In this article, “they/them” is used as a gender neutral pronoun to replace “he/she – his/her”.
ACT is the acronym for Acceptance and Commitment Therapy. It started in the 90’s with Hayes, Strosahl and Wilson and is a part of the latest wave of Cognitive Behavioral Therapy (CBT). CBT is based on the premise that thoughts create emotions, emotions create behaviors, and behaviors create thoughts. The goal of this brief therapy is to replace negative ideas and inappropriate behaviors with thoughts and reactions that reflect reality. CBT was developed in 3 waves. The first wave focused on the behavioral component and its objective is to modify observable behaviors. The second wave studied more specifically the cognitive component. Its goal is to modify dysfunctional thoughts to improve the emotional state or the adaptation. Then the third wave digs more into the emotional component. It seeks to highlight the importance of the experiential and emotional life, and their influence on behaviors.
ACT’s purpose is for the patient to pay attention and to work on their relationship with their emotions, cognitions and behaviors. It’s an experimental therapy, meaning that during the sessions the patient experiments with their therapist, and then try to reiterate it in real life.
ACT therapy has several therapeutic goals. Indeed, this therapy works around the patient’s suffering, and accompanies them to realize their fight against “their inner contents” constitutes a factor in maintaining suffering. To do so, ACT will use several “experiential tools”. They will allow the individual to learn how to change their relationship with their inner experience and identify what is important to them. Thanks to their psychological flexibility, they will be able to take actions in favor of a life close to what matters to them, towards valued life directions. Ultimately, the goal is for the individual to regain the possibility of choosing.
ACT is organized around 6 core processes guiding the therapy: Self as context, being present, acceptance, cognitive defusion, values, committed actions.
In the self as context concept, the goal is to differentiate whether one is judging or observing when they make a statement about themself. For example, when one says “I feel sad”, it’s a judgment, not a stated reality. It’s an interpretation one makes which could be different for someone else in the same situation. But when one thinks: “my feet are cold”, it’s an observation.
In an attempt to be less judgemental, ACT uses mindfulness. A time to reconnect with one’s breathing, and the sensations/feelings of their body. Trying to be connected to the full experiment of the here and now, and find good and positive things even during bad times. This is the being present concept. When one tries to control their emotions and cognitions, they are fighting and it only worsens the problem. It is not a sustainable solution. One may feel better at the moment, but the problem will still exist and bounce back at them. That is called experiential avoidance. During ACT sessions, the patient and their psychologist try to talk about an experiential avoidance that occured for the patient, and to observe it. With the being present concept, one is more in the acceptance of their feelings than in their avoidance.
This is strongly related to a third concept : acceptance. It’s a voluntary and intentional attitude to come into contact with one’s private experiences, whether positive or negative, without trying to deny or change them. It’s an alternative to one’s instinct of avoidance when it comes to negative thinking – or potentially negative – about experiences. The objective is to welcome by choice, in an open and caring manner, one’s experiences, in all their dimensions (thoughts, physical sensations, emotions, feelings…). (→ Acceptance is not resignation.)
Cognitive fusion refers to the habit one may have of not distinguishing their thoughts, behaviors, the experience of their senses and perceptions. Throughout this process, thoughts become reality. For example, if one thinks that they are boring and no one likes them because of it, they will act on it, and their thoughts will become reality. The goal of ACT therapy is to change the patient’s perception of their thoughts and feelings; and guide/lead them towards understanding that they are not a stated reality that could rule their life. All this in order to achieve the cognitive defusion concept.
ACT therapy considers that “all individuals have the opportunity to lead rich and meaningful lives”. However, cognitive fusion and experiential avoidance prevent the individual from moving towards their values, the fifth concept, and thus constitute factors of sustaining suffering. From this premise, and through its tools, ACT allows the individual to rediscover the potential of choosing what is important to them. Thus, it allows them to move and act towards their values, and what is fundamentally important to them. Values are considered as a direction of life, they are desired and chosen by each individual. We set goals for ourselves, objectives, which must be achieved while values give direction. Values underlie our daily actions, we cannot reach them. However, we can consider that our objectives are small steps towards our values. Going in the direction of one’s values also means accepting, sometimes, to come across unpleasant experiences . This is also how one feels fully alive.
Finally, once the patient has identified their main values, the concept of committed actions helps the individual to live a life consistent with themselves. It aims at helping patients to commit to actions that will assist them in their long-term goals.
Words we have learned :
- Commitment, digs : Engagement
- Experimental therapy : Thérapie expérimentale
- Inner : Intérieur
- Core processes : Processus fondamentaux
- Committed actions : Actions engagées
- Mindfulness : Pleine conscience
- Experiential avoidance : Évitement expérientiel
