What is ACT and what do you do during treatment?
Acceptance and Commitment Therapy helps you deal more flexibly with difficult thoughts, feelings and physical experiences, so that you can act more on what is important to you. Acceptance does not mean that you have to agree with everything.
ACT focuses on psychological flexibility
This is the ability to be consciously present, to make room for difficult experiences when it helps and to choose behavior that fits your values.
To remark
Recognizing thoughts, feelings and physical signals without them automatically determining every choice.
Making space
Not every discomfort has to go away before you can take a meaningful step. That is different from approving or acquiescing.
Follow values
Clarifying what is important and translating that into feasible, concrete behavior in daily life.
ACT has been widely researched, but does not have the same status everywhere
Guideline option: chronic primary pain
NICE recommends considering ACT or pain-specific CBT in people aged 16 years and over with chronic primary pain, carried out by appropriately trained healthcare professionals. The guideline reports benefits for, among other things, quality of life, sleep, pain and psychological burden, based on a limited number of studies.
Broader, but heterogeneous evidence
ACT has been studied for various psychological and physical problems. Meta-analyses find an average improvement in psychological burden, but populations, types, comparison groups and study quality differ. Differences are often smaller against active treatments than against waiting list or usual care.
Not a universal first choice
ACT is not automatically the recommended treatment for every diagnosis. For PTSD, for example, ACT does not automatically replace the trauma-oriented treatments that guidelines mention as the first choice.
An ACT program connects experiences to behavior in daily life
There is no universal number of sessions or one fixed exercise order. The form can be offered individually, in a group, digitally or as part of rehabilitation.
Investigate jamming
You look at which struggles, attempts at control or avoidance provide relief in the short term, but which take you further from important activities in the longer term.
Clarify values
You investigate what you find important in, for example, relationships, health, learning, work or self-care. Values are directions, not tick-able goals.
Learn to respond differently
With conversations, metaphors and experiential exercises you learn to see thoughts more as thoughts and bring attention back to the present moment.
Investigate readiness
You practice making room for discomfort that can come along with a valuable step. Borders, safety and medical care remain relevant.
Choose small actions
You translate values into concrete behavior that suits your capabilities, for example making contact, planning breaks or resuming an activity in a measured manner.
Evaluate and adjust
You not only look at complaints, but also at functioning, avoidance, flexibility and steps towards your values. A plan that is overloaded is adjusted.
Exercises can seem simple and yet be confrontational
Attention exercises, metaphors, repeating a thought out loud or exploring avoidance can provide distance and freedom of choice. They can also evoke sadness, frustration or the realization of what the complaints have cost.
ACT usually requires practice outside of sessions. That should be feasible and goal-oriented. An assignment that ignores pain, exhaustion, or insecurity is not evidence that you are “not accepting enough”; discuss taxes and boundaries.
“Not: I have to like this. But: what helps me to make a conscious choice?”
Psychological flexibility is the central model, not a fully proven exclusive cause
What research supports
Research shows that ACT is on average associated with less psychological inflexibility and more flexibility, and that such changes are associated with a decrease in psychological burden. This supports the intended change processes.
What remains uncertain
A correlation or statistical mediation does not prove that flexibility is the only effective mechanism. The treatment relationship, expectations, practice, behavioral activation and other shared therapy factors can also contribute.
Acceptance is not resignation and not denial of causes
Acceptance within ACT
Consciously making space for thoughts, feelings or sensations that are there now, when futile fighting further narrows your life. You can set boundaries, ask for help or receive treatment at the same time.
What you should watch out for
ACT should not be used to psychologize real medical signs, discrimination, insecurity or inadequate care. An explanation and appropriate diagnosis remain important.
Questions that make an ACT proposal concrete
Is it about functioning, pain, fear, mood, avoidance or something else?
Ask for individual, group, digital, duration, frequency and expertise.
Ask whether ACT is included in the relevant guideline and what alternatives are available.
Discuss dosage, medical limits, rest and signals to adjust an exercise.
In addition to complaints, also record concrete goals regarding functioning and quality of life.
Agree on an evaluation moment and what will happen if the results are unsatisfactory.
Frequently asked questions about ACT
Does acceptance mean that you have to give up complaints?
Does ACT try to eliminate complaints?
Has ACT been proven for every psychological or physical complaint?
Reliable explanation and help
- NICE guideline for chronic primary pain - recommendation to consider ACT or pain-specific cognitive behavioral therapy in people aged 16 years and over with chronic primary pain.
- Cochrane: psychological therapy for chronic pain - systematic assessment of, among other things, ACT for chronic pain, with attention to effect size, study quality and side effect reporting.
- Guidelines database: explanation about ACT - Dutch guideline appendix on goals, core processes and points of attention for ACT for persistent physical complaints.
- Meta-analysis of change processes at ACT - research into psychological flexibility and inflexibility as possible change processes, with explicit recommendations for further research.