being fully present to all that each moment brings – and letting it pass by without judging, remembering or predicting.
Neither of these two processes are easy! Taking action is equally difficult – but the rewards of regaining momentum toward what is important becomes motivating, and life becomes about being rather than doing.