I’m excited to introduce you to a new mode of therapy that I’ve recently been trained in and that I’ve added to my therapy practice: Acceptance and Commitment Therapy, or ACT.
I was working with a client, who I’ll call Joe. Joe is 18, a senior in high school, and came to see me for depression he was experiencing. I felt like Joe and I had a pretty good working relationship. During one particular session, Joe brought up some anxious thoughts he’d been having. Namely, he was anxious about going to college next year, and putting a financial burden on his parents, who were already struggling financially. He consistently had the thought: “I am a burden to my parents.”
I pulled out some good ol’ Cognitive Behavior Therapy (CBT) and led him through a journaling exercise, in which he wrote down, “I am a burden to my parents,” and the situation that triggered the thought (recently filling out a financial aid application). I then asked him how he could challenge the thought, or look at the evidence in favor of and against his interpretation of the triggering situation. Joe wrote down these challenging statements (“Mom and Dad love me,” “They want me to go to college no matter how much it costs”), as well as alternative interpretations of the triggering situation (“I didn’t understand all the big financial words,” “I’m the first to go to college and Mom and Dad are stressed, trying to figure all of this out too”).
At the end of the exercise, Joe looked at all he had written and smiled at me. I’ll never forget what he said: “Wow, that was helpful. Now if only I could believe the alternative thoughts!”
Although this exercise did not have the final effect I had hoped it would have (and nothing against CBT – it’s an effective, evidence-based treatment), I empathized with Joe and found myself agreeing that, yes, actively forcing our minds to believe something that is going against what they’re naturally telling us is really hard, maybe even impossible. And when we try to force ourselves to believe something, or to suppress, distract, and ignore, we often spend more time and energy not facing the distressing thought or feeling than we’d spend if we actually faced it. We end up exhausted, missing out on living our lives the way we want to live them, and, oh yeah—still anxious.
What is ACT?
In his book, ACT Made Simple, Russ Harris writes: “The aim of ACT…is to create a rich, full, meaningful life while accepting the pain that inevitably goes with it.” (p. 7) So what does this mode of therapy involve? First, it involves identifying your values and what you want your life to look like. What really matters to you? What do you want your life to stand for? Second, ACT involves mindful action, or as Harris describes: “action that you take consciously, with full awareness—open to your experience and fully engaged in whatever you’re doing.” (p.2) (To read more about mindfulness, read my recent blog post here.)
Acceptance and Commitment Therapy helps us change our relationships with our distressing thoughts and feelings so that they no longer get in the way of living our lives in accordance with our values.
Joe was a straight A student and really had nothing to worry about when it came to being accepted into college. Since money was tight in his family, he hoped that by maintaining his 4.0, he would receive a full scholarship. As a result, he found himself studying late into the night, not getting enough sleep and missing fun activities with his friends. If I were to go back and use ACT with Joe, I’d ask him to evaluate what’s most important to him in his life and the difficult thoughts and feelings that get in the way of him living in accordance with these values. My guess is, he would tell me that working hard, getting a good education, and helping his family are all important to him, as is being an involved friend and enjoying his senior year.
One element of ACT is the concept of workability. Meaning, how is what I’m doing currently helping me grow and live a vital, meaningful life? A major part of ACT is recognizing all of the things we do to convince ourselves we are getting or, at least working towards, what we want in the long-run. For example, Joe would say he’s temporarily sacrificing time with his friends for the sake of providing for his future. He’ll have time for friends and sleep later. It’s perfectly understandable for Joe to want to earn a scholarship and relieve his parents of some of the financial burden. I may ask him to consider what happens when he gets “caught up” in the thought, “I’m a burden to my parents,” or what might happen to his life in the long run if he gives all his attention to this thought and lets it dictate what he does in his life.
Why I like ACT
We live in the tension of the now and not yet. As Christians, we know we have hope in Christ, and we believe that he is with us and guides us now. But we are not physically with him yet, and we still experience suffering. Ask any Christian struggling with depression or anxiety or other mental illness, and if they’re honest with you, they will tell you that hoping in Christ gives them comfort, but does not always alleviate their symptoms. Knowing and believing that he mattered to Jesus did not take Joe’s thought of “I’m a burden to my parents away.” Even when he recognized that thought as a lie. I like ACT because it recognizes our desire to live a life for Christ, but also allows room for suffering, which is and will always be a part of the human condition, until Christ returns and makes all things new.
If you would like more information about ACT, check out this website for resources and books. Or, do not hesitate to give me a call at 314-392-2895 with any questions you may have.
Harris, R. (2009). ACT made simple: An easy-to-read primer on Acceptance & Commitment Therapy. Oakland: New Harbinger Publications, Inc.