ACT stands for Acceptance and Commitment Therapy and is an approach used in psychotherapy. It is considered to be a third-wave type of therapy compared to second-wave therapies such as Cognitive-Behavioral Therapy (CBT). CBT is widely used for various mental health conditions, substance abuse, and alcoholism. CBT has also been extensively studied and supported by research for these conditions. Occupational therapy students likely have learned about and are most familiar with CBT, but what about ACT?
ACT has actually been around since the 1980s and was developed by psychologist Steven Hayes. ACT can be used for a variety of mental and physical conditions including anxiety, depression, OCD, psychosis, eating disorders, substance use disorders, stress, and chronic pain.
ACT Components for OT
ACT is comprised of several components (described in OT language after the = sign):
- Acceptance: acceptance of thoughts and emotions. Note that acceptance is not the same as tolerance.
- Cognitive Defusion = Metacognition for maladaptive thoughts, beliefs, experiences, etc.
- Being present = Mindfulness
- Self-as context: you are more than your thoughts, feelings, and experiences; not sure if there’s an OT concept for self as context. But this is a useful concept and approach to use.
- Value-Based Action = Meaningful occupations
- Committed action = Occupational participation
One of the most important parts of ACT is committed actions based on one’s values. Values are unique based on each client and similar to goals for OT. However, in ACT, values can be seen as broader than goals, as goals can be attained and completed, but values persist long after goals are completed. This is a powerful concept for occupational therapist to use with clients as values encompass their goals, and therefore, occupational participation in meaningful occupations.
What ACT adds in addition to the primary goal of occupational therapy of occupational participation is the concepts of how to reach them through acceptance, cognitive defusion, mindfulness, and self as context.
Other Benefits of ACT
Most OTs are familiar with mindfulness, or put simply “noticing” the present moment. This may include unpleasant thoughts and feelings such as pain as well. One of the theories of ACT is that the more we avoid these unpleasant things, the worse off we are. So instead, by facing our negative thoughts, we can overcome them and be able to take on committed actions towards essentially what OTs consider occupations.
As ACT involves acceptance, it can also be a powerful concept for clients to use as it involves their acknowledgment of their thoughts and emotions rather than again, avoiding or denying them. This is an interesting approach to the psychology of clients compared to the popular CBT.
Whereas CBT involves trying to change or challenge one’s negative thoughts, ACT simply involves accepting them.
My Experience with ACT and CBT
Personally, I find this much more intuitive and practical. It may not always make sense to challenge or question one’s negative thoughts as it is part of being human. Simply accepting them can be much more easier to practice, more forgiving of yourself and more self-compassionate.
If I were to mentally keep track of my thoughts that go on through my day, especially when I meet and interact with other people – a lot of these can be quite random. Some positive, some neutral, some negative, some judgmental (despite me not trying not to be judgmental), some out of the left field, etc. I find that accepting my thoughts rather than trying to flip the negative into the positive takes much less mental effort and gymnastics, leading to increased adoption and long-term use of ACT compared to CBT.
For my own mental health, I have tried CBT and ACT, but I find myself using ACT more. I also find it easier to accept my negative thoughts than to try to change them. It just takes less mental effort. Then combine this with mindfulness, which in itself has numerous benefits for mental health, stress, and outlook. Last, I add the occupational participation of my own meaningful activities and this makes me moving around more and doing physical activities, and leading a better meaningful life.