“The only way out is through.”Robert Frost
What if you were in a tug of war with a monster and there was a big pit in between you? No matter how hard you pulled, eventually you would lose and fall into the pit because the monster was much stronger.
What choices would you have in this situation? Should you continue to pull and fight until your inevitable doom? What would happen if you decided not to fight to the death, dropped the rope and walked away?
Acceptance and Commitment Therapy (pronounced as one word, “ACT”) is an empirically-based psychological intervention. It’s based on the premise of psychological flexibility that encourages us to look at our challenges through this lens.
What element of choice do we have with our suffering? How do language and context contribute to making humans suffer more psychologically than any other species?
How Does ACT Help Anxiety?
ACT practitioners believe that language, which is invaluable, has the ability to contribute to feelings of misery through the ways we process it in our minds. This is based on relational frame theory (RFT), which explains the human ability to create bidirectional links between things.
We don’t just know a dog is an animal. We also, depending on our experience with dogs, have positive or negative pictures that come in our minds when we think of the word “dog” based on those experiences.
For example, if I was bitten by a dog once, I might be afraid of dogs. When reading the word “dog”, I could visually represent that experience in my mind. Therefore, I might experience negative emotional and physical feelings as a result.
Conversely, if I had a dog I loved, I could conjure that picture in my mind. I would experience joyful or calming feelings that come up as a result of hearing or seeing the word “dog”.
Either way, words have different meanings for all of us. Ultimately, their meanings are based on more than just their simple definitions.
How Does ACT Help Us Through Pain?
ACT practitioners have the existential viewpoint that human pain is inevitable. All of us will experience shame, doubt, fear, anxiety, embarrassment and/or humiliation at some point in our lives.
Every one of us is certain to lose loved ones if we are fortunate to live long enough. Considering this viewpoint, the concept of running from our pain is futile. It ultimately only amplifies it by creating the expectation that we should be able to find a way to avoid something that is guaranteed to occur.
The ACT framework operates under the premise that psychological flexibility can increase. The figure below demonstrates the understanding of how we can implement acceptance practices in our lives. We can work toward committing to and achieving a values-based lifestyle.
Acceptance: Allowing unwanted thoughts, feelings or urges to come and go without struggling with them.
Cognitive Defusion: Separating our thoughts from reality (ie: looking at our thoughts not from them).
Self-as-Context: Separating ourselves from the roles we embody, our histories, attributions, and/or dispositions.
Contact with the Present Moment: Mindfulness, or being aware, through paying attention, on purpose, in the present moment, non-judgmentally.
Values: The life direction you choose and ultimately what you want your life to be about.
Committed Action: Setting goals in line with your values and working toward achieving them to move in the direction you chose.
The ultimate goal of ACT is to help clients build psychological flexibility in order to live their chosen values-based lifestyle which will incorporate all of these factors. It is a modality that works with many diagnoses and is especially relevant to anxiety.
Due to its emphasis on language and context, ACT therapists often use metaphors to help clients understand some of the concepts and work towards positive change. Below, I will explain several popular metaphors used in ACT for anxiety. However, there are many more and ACT practitioners use exercises as well as other techniques in practice with their clients.
CHINESE FINGER TRAP
What happens when you pull away from a Chinese finger trap? Your fingers get stuck! It becomes uncomfortable and harder to get out. Think of your anxiety as that trap.
What happens if you lean into it? It may not go away completely but you will create more wiggle room. Next time you are feeling anxious, visualize this Chinese finger trap. Work toward creating more space for yourself within those challenging emotions.
When you hear the word “quicksand”, what thoughts do you have? I imagine it might be sinking and possibly fear. Do you know what happens when you try to struggle to get out of quicksand? You sink into it more quickly. This ACT metaphor encourages you to think about exposing more of your body to the quicksand by lying back and almost attempting to float on it.
You will be more exposed, but ultimately, it will be easier to get out. It is important to remember that while it may be very uncomfortable and scary to sink into quicksand, it is unlikely that you will drown in it. Click here to watch a guided relaxation video based on this metaphor and substitute the word “anxiety” for “quicksand”.
UNWANTED PARTY GUEST
Have you ever been to a party that would have been great were it not for that one unwanted guest? Whatever the reason, did that person dampen your ability to enjoy your time even though there were so many other people you could have talked to or focused on instead? Sometimes, when we fixate on the negative, no matter how valid it may be, we miss out on all of the opportunities around us.
This metaphor encourages you to think of your anxiety as that unwanted guest. Instead of trying to remove them or remove yourself from the party because they are there, only acknowledge them. Focus on all of the other pleasant or possibly even wonderful people around you.
Eventually, you may not be so bothered by that unwanted guest anymore. Either way, their presence won’t prevent you from experiencing and enjoying the party too.
Compare your struggle with anxiety or pain to a baby pet tiger. It seems harmless at first. Maybe it can even protect you someday. Now, imagine the behaviors you use to control your anxiety, typically experiential avoidance, as the red meat you feed that baby tiger.
The more you feed it, the bigger it will grow. Eventually, the tiger will become much bigger and stronger than you. The more we use avoidance strategies, the stronger our anxiety becomes, and the harder it is to control.
We get very caught up in our thoughts to the point where we actually believe they are true. We have learned to think a certain way through language, reasoning, problem-solving, and conditioning. Often, our thoughts are very didactic. We either agree with and believe everything in our heads or, if we have had trouble with those thoughts in the past, may have learned to disagree with and challenge them.
In ACT therapy, we’re taught to jump off the train from time to time. We don’t necessarily have to agree with or disagree with our thoughts, we can acknowledge they are there and take a break from them, especially if they are unhelpful. This video can help you visualize the sushi mind train. Think about observing your thoughts as though you are not fully connected with them. You may like, dislike or even feel neutral about some of them. Either way, you can separate yourself from them every once in a while by hopping off the train.
In ACT therapy you will be encouraged to consider the possibility that there is a real alternative to your struggles. It is important to accept the reality that avoidance strategies will not work to ease your suffering.
It is also important to have self-compassion and recognize how hard you have been trying to deal with your pain. You shouldn’t blame yourself for not being able to make avoidance strategies work. If you are willing to accept the alternative and practice acceptance, instead of trying to feel better, you may ultimately learn to feel better.
Steven Hayes is the founder of Acceptance and Commitment Therapy and has many books on the topic. The following resources were used to put this information together:
- Acceptance and Commitment Therapy: The Process and Practice of Mindful Change by Steven Hayes, Kirk Strosahl and Kelly Wilson
- The Big Book of ACT Metaphors: A Practitioner’s Guide to Experiential Exercises & Metaphors in Acceptance & Commitment Therapy by Jill Stoddard and Niloofar Afari.
- Get Our of Your Mind and Into Your Life by Steven Hayes with Spencer Smith