Note: This is part one of a two-part post.

When our anxious thoughts interfere with our ability to engage with the world around us, we quickly become overwhelmed, driven by fear of what might happen instead of a desire and willingness to experience each moment as it unfolds. Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults, or 18.1% of the population every year. While anxiety disorders are highly treatable, estimates suggest that only 36.9% of those suffering receive treatment.

Several therapies are particularly effective in addressing anxiety, including, acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), exposure therapy, and dialectical behavior therapy (DBT). Acceptance and commitment therapy, or ACT, helps individuals create a rich, full, and meaningful life, while accepting the pain that inevitably accompanies it. Through the utilization of mindfulness techniques and goal-directed or values-based behavior, clients can learn to reduce the influence and impact of painful thoughts and feelings and take steps that enrich their quality of life rather than diminish it.

In this post, we’ll explore what often leads us to feel stuck and the six core therapeutic processes of ACT. In part II, I’ll share who ACT is most helpful for, and some exercises you can do to begin implementing strategies from ACT in your own life. Without further ado, let’s get started!

Why Do We Suffer?

ACT proposes that the cause of most suffering is a result of two psychological processes: cognitive fusion and experiential avoidance.

Cognitive Fusion

Have you ever felt like you can’t shut off your mind, or that instead of controlling your thoughts, they control you? Cognitive fusion refers to getting entangled in our thoughts or holding on to them too tightly. When we fuse with our thoughts, they dominate our behavior. We become so caught up with our mind’s stories, we’re not even aware that we’re thinking.

As humans, we dwell in two different worlds. When we’re born, we take in the world through our five senses: the world that we can see, hear, touch, taste, and smell. As we grow older, we learn to think, and spend more and more time in the world of language. Fusion means we’re stuck in the world of language and become so preoccupied by the words and pictures running through our mind that we lose contact with the world of direct experience.

In a state of fusion, a thought can seem like:

• The absolute truth
• A command you have to obey or a rule you have to follow
• A threat you need to get rid of as soon as possible
• Something that’s happening right here and now even though it’s about the past or future
• Something very important that requires all your attention
• Something you won’t let go of even if it worsens your life

In a state of defusion, you recognize that a thought:

• May or may not be true
• Is not a command you have to obey or a rule you have to follow
• Is not a threat to you
• Is not something happening in the physical world
• May or may not be important –- you have a choice as to how much attention you pay it
• Can be allowed to come and go on its own without any need for you to hold on to it or push it away

Experiential Avoidance

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Experiential avoidance means trying to avoid, get rid of, suppress, or escape from unwanted “private experiences”, or thoughts, feelings, memories, images, urges, and sensations.

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Experiential avoidance means trying to avoid, get rid of, suppress, or escape from unwanted “private experiences”, or thoughts, feelings, memories, images, urges, and sensations. While doing things to avoid troubling thoughts and feelings may initially provide temporary relief, the long-term result is often more pain and suffering.

For instance, if you become anxious in social situations, you may try to avoid those feelings by not going out. While this is certain to alleviate your anxiety in the short-term, the future consequences, such as isolation and limited interaction with others, can be harmful.

The greater value we place on avoiding what makes us uncomfortable, the more we develop anxiety about our anxiety. A large body of research shows that higher experiential avoidance is associated with anxiety disorders, excessive worrying, depression, poorer work performance, higher levels of substance abuse, lower quality of life, high-risk sexual behavior, borderline personality disorder, greater severity of PTSD, long-term disability, and higher degrees of overall psychopathology.

Now that we’ve talked about the two primary causes of suffering, let’s take a look at how ACT can help us be more mindful and live by our values.

Key Terms

Mindfulness

Mindfulness means paying attention with flexibility, curiosity, and openness. It involves bringing awareness or paying attention to your experience in this moment. Even if your experience is difficult or painful, you can be open to it and curious about it instead of running from or fighting with it. Mindfulness also involves flexibility of attention: the ability to consciously direct, broaden, or focus your attention on different aspects of your experience.

Valued Living

Valued living means taking action, on an ongoing basis, that is guided by and aligned with core values.  

Six Core Therapeutic Processes

The six core therapeutic processes in ACT are:

1. Contacting the present moment
2. Defusion
3. Acceptance
4. The observing self
5. Values
6. Committed action

As we go through them, I’ll also note in parentheses the problem areas each one addresses.

1. Contacting the Present Moment: Be Here Now (Dwelling on a conceptualized past and future)

When we’re out of touch with our here-and-now experience, we cling to a conceptualized past and future: we dwell on painful memories and ruminate about why things turned out the way they did; we fantasize about the future, worry about things that haven’t happened yet, and concentrate on all the things we have to do next.

Contacting the present moment means being psychologically present: consciously connecting with and engaging in whatever is happening in this moment. We bring our awareness to either the physical world around us or the psychological world within us, or to both simultaneously, without becoming consumed by our thoughts or operating on automatic pilot. 

2. Defusion: Watch Your Thinking (Cognitive fusion)

Defusion refers to learning to step back and separate or detach from our thoughts, mental images, and memories. Instead of getting tangled up in our thoughts, we step back and observe them. We see them for what they are – nothing more or less than words or pictures.

3. Acceptance: Open Up (Experiential avoidance)

Earlier we learned that experiential avoidance often has negative long-term consequences, even though in the moment, it can provide a tremendous sense of relief. Acceptance means opening up and making room for painful feelings, sensations, urges, and emotions. Instead of fighting them, resisting them, running from them, or getting overwhelmed by them, we give them some breathing room and allow them to be as they are. This doesn’t mean liking them or wanting them, but simply creating space for them.

4. The Observing Self: Pure Awareness (Attachment to the conceptualized self)

We all have a narrative about who we are – it includes our name, age, sex, and cultural background, in addition to descriptions and evaluations of our roles, our relationships, our strengths and weaknesses, our likes and dislikes, and our hopes, dreams, and aspirations. When we hold this story lightly, it can give us a sense of who we are and what we want in life. But if we cling to this story too tightly, and start to believe that we are the story, it becomes problematic. For instance, we might begin to believe that we’re bad, worthless, hopeless, unlovable, ugly, or incompetent, instead of recognizing that we’re separate from our self-description.

Most of us are well-acquainted with the part of us which is always thinking – churning out thoughts, beliefs, memories, judgments, fantasies, plans, and so on. But few of us are familiar with the observing self, the part of us which is aware of whatever we’re thinking, feeling, sensing, or doing in any given moment. As you go through life, your body, thoughts, feelings, and roles change. But the “you” that’s able to notice or observe all those things remains constant.

5. Values: Know What Matters (Lack of values clarity/contact)

As our behavior becomes increasingly driven by fusion with negative thoughts or attempts to escape unpleasant experiences, we often lose touch with our values. When we’re not clear about our values, we can’t rely on them to effectively guide our behavior.

Through ACT, we learn to clarify our values so we can create a meaningful life. We ask ourselves, “What do you want your life to be about?”, “What do you want to stand for?”, and “What really matters to you in the big picture?”

6. Committed Action: Do What it Takes (Unworkable action)

Unworkable action means patterns of behavior that pull us away from mindful, values-based living; patterns of that action that instead of making our lives richer and fuller, leave us feeling stuck or increase our struggles. This includes action that’s impulsive, reactive, or automatic as opposed to mindful, considered, and purposeful. Common examples of unworkable action may include, using drugs or alcohol excessively, withdrawing socially, being physically inactive, avoiding work or household tasks, or sleeping too much.

Committed action, on the other hand, means taking effective action guided by our values. Values-guided action evokes a wide range of thoughts and feelings, both pleasant and unpleasant. So committed action means “doing what it takes” to live by our values even if it brings up pain and discomfort.

Putting it All Together

Let’s summarize what we’ve learned so far: ACT speculates that the two primary drivers of suffering are cognitive fusion and experiential avoidance. To overcome these tendencies, there are six core processes in which we can engage to live more mindfully and integrate our values into our ongoing actions. The overall goal of ACT is to help us create a rich, full, and meaningful life, while accepting the pain that life inevitably brings. This is accomplished by:

Mindfulness: Teaching us psychological skills to handle painful thoughts and feelings effectively, in such a way that they have much less impact and influence.

Values clarification: Helping us to understand what’s truly important and meaningful to us so we can set goals and take action that enriches our life.

Stay tuned for part II of this post where I’ll share who ACT is most helpful for, and some exercises you can do to begin implementing strategies from ACT in your own life..

Bonus

Download the first chapter of The Happiness Trap by Dr. Russ Harris by clicking here!