Are you feeling overwhelmed by stress or anxiety? Do you feel that you are sometimes living in an auto-pilot mode or that you have lost your sense of meaning or purpose? Imagine finding a way to navigate these challenges with ease and confidence. When choosing which psychological approach to specialize in, I felt in love with Acceptance and Commitment Therapy (ACT), a powerful approach that helps you be present, open up, and do what truly matters to you. These components helped me and thousands of other people to start living a truly meaningful, full-hearted, present life.
ACT (Acceptance and Commitment Therapy) is supported by a substantial body of scientific evidence demonstrating its effectiveness in treating a variety of psychological disorders, including anxiety, depression, chronic pain, and stress. Numerous randomized controlled trials and meta-analyses have shown that ACT is effective in enhancing psychological flexibility and improving overall well-being. If you are curios, in the literature below I added some further references to trials, papers and other scientific publications on the matter.
ACT is often compared to Cognitive Behavioral Therapy (CBT), as both are evidence-based approaches. However, while CBT focuses on changing maladaptive thoughts and behaviors, ACT emphasizes accepting difficult thoughts and feelings and committing to actions aligned with personal values. Both therapies share common principles but differ in their strategies and techniques.
ACT is a creative theraputic approach that rests on a formal structure, which is often presented with this so-called "ACT hexaflex", pointing out the core principles to be addressed during therapy:
Let me present you the different points, so that you can get an idea about what we will work on together:
Contacting the Present Moment (or Be Here Now)
Contacting the present moment involves being psychologically present, consciously engaging with whatever is happening right now. It’s common to get caught up in thoughts and lose touch with the world around us, often operating on automatic pilot. Imagine trying to enjoy a movie but constantly getting distracted by your phone. Contacting the present moment is like putting your phone down and fully immersing yourself in the film. This approach is frequently utilized in ACT counselling to help clients stay grounded. I normally use a wide vary of techniques, from meditation to visualization, from breath-work to focused attention. It is important that you find the technique(s) that works for you, since we all operate differently.
Defusion (or "Watch Your Thinking!")
Defusion is the process of “stepping back” and detaching from thoughts, images, and memories. Instead of getting entangled in thoughts, we observe them as if they were cars driving past a house. Think of it as watching clouds drift by without trying to grab them. ACT therapists might use defusion techniques to assist clients in managing intrusive thoughts more effectively.
Acceptance (or "Open Up")
Acceptance involves opening up and making room for painful feelings, sensations, urges, and emotions without struggling against them. It’s about giving them breathing space and allowing them to be as they are, without fighting, resisting, or running from them. Imagine you’re at a party, and instead of avoiding that one awkward relative, you just let them be and enjoy the party anyway. I often incorporate acceptance strategies to help clients understand and deal with emotional pain.
Self-as-Context (or "the Observer")
The concept of self-as-context differentiates between the thinking self and the observing self. The thinking self generates thoughts, beliefs, memories, and judgments, while the observing self is aware of whatever we’re thinking, feeling, sensing, or doing at any moment. This observing self remains constant throughout life, providing a sense of continuity. Think of it as the steady Wi-Fi signal that keeps you connected no matter how many devices you have running. ACT psychological counsellors often use the observer techniques to foster a deeper self-awareness in clients.
Values (Know What Matters!)
Values define what we want our lives to be about, what we want to stand for, and what truly matters in the big picture. They are desired qualities of ongoing action, guiding how we want to behave consistently. Clarifying values is essential in creating a meaningful life, often compared to a compass that gives direction and guides our ongoing journey. I love to work with clients to identify and act upon their core values, as this often happens to be a big eye-opener or a AHA! moment for most people. Imagine your values as your personal GPS, guiding you towards a fulfilling life destination. How will you reach your paradise if you don't know where it is?
Committed Action (Do What It Takes!)
Committed action involves taking effective actions guided by values. Knowing values alone isn't enough; it's the ongoing values-congruent actions that make life rich and meaningful. Committed action means doing what it takes to live by values, even if it brings up pain and discomfort. This can include traditional behavioral interventions like goal setting, exposure, behavioral activation, and skills training, as long as they support valued living and not experiential avoidance. ACT therapists might use committed action techniques to help clients achieve their personal goals. Think of it as finally getting off the couch and following your GPS directions to that amazing new restaurant you’ve been meaning to try.
So, why do we do all this?!
...We do it to create Psychological Flexibility!
The six core processes of ACT are indeed just different facets of our potential psychological flexibility, the ability to be in the present moment with full awareness and openness to experience, and to take action guided by values. Psychological flexibility enhances our quality of life, enabling effective responses to life's challenges. Engaging fully in life and allowing values to guide actions fosters a sense of meaning, purpose, and vitality.
Vitality, often emphasized in ACT, is not a feeling but a sense of being fully alive and embracing the present moment, regardless of current emotions. It highlights that there is as much living in a moment of pain as in a moment of joy.
For those seeking the expertise of a psychological counsellor in Zurich, understanding the principles of ACT can be a valuable part of finding the right approach for you. If you resonate with parts of this article, or you at times feel anxious, in auto-pilot, lost, detached, numb or purposeless, then there is a good chance that learning more about ACT and its six core processes will be of tremendous help for your personal growth and psychological well-being.
Ready to take the first step towards a more fulfilling life?
I am here to answer any questions you might have on the topic! Just drop me an email at fnc.valentini@gmail.com
Literature for further readings about ACT and its effectiveness:
Twohig, M. P., & Levin, M. E. (2017). "Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review." Published in Psychiatric Clinics of North America. This review discusses the effectiveness of ACT in treating anxiety and depression, summarizing numerous RCTs.
Hacker, T., Stone, P., & MacBeth, A. (2016). "Acceptance and Commitment Therapy - Do We Know Enough? Cumulative and Sequential Meta-Analyses of Randomized Controlled Trials." Published in Behavior Therapy. This meta-analysis covers a wide range of studies evaluating ACT's efficacy across different disorders.
Powers, M. B., Zum Vörde Sive Vörding, M. B., & Emmelkamp, P. M. G. (2009). "Acceptance and Commitment Therapy: A Meta-Analytic Review." Published in Psychotherapy and Psychosomatics. This paper provides a meta-analysis of RCTs to evaluate the overall effectiveness of ACT.
A-Tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., & Emmelkamp, P. M. (2015). "A Meta-Analysis of the Efficacy of Acceptance and Commitment Therapy for Clinically Relevant Mental and Physical Health Problems." Published in Psychotherapy and Psychosomatics. This meta-analysis examines the efficacy of ACT in treating a variety of mental and physical health issues.
Ruiz, F. J. (2012). "Acceptance and Commitment Therapy versus Traditional Cognitive Behavioral Therapy: A Systematic Review and Meta-analysis of Current Empirical Evidence." Published in International Journal of Psychology and Psychological Therapy. This review compares the effectiveness of ACT and CBT across multiple studies.
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). "A Randomized Controlled Effectiveness Trial of Acceptance and Commitment Therapy and Cognitive Therapy for Anxiety and Depression." Published in Behavior Modification. An RCT comparing ACT and cognitive therapy in treating anxiety and depression.
Fletcher, L., & Hayes, S. C. (2005). "Relational Frame Theory, Acceptance and Commitment Therapy, and a Functional Analytic Definition of Mindfulness." Published in Journal of Rational-Emotive and Cognitive-Behavior Therapy. Discusses the theoretical underpinnings of ACT and its practical applications.
Wetherell, J. L., Afari, N., Ayers, C. R., Stoddard, J. A., Ruberg, J., Sorrell, J. T., ... & Patterson, T. L. (2011). "Acceptance and Commitment Therapy for Generalized Anxiety Disorder in Older Adults: A Preliminary Report." Published in Behavior Therapy. An RCT examining the effectiveness of ACT for generalized anxiety disorder in older adults.
Arch, J. J., & Craske, M. G. (2008). "Acceptance and Commitment Therapy and Cognitive Behavioral Therapy for Anxiety Disorders: Different Treatments, Similar Mechanisms?" Published in Clinical Psychology: Science and Practice. Compares ACT and CBT, exploring their mechanisms and outcomes in treating anxiety disorders.
Graham, C. D., Gouick, J., Krahe, C., & Gillanders, D. (2016). "A Systematic Review of the Use of Acceptance and Commitment Therapy (ACT) in Chronic Disease and Long-Term Conditions." Published in Clinical Psychology Review. This review covers the use of ACT in managing chronic diseases and long-term health conditions.
Russ Harris, 2009, ACT Made Simple.
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