“Our medications are anti-depressants, or anti-anxiety, as if the only sensible goal is to subtract them. Our disorders are called “mood disorders” or “thought disorders” or “anxiety disorders”—once again feeding a cultural view that is often outright hostile to anything painful. We’ve got to put aside this unhelpful messaging to create some space to try truly new things.”Steven Hayes
Acceptance and Commitment Therapy, pronounced “ACT” (as in action) was created by Steven Hayes. I often think of ACT as closely related to Cognitive Behavioral Therapy but with the addition of Eastern philosophical ideas such as acceptance and mindfulness.
I personally find the language and metaphors of ACT to be extremely useful and effective in helping people meet their personal and professional goals.
What follows is a list of ACT concept explanations and applications.
In ACT, pain of presence refers to the pain from the unavoidable problems in our lives, and it is distinguished from pain of absence, which is the pain we feel from not engaging in the positive behaviors that would bring up discomfort.
These two concepts are, from what I can tell, related to the “1st and 2nd arrows” metaphor in Buddhism. The 1st arrow is often called “pain” (unavoidable) and the 2nd arrow is called “suffering” (avoidable), which is the combination of pain plus resistance to the pain. The Buddhist parable warns us to not shoot ourselves with a 2nd arrow by resisting the unavoidable 1st arrow. The metaphor instructs us that we do have control over that portion (acceptance vs resistance) of our experience. The more we struggle against (resist) our pain, the more we experience suffering. The word suffering is derived from Latin roots which means “carrying a heavy burden that one is unwilling or unable to carry.”
Like Buddhism, ACT emphasizes that feeling pain is part of being human. We all experience emotional and physical injuries, stress, loss of love, disappointment, aging, sickness, and death of loved ones.
In ACT, pain of presence often refers to an emotional state, such as a fear, whereas the pain of absence often refers to a lack of appropriate behavior, due to us being controlled by the fear or other emotional state. Here are a couple of examples:
A few examples:
- Suppose I have a fear of conflict with others (pain of presence / 1st arrow). We may try to protect ourselves by not being assertive and asking for what you we want. We then judge and resist that fear (2nd arrow), and create pain of absence by, say, being passive rather than assertive, such that we don’t get our needs met. Now we not only have the fear of conflict, we also don’t have met needs. ACT would suppose that there’s nothing we can do in the short term about the first problem, but there is a lot we can do about the 2nd problem. In the long term, being assertive is likely to also decrease the fear of conflict, since we’d get practice at having positive outcomes resulting from such conflict. However this can take a lot of time and effort, sometimes over many years depending on how deeply the fear runs. And it may be the case that our fear never completely goes away, but it won’t remain as high either.
- Social anxiety (pain of presence) may prevent us from socializing (pain of absence of interaction). Now we are both afraid and isolated, rather than afraid and connected. The pain of absence is most directly and immediately within our control. The pain of presence will take time, and acceptance in the meantime.
- For no apparent reason, we find ourselves in a bad mood, depressed (pain of presence). We then don’t go out and exercise, or eat well, or seek healthy connection with others (pain of absence). Now we’re depressed and also not taking care of ourselves, which can lead to feelings of shame as well as physical and pragmatic problems.
Pain of absence is always an attempt at decreasing pain of presence. And there is some validity to it. We do get a very short term relief when we protect and avoid by not engaging in effective behavior. If we stay home, our social anxiety is temporarily quelled. If we don’t crawl out of bed and go jog, our depression feels a bit more manageable for those first few minutes. If we avoid the conflict, our bodies don’t react with the stress of necessary confrontation.
But in the mid-to-long term, both types of pain are increased by not doing the effective thing. We are always practicing something, and practice makes perfect. If we practice effectiveness, we gain confidence and decrease fear. If we practice over-self-protection, we become weaker. We need to find the balance between over and under-protection. ACT assumes that, generally, we are overprotecting ourselves.
This concept helps to get “under the philosophical hood” of ACT, and informs some of the basic assumptions and goals of ACT.
Relational frame theory (RFT) theorizes that human beings are, among all animals, by far the best at making connections (relationships) between symbols, ideas, and tangible real-world objects. In other words, we can relate anything to just about anything.
RFT matters because it suggests that our human relationship/connection abilities are a mixed bag of rich creativity and power, as well as a burden of pain. I believe it is a way of understanding why the Buddha said that life entails suffering. As the name suggestions, acceptance is a key part of ACT, and we tend to only get on board with acceptance of our pain when we realize that some extent of it is unavoidable. RFT helps explain why we suffer, and why various ways of trying to fight against the suffering is often counterproductive.
Research shows that even the most intelligent chimpanzees do not have as much ability as a 16-month-old human baby in this regard, and that makes us uniquely prone to both amazing success in the material world, as well as psychological suffering. The same abilities that have allowed human beings to engineer automobiles and skyscrapers and create governments are the same abilities that account for much of our fear, shame, anger, and grief.
An example from ACT of how humans create relational frames in ways animals don’t:
- “Wow, what a beautiful sunset!”
- “Reminds me of that sunset I saw with my ex.”
- “I miss him/her… she/he left me for someone else.”
- “I’ll never find lasting love.”
Such quick flights of association happen all the time, sometimes in just 1 or 2 seconds, outside of our conscious awareness, because we are so expert at connecting one thing to another thing, that we can see a beautiful sunset and then feel hopeless with just a few quick cognitive jumps, which then affect us at an emotional level.
Thinking relationally is great for survival, because it allows us to learn and imagine without direct experience. We can imagine failures and rejections that we never had, for example. This helps us avoid such failures, which is good, but in order to avoid them we first have to run mental simulations of all the ways we could fail, most of which are highly improbable. How stressful! As Mark Twain said, “I’ve seen a great many terrible things, most of which never happened.”
Humans are relating machines. We relate things to other things, experiences to meanings, meanings to objects, and objects to symbols. We track temporal relations (x happened before y), significance relations (z is more important that x), size relations (a is bigger than b), and dozens of other classes of links.
We even created writing and print so that we could relate squiggly ink lines and curves (letters, characters) to objects, events, sensations, and emotions.
We make sounds like “bark” and “meow” to connect auditory noises to actual forms like dogs and cats. A language is a very large collection of sound combinations that are mapped onto our complex experience through relationships. This makes it possible to quickly tell someone how to get to the town square from the suburbs. It also makes it possible to feel bad when we hear negative words about us or directed at us.
Animals create connections too, just far fewer than humans, generally speaking for the most part, although there are some exceptions. They use sounds to communicate, but their language is far more basic, although they do communicate and sense things that we human cannot. This makes us the apex creators and problem solvers, since creativity is largely about creating new relationships and connections between other known things. But it also makes us apex sufferers, since we can easily and instantaneously link anything pleasant, useful, or neutral, to just about anything painful, unhelpful, or destructive. And these links happen first in our own thinking processes, as in the sunset example above.
Experiential avoidance, like it sounds, is when we avoid thoughts, feelings, and bodily sensations. It is a way of defending ourselves from unpleasant experience, but it ends up limiting our options and creating greater pain and suffering for us down the road. It often increases our inner turmoil in the long term, although it can “numb us out” in the short term. It limits our options and choices for behavior, which creates more real-world problems and stress.
In ACT, the intent is to decrease experiential avoidance by increasing willingness, mindfulness, and acceptance.
The problem with solving (inner) problems
Humans are experts at solving problems in the outside world. The same ability that allows us to imagine 100 uses for a paperclip also helps us solve the problem of fixing a broken car engine, or filling out our tax forms.
ACT theory highlights the phenomenon that whatever we focus on tends to increase in significance and become “bigger” in our consciousness. This is true for both pleasant and unpleasant situations, thoughts, and feelings.
The more we try to “fix it” to avoid thinking about something, the more we think about it. If we instruct someone, “don’t think about bubble gum ice cream” they will tend to think about just that (probably a lot more than they were).
The same goes for painful thoughts and feelings about ourselves, about others, and about the world. Trying to problem-solve our way out of fear, sadness, anger, guilt, etc, may cause us to experience them with greater intensity and duration. When we resist and push away negative thoughts, they tend to push back.
In ACT, the goal is to not struggle by trying to get rid of our inner-problems, which tends to amplify them, but instead allow them to be, and eventually dissolve on their own.
Fusion is a concept and metaphor from ACT in which some experience (thoughts, emotions, sensations) becomes our reality, rather than something we observe. We might say we get fused to our thoughts, for example, similar to how metal can be fused thorough welding. This type of fusion is called “cognitive fusion.” Because all thoughts are only models of reality, it’s not good to believe our thoughts entirely. It’s more adaptive to notice them and apply some agnosticism.
Words and phrases that I use that point at the same “fusion” concept include:
- identifying with … (e.g. thoughts)
- being hooked by… (e.g. a story)
- getting lost in…
- becoming…(e.g. a feeling)
- being swept away in…(e.g. an experience)
Defusion is the opposite of fusion. It is the state of having some “distance” from our thoughts and emotions. It is also a skill of disentangling awareness from the objects of awareness (thoughts, feelings, etc), while still pointing awareness towards them.
Defusion is useful because it allows us to free ourselves from thoughts and emotions while not losing access to their utility.
There are myriad ways to classify types of fusion. “Cognitive distortions” lists attempt to do this, as do lists of “core schemas“. For example, the cognitive distortion “black and white thinking” can only negatively impact us to the extent that we are fused with black and white thoughts (i.e., believing them).
While fused with our thoughts, we are generally less creative, less in tune with reality, and more anxious/stressed.
Fusion occurs on a spectrum from very fused to very defused. For example,
- “I am depressed” (very fused)
- “I feel depressed” (somewhat fused)
- “I am feeling depression now” (slightly fused)
- “I am currently experiencing sensations that are commonly labeled depression” (not fused)
In the first statement, the thinker is fusing their identity as a depressed person with the temporary experience of feeling sensations that are sometimes called depression. As a result, they are more likely to engage in experiential avoidance in order to avoid thinking of themselves as flawed and feeling shame.
Generally, a primary goal of ACT is to decrease fusion.
There are many ways to do this, even as subtle as shifting our language a little. For example, we can add the following phrase to the beginning of any thought:
“My mind is currently creating the thought that _______”
So that the thought, “No one cares about me” becomes…
“My mind is currently creating the thought that no one cares about me.”
And the thought, “I’ll never achieve my goals” becomes…
“My mind is currently creating the thought that I’ll never achieve my goals.”
This exercise is very typical of ACT, which allows for the the thoughts to be there, as long as we attempt to look at them from an observer perspective. It’s perfectly okay to notice the negative thoughts, and there isn’t an attempt to rewrite them to something positive. The work is taking the wind out of their sails by shining light on the fact that they are primarily mental chit chat being generated by the thought-generating machine of the mind.
The opposite of experiential avoidance is known as willingness (essentially, acceptance) in ACT.
If experiential avoidance is saying “no” to your present experience, willingness is saying “yes” to your present experience.
According to ACT, willingness is like a switch, rather than a dial. A dial has gradient levels, for example, from 1 to 10. A switch is all or nothing, either on or off. Willingness is like that — it is all or nothing. You can turn the switch off and on, in effect, alternating between willingness and unwillingness with different frequencies (and in fact, this is one of the interventions of ACT), but you cannot “turn down” or “turn up” willingness. If you tell yourself, “I’m willing to experience this pain as long as it does not get over a 7” then your willingness switch is flipped on until your pain gets about seven and then switches off above the seven. There was an evaluative judgment about the pain (it is tolerable only up to a certain point), and willingness does not involve judgment. It simply involves saying an unconditional “yes” to what is.
The goal for willingness is to switch it on more often, and for longer.
ACT defines three senses of self:
- The “conceptualized” self (personality, narrative, meaning given to achievements and qualities, etc); sometimes called “ego”
- The “ongoing self-awareness” self (knowledge of your experiences in the present moment)
- The “observing” self (the difficult-to-describe, spiritual self that transcends time and thought)
The conceptualized self is the self that most people think of and behave as most of the time. This sense of self is ultimately imaginary, temporary, and uncertain. It results from judgment (evaluating ourselves as good or bad). Being too invested in this conceptualization of self creates an endless pattern of either feeling unhappy with the self (shame, depression) or worry/anxiety that we’ll lose the narrative and no longer feel good/okay.
The other two forms of self are psychologically, mentally, and spiritually healthier places to rest one’s identity, because they do not depend on our performance and factors outside of our control to stay intact. You can think of the third self as an unchanging witness of experience, and the second self as that which the third self is witnessing, but without any meaning or judgment added on to it.
ACT informs us to decrease attention and importance placed on the conceptualized self, and to nurture the ongoing self-awareness and observing self.
Mindfulness is awareness of your thoughts, emotions, physical sensations, and actions. Another definition I like is focusing on one thing at a time with openness, curiosity, and flexibility.
Mindfulness is the cornerstone of many (if not most) forms of therapy. When people come to therapy to talk about their problems, they are “slowing down” their experience in order to become more aware of patterns so as to change them in the future. I often think of a therapy or coaching session as an hour-long meditation.
Another benefit of increased mindfulness is the ability to take refuge in the peace of the present moment. Most of human suffering is caused by thoughts about the past and the future (usually regret of the past and fear of the future). When we find ourselves suffering mentally, emotionally, and even physically, it is often because we have spent far too much time in the worlds of yesterday and tomorrow, and are not focused on what is going on around us right now.
Mindfulness ties into every other concept of ACT. For example, in order to practice acceptance/willingness), one must first be mindful and aware of their current pain and unwanted experiences. In order to practice cognitive defusion (separating oneself from one’s thoughts), one must become aware of the thoughts we are fused with.
Mindfulness implies an awareness of present moment experience, but a nonjudgmental stance on that experience. Mindfulness means neither striving for, nor resisting, one’s thoughts, feelings, and bodily sensations as they unfold, moment by moment.
ACT aims at helping people live a value-centered life. A metaphor that illustrates values is a direction on a compass, such as northeast. Examples of values include friendship, family/marriage/parenting, career fulfillment, leisure, contribution/altruism, spirituality/religion, health, personal growth, and lifelong learning. Different people place varying levels of importance on different values. A goal of ACT is to help people solidify and discover their values, and make decisions to “act” based on their values rather than based on avoiding pain. The goal is to go after what you want in the long-term, despite the discomfort on the way to achieving it, rather than avoid what you don’t want in the short term (unpleasantness), at the expense of not living your values.
If values are like a direction on a compass, goals are like landmarks on a map. If you decide to head northeast, you may run into specific lakes, mountains, or valleys. Your goal may be to reach those destinations as you travel in your desired direction.
For example if your value is family, your goal may be to get married and have a child, and live close enough to your parents and extended family to where you can see them often. Another person may have the value of personal growth and education, and might move thousands of miles away in order to obtain certain educational opportunities.
While meeting our goals is uncertain (we may never reach certain destinations), living our values is always available now. While it is painful to not reach a goal, it is far more painful to walk in the wrong direction, just because that direction has easier terrain.
If experiential avoidance guides our behavior (e.g., fear of intimacy, fear of travel/moving in the above two examples), we will not be living our values and that way will certainly not meet our goals.
ACT aims to help us discover and shape our values and goals, and commit to taking steps toward our goals along the path of our values.
ACT books that can help enhance your therapy
I first learned about ACT from this book, Get Out of Your Mind and Into Your Life by Steven Hayes.
A newer book by Russ Harris, another ACT practitioner:
An audiobook series of eight sessions by Steven Hayes on ACT
Russ Harris wrote this self-help book that used an ACT approach:
A book that uses ACT to help build self-esteem and confidence:
An ACT book that focuses on healing from trauma:
Here is a quick 3 minute video that highlights a core concept of ACT: observing thoughts and feelings neutrally rather than directly intervening (as is done with CBT) by challenging them.
Russ Harris has several other similarly concise and illustrative videos on ACT concepts on his YouTube Channel.
Here are two good videos/talks from Steven Hayes, the creator of ACT.