How does Acceptance and Commitment Therapy benefit patients?

What is the aim of ACT?

ACT is an evidence-based third wave cognitive behavioural therapy (CBT).  ACT currently has over 1,000 randomised controlled trials, and is shown to be effective for a wide range of mental health-related presentations that present frequently in general practice; for example, depression, anxiety, obsessive compulsive disorder (OCD), chronic pain, addictions and burnout.

The main aim of ACT is to help people to become more psychologically flexible. Just as we can learn to become more physically flexible through engaging with and practising a number of skills and physical stretches, so too can we become more psychologically flexible through practising a range of psychological skills and practices. 

We, and those we work with, are more likely to be psychologically inflexible when we are:

• disconnected from the present moment, predominantly focusing on the past and/or the future
• closed to new experiences and unwanted thoughts and emotions
• disengaged from what we truly care about.

ACT teaches skills to help us to become psychologically flexible through building our capacity to connect more fully to the present moment and open up to new experiences, and to respond openly and compassionately to the unwanted thoughts and feelings that arise. It also helps us to engage more fully by actively connecting to our values (those things that matter most to us) and to engage in actions that are aligned with these values on a daily basis.

Who might ACT be helpful for in general practice?

ACT can be particularly helpful for patients who are keen to learn skills to help bolster their mental health and psychological wellbeing.  

It is helpful for those who feel like they’ve been running on a treadmill, constantly on the go in their autopilot mode, and those who have gotten completely stuck in their comfort zones to the point that life is feeling quite meaningless and unfulfilling.

ACT can be useful for those who have experienced a number of setbacks and challenges over the last few years; for example, those who have experienced long COVID, those who have lost loved ones through death or life circumstances, those struggling to come to terms with a breakdown of a relationship, and those living in a near constant fight or flight sympathetic autonomic state.

ACT can be a good fit for those who prefer more structure than psychodynamic and humanistic psychotherapy, and for those who find traditional second wave CBT too rigid or structured. ACT is somewhere between these approaches, as it provides more structure than psychodynamic and humanistic therapies with key practices and skills. Yet, it is a lot more process-based and gives several ways to adapt key skills and practices to an individual’s preferences and learning styles.

Ultimately, many people come to ACT when they’ve tried many things to try to get rid of their unwanted thoughts and emotions, which have often made things worse rather than better in the long run. 

One way to assess a person’s psychological flexibility within general practice is to give the person the Acceptance and Action Questionnaire (AAQ-11). GPs are free to use this assessment measure with patients in general practice: the AAQ-II is available here. This measure helps to assess just how much time and energy the person has invested in trying to control their unwanted experiences. 

What kinds of skills are learned through ACT?

ACT helps people to connect, open up and engage more fully in their daily lives through a number of skills, including learning to identify:

• their vulnerabilities, or the things that they really don’t want to think, feel or experience, such as thoughts of not being good enough or being too much, feelings such as anxiety and loneliness, or experiences such as rejection and failure
• their values, or those things that matter most to them eg. living in the moment, connection or creativity. This is facilitated through experiential exercises such as values cards or journaling prompts.
• ‘away moves’, or those actions aimed at helping them get away from their vulnerabilities, yet often also bringing them away from their values in the long-term; these often involve distractions such as social media, eating unhealthy foods, drinking alcohol or overworking, opting out (avoiding particular places, people and situations) and self-defeating actions such as addictions, interpersonal conflicts, or not asserting needs and boundaries
•  ‘towards moves’, or those actions aimed at moving closer towards our values that often involve some short-term discomfort in the service of a richer, fuller and more meaningful life in the long-term.

People also learn about their unhelpful thinking patterns and learning new ways of responding to unwanted thoughts. The aim in ACT is not to change the thought itself, but to change our responses to the thoughts. This is taught through mindfulness, acceptance and compassion skills of noticing, naming and observing thoughts.  A more pragmatic approach to thoughts is fostered by asking questions such as "regardless of whether this thought is true or untrue, what happens to your actions when this thought dictates your actions and inactions?". This can be particularly helpful for those who get caught up in true thoughts, such as those about chronic pain, bereavement or rejections.

ACT can also help to develop skills to respond in a more compassionate and validate way towards unwanted feelings such as anxiety, sadness and loneliness, and to notice the blocks and barriers to compassionate responding and giving skills so that they have choice in terms of their responses to unwanted emotions.

How can patients be referred for ACT?

GPs can refer directly to the online ACT programme at SPMHS. This programme consists of 12 weekly half-day groups, with an option to attend up to one year of monthly ACT aftercare group, and a further year of advanced ACT aftercare groups for those fully engaged with the programme.

Referrals can be made electronically through Healthlink or your GP Practice IT Management System. Alternatively, you can download a referral form to SPMHS here.

ACT practitioners in Ireland can be found through the Association for Contextual Behavioural Science (ACBS) website.