Acceptance and Commitment Therapy (ACT) in Liverpool and North West
Acceptance and commitment therapy (ACT) is a “Third Wave” form of Cognitive Behavioural Therapy and is the perfect alternative for people who have tried more traditional CBT (perhaps through an IAPT service) and have not achieved the desired results.
ACT combines the cognitive and behavioural basis of traditional CBT with more recent developments such as mindfulness and behavioural contextualism to create an active, creative mode of therapy with the objective of helping you to live a rich, full and meaningful life.
Acceptance and Commitment Therapy (ACT) is delivered by Access CBT face to face in Liverpool or Online to anywhere in the world.
You can contact us on 07887 701 176 or enquiries@Accesscbt.co.uk to make an appointment and to find out more.
What is Acceptance and Commitment Therapy (ACT)?
ACT is type of therapy in which we aim to develop an understanding of, and change our relationship to, the thoughts, feelings and behaviours that are getting in the way of living a full and rich life.
ACT is not about just getting rid of our symptoms. Instead we’re looking to change how we actually relate to our thoughts and feelings and, despite what they make us feel like not doing, choose to take committed action in the areas of our life that we want to develop.
“Experiential avoidance” and “Cognitive Fusion” are two types of problem which can get in the way of people living the lives that they want to lead. Experiential avoidance is, as the name suggests, when there is an unwillingness to feel and experience aspects of our external and internal lives. For instance, we may avoid asking our boss for that raise because of the potential experience of rejection. Or we might stay in a difficult relationship to avoid the pain that we associate with change. Mental health problems like Panic Disorder, OCD and Depression all carry with them an aspect of Experiential avoidance – where we invest so much time in avoiding an experience that the avoidance itself creates a problem.
Cognitive Fusion is the term we use to describe when we believe a thought to be an accurate way of interpreting the world or our inner experience. When we hold on tightly to such thoughts as “I’m a failure” or “I’ll panic so much, I’ll lose control” and treat them as an absolute truth, rather than just one of many other thoughts, then we are “fused” to our thoughts.
ACT aims to create positive change in our lives through teaching us skills to develop “Psychological Flexibility.” Psychological Flexibility is a construct in which we can diffuse from our most challenging thoughts, sit with difficult and challenging emotions, understand how they relate to us as a human being and then choose to take action in our lives that is consistent with what we truly value.
How does ACT work with unhelpful thoughts?
CBT places a big emphasis on the role of negative thoughts in mental distress, suggesting that it is the way that we think about things that gives rise to the emotional states we experience. In traditional CBT, by working out whether the thought is an accurate representation of our experiences (and not a thinking bias or unhelpful thinking style), we can treat problems like depression, anxiety and trauma etc. Traditional CBT based interventions work well with a number of problems but, as with all things in life, are not for everyone.
ACT’s approach to working with thoughts is to develop “Cognitive Defusion”. What does this mean? We typically view our thoughts as being “us”. To quote Descartes, “I think, therefore I am.” When we routinely attach or listen to a particular type of thought and believe it as being “True”, then we would say that we are “fused” with the thought. For example, if I experience the thought, “I’m a failure” and automatically treat it as being an accurate, believable representation of life then we would say that I am fused to the thought.
If I am fused to the thought, “I am a failure”, then this will likely get in the way of me living a full and meaningful life. In fact, I am probably very aware of this and have tried to think differently about this many times before. I may have used traditional CBT techniques like thought challenging and still not managed to believe an alternative thought such as “I do quite well given how I feel.”
In ACT, we engage in a process of cognitive defusion to help us to treat the thought as just another mental event and to, rather than get into a battle with it or to let it stop us from doing things, learn to hold the thought lightly. The thought is there, but we don’t have to do anything with it. Learning cognitive defusion skills in ACT enables us to do this.
How does ACT work with difficult feelings/emotions?
If you have ever experienced difficult emotions then you will have no doubt tried to find ways to get rid of them. When we are experiencing Depression, sometimes when we wake up in the morning we will “scan” our bodies to see how low we feel on that day and then spend the rest of the day trying to avoid that difficult feeling – we might get back in bed, call work to say that we’re not coming in or take a drink or drugs. And with panic attacks we are so invested in avoiding that intense anxiety that we develop all sorts of safety strategies and use so much avoidance that the problem takes over our life.
The problem with trying to avoid an emotion is that when we try to avoid it, we are often likely to end up increasing it or get another difficult emotion in it’s place. If I wake up feeling low and immediately try to push it away, I’m then likely to get frustrated (another emotion) with myself because it’s still there, or get anxious because it might not go away in time for work this afternoon.
Struggling to get rid of an emotion rarely works and often makes things worse. So we need an alternative.
ACT invites us to approach our difficult emotions and get to know them. We experience them from a place of compassion and openness, so that when they do show up out of the blue, we are prepared to sit with and accept them rather than to go into a battle with them.
The Observer self
So, we’ve established that ACT enables you to work with difficult thoughts by “holding them lightly” and not engaging in them by treating them as “the truth”. We’ve also looked at how ACT will help you to work with difficult feelings by choosing to sit with them rather than entering into a struggle with them. But this leads us to a further question? If we’re observing our thoughts, and we’re sitting with our feelings, then just who is doing the observing and sitting?
We answer this question with an idea that we call “Self as Context” or “the observer self”. This refers to the more constant experience that we have of being ourselves, a sort of observer “me” that has been “me” despite whatever thoughts, feelings and experiences that I have had across my life. It might sound a little complicated so consider the following questions as an example…
For a minute, as you are reading this webpage, notice what it is that is in front of you. The computer, tablet or phone screen, your hand holding it and scrolling, the images and text that are on the screen.
Now, ask yourself a question…who is doing the noticing? There’s all of this in front of you, and then there’s “you” doing the noticing.
Try to notice the “You” that’s doing the noticing. What do you get? Is it more thoughts? Memories or feelings? Who is noticing these?
Here we are illustrating the observer self as being an aspect of ourselves which observes our experiences. By developing an understanding of the observer self as being different and separate from the “thinking self”, we are better able to observe our thoughts, feelings and experiences in a way that supports our wellbeing, rather than them being more problems to be struggled with.
Contact with the Now
As part of developing psychological flexibility, ACT uses a number of techniques to enable us to be focused and present in the moment. By cultivating being mentally focused and present we are better able to notice our thoughts and feelings, work to accept them and then commit to the Values and action needed to live the life that we want.
ACT uses a number of different approaches to develop “contact with the now”, some of which can be more formal and extended versions of Mindfulness and others considerably less so.
“Dropping Anchor” is a technique which ACT uses to help us to re-establish present moment awareness – this video, from St Patrick’s Mental Health Services in Ireland, shows us a very brief version of it.
ACT, as it’s name suggests, is a very active therapy and aims to focus less on what we are not doing and more on what we want to do. This can be a challenge for some of us at times however as, because we have spent so much time trying not to have “bad” experiences, we don’t always know what we would be doing differently instead.
Understanding Values is an important step in addressing this. Values can be thought of as a sort of direction that we want the different aspects of our life to organise around. So for instance, in my relationships I might have Values like, “to be supportive” or “to be able to grow.”
You will notice that these Values are not defined in terms of something that can be definitively achieved – there is never an end point to being supportive or to being able to grow. This is how Values differ from Goals – A value is never arrived at but instead gives me the direction around where I want me life to develop.
Now, if we imagine our Values to be like a sort of compass, but instead of saying North, South, East or West, it instead has things like “Family”, “Work” or “Health”. We can assign Values to each of these life areas and then choose to take action to organise our lives (that is, take Action towards) these areas on a daily basis. We move in the direction that the compass points us. If we lose direction, we can refer back to our Values and get back on track.
Committed Action – F.E.A.R. vs. D.A.R.E.
Let’s say that you understand what your values are and you have developed psychological flexibility around your thoughts and feelings. What next? You now have to take Committed Action.
What this means is that we are now taking the active steps in the direction that we want our life to move. If my panic attacks have been stopping me from going out, using my ACT skills, I now take the steps of actually going into the avoided situations. If my social anxiety has been preventing me from developing better relationships at work, I now take the steps of making small talk with my colleagues.
Here we are all about tackling the challenges that we face which are getting in the way of us living our fulfilled and meaningful lives.
The ACT therapist and author Russ Harris breaks down the committed action process into two helpful acronyms. The first, “FEAR” highlights all of the barriers to positive change:
- F – Fusion. Are you fused to a particular thought, image or thinking process (worry, brooding, etc).
- E – Excessive Goals. Is what we are trying to achieve reasonable for you at this time?
- A – Avoidance of discomfort. Are we trying to avoid feeling any distress?
- R – Remoteness from Values. Are we moving in a way that is consistent with what we truly value in life?
It’s helpful to use the FEAR acronym to work out why we are struggling to take committed action towards things we want. We can then use the previously described techniques to further get us back into taking committed action.
Here is the DARE acronym:
- D – Defusion. Seeing thoughts for what they are and not allowing them to “hook” us into believing them if they are unhelpful.
- A – Acceptance of discomfort. Difficult feelings are a part of you and trying to avoid them hasn’t worked so far. Let’s allow the discomfort to sit there while we move in our valued direction.
- R – Realistic goals. Simply, is what we are trying to achieve a realistic option at this time? Do we have the skills, time and resources to achieve the goals right now? If not, let’s scale back for a moment and see what we can do to move us in the direction of our goals right now, developing the resources, skills and whatever else we need for bigger goals in the future.
- E – Embracing Values – Our Values are our main source of motivation. To remain committed to working through the tricky stuff in life, we want to make sure that it is in the service of living to our values.
As you can see, Committed action brings together a lot of the other parts of the ACT model into reality and seeks to move us towards that rich, meaningful life that we desire.
Interested in trying ACT?
If you like what you see here and would like to give ACT a try, you can contact us on 07887 701 176 or email at email@example.com
We look forward to hearing from you