Dr Nic Hooper, senior lecturer in psychology at UWE and co-author of The Acceptance and Commitment Therapy (ACT) Journal, spoke with Mental Health Today about ACT in theory and practice and also about his recently published 12-week journal, discussing how it can help people navigate the sometimes choppy waters of their lives.
Imagine that you're in a tug-of-war with a monster that represents the unwanted thoughts and feelings that exist in our daily lives. And between you and the monster, there is a bottomless pit that threatens to engulf you.
In this scenario, you would instinctively pull as hard as you can on the rope and attempt to drag down and win against your depressive or anxious daemons. But, as hard as you try, the monster is too strong; it is seemingly impossible to drag it down.
Why can’t you win against your monsters? In Acceptance and Commitment Therapy (ACT), the answer would be that there is no gifted life without these problems – they are part and parcel of the human experience. So, what can you do? You can drop the rope and do something that matters. You do not need to continue the never-ending struggle; you can move towards something meaningful whilst carrying your unwanted thoughts and feelings with you.
- See also: 'Rules for living - what is Cognitive Behavioural Therapy?'
- See also: 'The examined life and the work of psychoanalysis'
What is ACT? How does its approach differ from other psychotherapies?
“Many therapies have the same basic aim, which is to take away people’s unwanted thoughts and feelings.”
Dr Hooper explained the uniqueness of ACT’s approach to psychotherapy and mental health is that the therapy “doesn’t try to change unwanted thoughts and emotions, it doesn’t try to take them away. Instead, it tries to help people relate to their unwanted thoughts and feelings in a more flexible way.”
In ACT, the goal isn't symptom reduction (although that might be a positive side-effect) or to exorcise the parts of our psyche that we find unbearable or hard to experience. The aim is to reduce their influences on our lives, engage with who we are as an individual, and discover what is personally meaningful to us – asking ourselves what values we have? What is important to us at this moment?
Promoting psychological flexibility
“The point of ACT is to develop what's called psychological flexibility, which is the ability to accept our unwanted thoughts and feelings, and not to fight with them as monsters that we need to get rid of, while keeping our feet moving towards what’s important”, Dr Hooper added.
Psychological flexibility aims to situate us in the present and asks us whether we can persist with or change our behaviours, realise our values fully, foster a meaningful life, and accept the inevitable trials and pain that comes with it.
The Hexaflex model of ACT establishes psychological flexibility through the six core processes of:
- Acceptance: Practicing non-judgmental awareness of internal and external events.
- Cognitive Defusion: Learning to notice our thoughts from a distance.
- Mindfulness: Thinking in the present moment.
- Self as Context: Practicing contact with the observing self.
- Values: Defining what is most important to us at the current moment.
- Committed Action: Taking concrete steps towards our values.
Dr Hooper explained: “Psychological flexibility is the overarching thing that ACT is trying to achieve. One of the processes would essentially be mindfulness – contact in the present moment. And another process is called self as context, meaning over time, we build stories about who we are, and often those stories can serve to imprison us.”
“Also, if you want to do anything worthwhile, you're going to have discomfort; so, you've got to develop this ability to act in the face of discomfort, to keep your feet moving. And that is what we mean by acceptance.”
Fundamental to alleviating our unwanted thoughts and feelings is Cognitive Defusion, which requires noticing our thoughts, rather than spiralling downwards with them; seeing these sensations for what they are, not as they seem to be. In practice, Defusion involves distancing and disconnecting ourselves from the constant flashes of emotions that so easily spill over and become uncontrollable.
The technique helps to liquefy thought patterns that have become solidified barriers to our development; thoughts like ‘I am always anxious’, or ‘I am depressed’, are reframed as 'I am telling myself that I am...’, or ‘I notice that I am feeling… at the moment’ – undoing and transforming the concrete into the ephemeral.
Dismissing anxious avoidance and enacting our values
It is almost cliché, but the moment sometimes passes us by in our anxiety; even if we value our job or relationships, that critical business meeting can cause several sleepless hours, and the dread of some social event may cause us to internally rehearse some ill-thought-out excuse in advance.
To cope with feelings of inadequacy and anxiety, we might take two steps back rather than a step forwards by not exposing ourselves to situations even if they have meaning to us. The sweaty palms and racing heartbeats become barriers that are solved through the short-lived relief of doing something else, although at the expense of being no closer to who we want to be.
Consequently, an essential element in ACT is the identification of personal values and the discovering of what matters to us as individuals, and then the taking of effective action to enact those values and actions, whilst also practicing acceptance, defusion, self-as-context and mindfulness to stay present and exist with our tricky thoughts and emotions.
Dr Hooper illustrated this point: “Imagine you're standing in front of the changing room mirror at a swimming pool, and imagine that you feel yourself to be overweight. You have the thought: ‘I'm not going into that pool, if I go out there, I'm going to feel awful, and people will laugh at me because I'm so big.”
“When you're at that choice point, if you turn around and go back home, the first thing you're going to feel is relief. You're going to feel great about it. But the next day, when you wake up, you would have moved no closer towards this thing that is important to you.”
“Maybe it's alright, to have those feelings, to pick them up, to look at them and to interact with them, and to put them in our pocket and to take them with us while we do this thing that's important. That’s what ACT is all about.”
- See also: 'Being free - the liberation of Psychological Flexibility'
- See also: 'Validation – before there is change a person must be heard'
A journal that is a journey
The Acceptance and Commitment Therapy (ACT) Journal is a 12-week workbook designed to create lasting change in the user’s life. Weekly short, accessible exercises and reflective metaphors will guide the reader to identify what matters to them and give them the tool of psychological flexibility to act to achieve their personal goals.
Dr Hooper said that it is not a cookie-cutter approach, but rather the journal utilises ACT to find out what is significant in the readers' lives by “being asked, what are your values? What is important to you in the world? What can you do to move towards those things?”
The journal's flexibility means that it can be used as a companion to therapy or as a standalone introduction to ACT and psychological flexibility, which can also serve as a reference for the thoughts and feelings you were having over the 12-week course.
The goal of ACT is liberation from thoughts, feelings and sensations that weigh people down and act as barriers that prevent them from achieving their goals. The journal aims to begin that journey of liberation; you no longer have to struggle against yourself or your monsters, you can have them while you are moving towards something that matters to you, and live a life full of meaning as a result.
As Dr Hooper said: “It's a liberating feeling to know that your thoughts and feelings no longer have to control your behaviour.”