Acceptance and Commitment Therapy

Last week, Sadie said she had been reading about Acceptance and Commitment Therapy (ACT).  She noted that she’s not trained in it, but there are other people at CMHC who are.  My mind was screaming, “No, don’t abandon me!”  I worry about this often.  I worry that she will move or change jobs, or worse, that she’ll stay right where she is but pass me off to someone else because I’m too much work and not worth the trouble.

I need to learn to hear everything a person has to say before spiraling into panic mode.  She had no intention of abandoning me, and said that she’d do some more reading and we could try out some elements of ACT.  She had me fill out a questionnaire from a book called The Happiness Trap.  It’s pretty obvious after the first couple of questions that you are supposed to be choosing option B for everything.  Out of 15 questions, I chose option B for 5 of them, which Sadie thought was pretty good starting out.  A couple of examples of the questions:

A. Negative thoughts and feelings will harm you if you don’t control or get rid of them.
B. Negative thoughts and feelings won’t harm you even if they feel unpleasant.

A. In order for me to do something important, I have to get rid of all my doubts.
B. I can do something important, even when doubts are present.

I answered the first one “wrong” and the second one “right”.  My answers came from past experience.  My negative thoughts have harmed me…or at least, the actions I’ve taken in response to those thoughts have harmed me.  On a happier note, I know I can accomplish things even when I have doubts, because I always have doubts and have apparently accomplished at least a few things in my life.

ACT, like Dialectical Behavior Therapy (DBT) is mindfulness-based.  It appears to have a lot in common with the Mindfulness and Emotion Regulation modules of DBT.  Allowing thoughts to come and go, observing them non-judgmentally, living in the present moment, viewing emotions as neither good nor bad.  They share the concept that dwelling on pain creates suffering.

The difference is that ACT discourages avoidance techniques.  DBT’s Distress Tolerance module is filled with ways to use distraction and relaxation to alleviate discomfort, and ACT focuses more on facing the thoughts head-on.  Some avoidance techniques are considered acceptable, in moderation, but they aren’t the focus of the therapy.

According to the article “Embracing Your Demons: an Overview of Acceptance and Commitment Therapy”, the six core principles of ACT are:

  • defusion
  • acceptance
  • contact with the present moment
  • the Oberving Self
  • values
  • committed action

Sadie proposed trying the thought defusion techniques, such as repeating the thought aloud until it becomes meaningless noise, or saying “Thanks, mind” for the interesting thought.  A few days after this appointment, I e-mailed her about some lingering suicidal ideation despite the vast improvement in my life circumstances.  She asked if I’d tried these techniques.  I actually had tried those two, and found that “Thanks, mind” made me laugh…so I suppose that was effective?  Repeating the thought over and over was not so successful, as it never became meaningless and just left me feeling increasingly agitated.

I’ve ordered a copy of The Happiness Trap and will be bumping it to the top of my 100-book reading queue.  I’m eager to move on and try something new, but there are certain elements of DBT I’ll be holding onto.  I carried my textured Tangle Jr. at work today and it helped quite a lot with some inexplicable sadness and agitation that I felt.


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