What is Acceptance and Commitment Therapy? Is Acceptance and Commitment Therapy (ACT) an empirically supported treatment for any disorders?
Acceptance and Commitment Therapy (ACT) is a scientifically based and supported treatment for many mental health and behavioral problems. ACT is sought after in NYC because of its strong foundation in science. New Yorkers are passionate advocates for themselves when it comes to identifying expert psychologists who utilize scientifically supported treatments. While ACT is somewhat new, it is well on its way to becoming one of the most evidence based treatments for mental health, which is why many people in New York want their therapists to be well trained in this form of Behavior Therapy. This therapy is considered to be in the Third Wave, the newest set of therapies. The first wave was behavioral therapy and the second, Cognitive Behavior Therapy (CBT).
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While ACT is newer than traditional CBT or certainly psychodynamic therapy, it has been with us for more than two decades. And its foundation is rooted in rigorous scientific research.
ACT has been scientifically shown to treat:
• work burnout,
• Post-traumatic Stress Disorder (PTSD),
• heroin abuse,
• marijuana abuse,
• worksite stress,
• panic, and many other issues.
• It has been used successfully to treat obesity and smoking.
So if your health could be improved by a successful weight loss program or smoking cessation, ACT could be right for you.
Acceptance and Commitment Therapy (ACT), like its name, has two major components. The first is acceptance.
NYC residents have plenty of opportunities to learn about acceptance in the plethora of yoga studios and meditation classes offered in New York. Regardless of where you live though, you have likely been bombarded in recent years by media accounts of the benefits of mindfulness and meditation. For ACT these are encompassed in the acceptance part of the treatment. Clients learn mindfulness and acceptance skills to develop the capacity to experience and better tolerate intense, difficult thoughts and feelings. Worrying, rumination, depression, anxiety, guilt, shame, etc. can wreak havoc on our lives.
With ACT, you can learn how to experience these without suffering. In ACT, suffering is defined not by having the pain of a negative emotion or aversive thought. Suffering is resisting or rejecting those experiences, the pain.
While an ACT therapist might certainly encourage a daily meditation practice, ACT contains many other techniques that aim to get you the same benefits of a long meditation practice in a shorter time frame.
Before discussing the second aspect of ACT, behavioral change, let me briefly touch on how ACT’s scientific foundation might make it more time efficient and flexible.
ACT, more than many forms of Cognitive Behavior Therapy (CBT), has scientifically supported the processes or mechanisms by which the techniques work. So for instance, an ACT therapist can develop a specific technique designed to “hit” the same mechanism of change that meditation does.
Maybe sitting for 60 minutes meditating every morning before work is your thing. If so, great. But if not, an ACT therapist will be able to suggest and guide you through many exercises that are designed to enhance some of the same processes that a formal meditation would.
The number and variety of techniques allow for great flexibility and customizability based on your preferences and schedule.
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Now back to the second component, commitment.
So the first component involves you learning how to create greater bandwidth to experience difficult thoughts and painful negative emotions without suffering, the second component is developing the ability to behave in goal directed ways in a variety of circumstances.
Who couldn’t benefit from more of that in your life? What does that mean? That means after clarifying what is most meaningful to you in the long-term, specific goals are set.
For many of us, we frequently deviate from the path that leads directly to our goals. Why? Usually because we lose motivation, become too fearful, are overwhelmed by doubt, get frustrated, and find ourselves procrastinating, drinking, overeating, shopping too much, isolating, or grabbing on to some fantasy as a way to escape.
ACT can teach you how to stay committed to the very actions that are directly in line with the most efficient path to your goals.
ACT can look very different depending on the client. The techniques that are used vary greatly. They can be very behavioral, where making specific plans to carry out very overt behaviors while experiencing doubts could be assigned. They can often be experiential, in which case they could sound like something you might hear at the beginning of a meditation or yoga class.
But in every case, these techniques are targeting the six ACT processes that will allow you to become more satisfied with your life by increasing the likelihood you are going to take action towards your goals(remember ACT is pronounced “ACT” not “A, ” “C,” “T” for a reason; action is critical—this is a behavioral therapy).
You are going to live your values more and more . And science has told us that when you do this, your life is more meaningful and satisfying. That is what ACT is about. And with ACT you get decide what you want your life to be about, and then get to living it more effectively.
How can Acceptance and Commitment Therapy (ACT) be helpful?
This is where ACT differs from many other therapies. This is also where some of you may freak out and decide ACT isn’t for you.
As we just discussed, ACT addresses both internal experiences (thoughts, feelings, and physical sensations) and behaviors. But it addresses them differently.
Living a more satisfying and meaningful life is the goal.
Science tells us that consistently behaving in goal directed ways, when those goals are congruent with our values brings us more satisfaction and meaning. So in ACT, you are going to learn to do more and more of that.
Here is the catch. Many of us and many therapies, believe the way to get more of those goals accomplished is by getting rid of our doubts, worries, and negative emotions, so we can take action. ACT stands that notion on its head. ACT argues and teaches clients to learn to approach those scary situations, not reduce the fear first.
Are there any things in your life you have avoided doing because you were anxious?
Any conversations you have put off having because you knew how angry you’d become?
Any paths you decided not to take because you doubted yourself?
Any kind of life you wanted to live, but didn’t give it enough of a try because of who you thought you were?
Most of us know that there are many projects we haven’t tackled because we are waiting for the right time.
Have you been putting things off, putting your life off—waiting until things are more calm? That could work for you. And at the same time, many of us know these are rationalizations—our life becomes waiting, and that path, that life, will never be ours if we wait for the doubts and fears to subside.
ACT is helpful by enabling you to ACT with your worries, self-doubts, and anxiety. We all know deep down that while sitting on the sidelines watching others, or procrastinating on that work task, or putting off that entrepreneurial side project temporarily keeps our anxiety away; two things usually happen.
First, we get more anxiety or other negative emotions like regret, disappointment, self-anger, or depression in the future because now time has passed, and we haven’t done what is important. And second, we miss out on the positive satisfaction, excitement, and learning (whether we completed or succeeded at the task). We pay at least double in the future, for the short-term benefit of avoiding the present moment discomfort.
That is what ACT is designed to change.
Most of us show up to therapy with something different in mind. You go to a therapist to decrease anxiety. You go to a therapist to learn that you really are a success and you won’t fail. But on some level, most of us probably realize that the things that we value the most, the things that can bring the greatest amount of joy and love, are also the things that bring the possibility of the greatest pain.
Anything we love, we can lose. People die, relationships end, businesses fail, people stumble, etc. How can you have something important without considering that it can end? How can imagining it ending not bring with it some negative emotion or aversive thought? The two cannot be separated. And how can we guarantee safety or success?
So we have a choice. Do we learn how to approach and strive for the life that brings us the most meaning, love, and satisfaction that also contains fear and possible regret, disappointment, and loss? Or do we sit back, on the sidelines, postponing, rationalizing, waiting, in the grey. That is up to each of us—how do you want to act?
For which emotional problems is Acceptance and Commitment Therapy (ACT) the best form of intervention?
- Anxiety — clients have learned how to get things done even when feeling anxious, and can stop letting worries take over their lives
- Eating Disorders – clients learn how to more effectively cope with body image issues, difficult thoughts, and learn how to engage in healthy eating, exercise, and self-care behaviors
- Chronic Pain – clients have improved functional ability, improvements in pain intensity and pain interference, had fewer sick days, decreased disability, had reductions in pain-related anxiety, and pain-related depression symptoms, and decreases in cognitive catastrophising
- Panic – clients have been shown to reduce panic attacks significantly with as few as ten sessions ACT has scientific support for the treatment of anxiety, panic, chronic pain, depression, eating disorders, confidence, and even psychosis. While all of these issues are different, there are common elements.
From an ACT perspective, you can learn to behave better, by getting better at feeling your feelings and having your thoughts (not letting your thoughts “have” you). And largely this is the approach for each of these problems.
The content of the thoughts, the kinds of emotions, and the behaviors that are being avoided or need to be taken for someone who is socially anxious may be different from someone with chronic pain or an eating disorder.
But in each case there is overwhelming scientific evidence that if you are suffering with depression, anxiety, chronic pain, eating disorders, or even psychosis, there is likely a high level of what is called experiential avoidance taking place.
This means that you are “struggling” with specific thoughts, feelings, or sensations and working hard to not have them. Maybe you are distracting yourself, maybe you are drowning the feelings with alcohol or food, maybe you are trying to sleep as much as possible, work all the time, or be overly social.
Regardless of the tactic, in most cases you are falling off the path to the satisfying life you want. Your “struggle” with your mind or your heart or your body, is keeping you from heading directly toward your goals. In fact you might be walking backwards, making your problems worse, creating new ones, and/or moving your goals farther and farther away.
ACT helps clients with chronic pain learn to stop using distraction techniques that take their attention away from painful sensations. This may sound paradoxical (it is) or even cruel (hopefully it isn’t). What research has shown now for decades is that when you are able to put your attention on those painful sensations more, instead of distracting from them, you have more control over your behavior.
In experimental studies, participants are able to do difficult things, e.g., tolerate cold temperatures for longer by doing this. In treatment studies, chronic pain patients who learn to put their attention on the pain, instead of distracting from it, decrease their depression symptoms, get out of the house more, miss fewer days of work, and become more satisfied with their lives. These are the outcomes we are striving to achieve.
While the initial goal is not to distract from the “depression,” as a side effect many times the negative emotions may be reduced. But from an ACT perspective, that is not the initial goal. You improve your life by feeling better (experiencing better) and thereby behaving better, not by feeling better (reducing contact with or reducing the intensity or duration of the negative feeling) and then behaving better.
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ACT therapists may think the latter will take too long, or will never happen—you will just be waiting to behave. Nonetheless, with ACT, some times if you keep approaching things that scare you and accomplishing your goals, some of your anxiety might just subside, and you will likely experience a lot more joy and satisfaction, but dropping the anxiety isn’t a prerequisite, just a nice possible side effect (much better than typical side effects like weight gain, or sexual dysfunction).
How to find a good Acceptance and Commitment Therapy in NYC
Finding the best ACT therapist in NYC for you, is really finding the right fit with an ACT therapist. And while New York presents some unique triggers for frustration and anxiety, finding the right fit for a therapist is the same wherever you are.
Aside from having lots of wonderful restaurants, tourists, parks, and pigeons, New York also has lots of psychologists and therapists. This is both good and bad for those looking to find the best therapist.
Unlike some areas of the country where you can’t find anyone trained in a particular kind of Cognitive Behavior Therapy (CBT) or other psychotherapy, New Yorkers can find hundreds of people claiming (some accurately, some not so much) to be well trained in every type of CBT, hypnosis, yoga-therapy, coaching-therapy, etc. This is good in that the right therapist is likely in New York for you. This is bad, or at least challenging because it will likely require some research and vetting up front to weed out people who not be an optimal fit.
(For a detailed list of questions, you can read this overview for finding a therapist in NYC).
You can ask, “What kind of supervised training have you received in ACT, CBT, or behavior therapy for the issue I have and who provided that training?” “What kind of certification or credentials did your supervisor have?” Is there scientific research showing that ACT works for this kind of issue, and if so, can you briefly describe one or some of the studies to me?” These three questions are just some possibilities.
I think the first two are very important in terms or the answers. I do believe there are plenty of good ACT therapists who may not know the scientific research that well. But I think it is still important to ask, because if he or she doesn’t know it, you want a clinician who is willing to say that non-defensively and validate for you that it is an important question.
He or she may then say he/she can find out, or while not knowing the research specific to the anxiety you have about one particular trigger, you could discuss the research on anxiety about something very similar that likely could be used as a comparison. The main thing is that there is an openness and way of relating that helps to make you feel comfortable that this is someone who can honestly acknowledge not knowing something and can skillfully handle a situation like that.
Steps for signing up in Acceptance and Commitment Therapy in NYC
- Step 1: Trusted Referral Source. To find the right ACT therapist in New York, first see if anyone you trust (and are comfortable asking), can recommend an ACT therapist. This could be a friend or family member, or another health care professional, e.g., your internist or psychiatrist.
- Step 2: Question and Assess. Realistically, even in New York, few people are well educated about ACT, or even CBT. Many professionals even claim to practice ACT and CBT, but unfortunately they may only have been to a workshop, read about it lightly, or have covered it in graduate school. Many times these well meaning professionals are endorsing the right treatment for your problems, but may not have the expertise to utilize the techniques. Therefore once you have some names for ACT Therapists from either a trusted source, or you conduct an internet search, it is critical to ask a number of questions by phone (and then assess how things go in the first few appointments before committing to a full course of treatment).You want to ask questions that give you a sense of the ACT therapist’s knowledge of the therapy, experience using the therapy with your issues, understanding of the research supporting ACT for your particular issues, and how he or she relates and communicates with you. And while it may not be reasonable to expect a psychotherapist has time to give away 30 minutes to everyone who calls, he or she should be willing to speak for a few minutes to answer a few questions.
- Step 3: Schedule the Appointment. Once you have interviewed a few ACT therapists by phone, select one, and call to make an appointment.
- Step 4: Save Time. You may want to ask if completing any questionnaires or keeping any behavior logs in advance of the session could be helpful.
- Step 5: Understand Financial Policy Commitments. You also want to ask what the cancellation policy is in case you are sick or otherwise kept from the appointment.
- Step 6: Insurance Questions. If using insurance is necessary, you want to ask whether or not the therapist is in-network, and you also will likely want to call your insurance carrier to know if the therapist isn’t in-network, if your plan has out-of-network coverage. Out-of-network coverage typically means that your plan will reimburse you directly for a percentage of what you have paid to the therapist, e.g., 50%, or 80%. Again, it is a good idea to know all of this in advance, if finding out it isn’t covered would be upsetting to you. The last thing you want is to become more anxious or distressed because you are out money you don’t have for therapy you don’t want or to have found a therapist that can help you and that you like, but you don’t believe you can afford to continue to see. So do what you can to get the answers you need ahead of time.
- Step 7: Ongoing Assessment and Advocacy. As mentioned earlier, continue to assess what you think and feel about the work you are doing, the progress you are making, and the professional relationship. Assertively ask the psychologist or therapist about what is to be expected, what interventions and models are being used, and what techniques will be used in the future. While you want an expert to be determining the clinical course, this is a collaborative process. You want the therapist to welcome this kind of advocacy and dialogue, never coming off as defensive. If you are continue to be pleased with the relationship and progress you may even decide to tackle other issues in your life that aren’t as significant, once the presenting problems have been tackled. Or you can simply stop or taper your sessions now that your problems have vanished or become manageable. Hopefully in the process you have developed skills that you can now use on your own to deal with these or other problems if they come up in the future. That is when you have really gained value from therapy.
By all means if I can be of help, please feel free to contact my private practice or New York Behavioral Health where I am the clinical director. The staff there all utilize ACT and we will be happy to answer questions about ACT or schedule an appointment with a staff member there to help you.