Acceptance Commitment Therapy (ACT): What it is and Why We Are Using it.
Rick Baumgartle CADCII.
If you have been to any of our groups lately, or know of people who have, you may have noticed a new theory or therapeutic model being used. That model is Acceptance Commitment Therapy or ACT (pronounced as one word not as letters). As one of the two practitioners here who are implementing this new therapy I wanted to explain a bit about what it is and why we have embraced it so fully when it comes to working with people with substance abuse issues as well as other issues like anxiety depression etc...
1. ACT is different from other theories.
For a very long time, one of the more popular theories in addiction counseling has been Cognitive Behavioral Therapy (CBT). CBT says that a trigger leads to a thought that leads to a craving (in the case of addiction) which leads to use. CBT says change the thought and the behavior will change..
ACT throws most that out the window. ACT says that trying to change the thought, feeling, emotion, etc.. is a futile battle, because in the end both actions end up making the situation worse. They refer to it as Experiential Avoidance. Instead ACT says people need to, for lack of a better term, make peace with and stop struggling with their unpleasant feelings and emotions in order to have what they call Psychological Flexibility.
2. ACT Loves Metaphors!
So do I, which is one of the reasons I embraced this theory as quickly as I did. Often a person can explain something to me using a metaphor and I will gain a much better understanding of that thing, than if they had tried to use a lot of clinical jargon, and fancy PhD terminology. For example, here is a great one to explain the idea of psychological flexibility, which is a major component of ACT. So here we go with out first metaphor…..
The Chinese Finger Trap
Remember when you were a kid and went to Chucky Cheese or wherever (or maybe you take your kids), you sucked at skee ball, and all your tickets would get you was that Chinese Finger Trap....Well, emotions, thoughts, feelings, pain, and all of our internal stuff is just like that finger trap. The harder you struggle, the more stuck you become. But what happens if you relax? You become unstuck, yes? You aren't out of the trap, but you have some wiggle room. Emotions and other internal experiences are just like that, except unlike the actual finger trap, relaxing won't get you out of the trap. You can't escape your internal experience, but you can give yourself some wiggle room, and enable yourself to have more choices than just struggling when it comes to dealing with your inner experience. Heck, you can even choose not to deal with it, if you want. How freeing would that be?!
3. ACT practices mindfulness.
Mindfulness is not new. ACT did not invent it. In fact it has been around for thousands of years. The Buddhist have espoused mindfulness for a very long time. Mindfulness is simply the act of looking at what is going on with you in the present moment; good and bad. Anxiety is almost always a worry about a future event, and depression usually hangs out in the past with regrets over what was.
If you are trying to go on a trip (here comes another metaphor) and lets say your destination is happiness, fulfillment, or whatever state you long for, how can you even get started if your not here. You can't start your trip in the past or the future. Your trip can only start in the here and now. If people are wrapped up struggling with anxiety and depression they can't head in the direction they want to go or any direction for that matter. They might not even know what direction they want to go in. Speaking of which....
4. ACT is about values.
Values are the things that we hold important. Those things that we stand for and believe in. Values are the direction we want to go on our trip. They are what we want written on our gravestone. Most people would not put struggling with depression or anxiety as an important value. No one ever says “I hope my epitaph reads “Here Lies _____. They spent their life struggling with anxiety and going nowhere.” It's ironic, because that's exactly what most of us do on a daily basis. Struggle against it, try and avoid it, take pills for it, take drugs for it, engage in mindless pursuits to avoid it, and a plethora of other examples I have either forgotten or haven't thought of, in an effort to try and make our internal experience behave in the manner we see fit. It doesn't work! So why do we keep doing it then?! Well.....segue to......
5. ACT teaches that our minds are both our greatest ally and our greatest enemy at the same time.
Human beings have this amazing capacity to problem solve. Let me give you another metaphor to show this.
Suppose I gave you a board, and in this board was a screw that you could get out with a flat head screwdriver. However, instead of a screwdriver, I give you a lighter and a plastic toothbrush (cause I'm mean like that) and tell you to get that screw out. How would you do it? Take a sec.....I'll wait......got it?.....good....moving forward! Most of you probably had no problem imagining what you would need to do to make that happen. Melt the toothbrush and while it's hot, mold it to the screw and twist. Melt the toothbrush and flatten it down to get it to fit the screw (this was mine and everyone else who immediately went to furnishing a shiv out of it. What's wrong with you people! HA HA). Light the board on fire and sweep up the ashes with the toothbrush (Pyros! Heh).
Whatever you came up with was proof of what a great ally your mind can be when problem solving things in the external world. Most people reading this had probably never encountered this scenario and yet had no problem figuring out a solution. This ability to problem solve is why we are the dominant species on the planet. It's also the reason we struggle so with our inner experiences.
See our beautiful, problem solving minds, since even before we learned to speak, have been learning to fix things. That ability causes problems when our minds want to use that same problem solving ability on our thoughts, feelings emotions, etc... to make them go way, get us away from them, or put them somewhere they won't bother us. It can't work. It's not possible, because our inner experience can't be manipulated like the screw in the board. Why is that...well, here we go......next metaphor please.
Think of a puppy.
Go on. Think of a puppy. A cute little guy or gal; your favorite kind. Picture it's size, color, all the wiggling joy, combined with puppy breath goodness that you can envision. Got the picture? OKAY, now stop thinking of it. For the next minute, do everything in your power to not think of that puppy. Use your minds amazing ability to fix things to make that picture of a puppy go away.
How did you do? If your like most people all you could think of was that PUPPY! You might say, “Not me I thought of a cat!” or “I am really good at suppressing thoughts. I didn't think of it at all.” Uh huh.....well in order to think of a cat your subconscious was required to understand that the reason you were thinking of a cat was because you weren't supposed to think of puppy. If you are one of those people who have gotten good at suppressing thoughts, your subconscious still knows why you are doing it and how much effort did it take you to do it? A bunch of effort, or more than you needed to expend anyway. Put another way and with yet another metaphor (you getting the picture how much us ACT believers like these yet?)….
Suppressing thoughts is like going to the pool and instead of swimming you try to hold a beach ball underwater. That takes enormous concentration and effort to do, and while you are busy trying to hold it under, everyone else is splashing and having fun in the water. Eventually you grow tired, let go of the ball, it shoots up, gets you all wet, and now your too exhausted to join everyone else having fun. You spent so much effort trying to hold that ball underwater that not only are you tired and frustrated (that ball will just not stay down), but you missed out on all the fun everyone else was having by just being at the pool.
6. ACT is about willingness.
Willingness is not the same as wanting. Most people if they are honest would rather not work (or maybe it's just me), but are “willing” to do it. ACT, when it comes to your inner experiences that are causing you pain, doesn't ask you to like or want them. No one ever woke up in the morning saying “Oh my God my anxiety is gone, I better go find it!”
Liking or wanting a painful inner experience has little to do with whether or not you have it. In fact the more you don't want it, the more you will have it. The harder you fight, the worse it gets. The more you try and suppress it, the more it comes back even bigger and badder than before.
People spend so much time trying to avoid whatever it is their mind tells them they shouldn't have to experience that they are missing out on all the great things life has to offer. Willingness is simply accepting your inner experience for what it is, so that you can have more time and more flexibility to enjoy life and move in the direction you want.
That is just scratching the surface of what ACT offers. There are a number of amazing books on ACT. Get out of Your Mind and Into Your Life by Steven Hayes is one we do in group. If you aren't currently enrolled with us, it is available on Amazon and other sites. The Happiness Trap, by Russ Harris is one I am digging into and is a great introduction to ACT.
The point is this. You DON'T have to struggle anymore. You CAN stop fighting. You CAN learn a better way. You CAN figure out the direction (values) you want your life to go in and start taking that journey. All that inner baggage isn't going anywhere. ACT teaches you how to take it along for the trip and after awhile you won't hardly notice it's there.
At Recovery Works NW we have a team of doctors, clinicians, and other professionals with decades of combined experience in working with substance abuse issues. If you or a loved one is struggling, please call us. We will work with you and help you to have way more wiggle room in your life, so you can stop struggling and do what's really important. Call us. We'd love to help.
If you want a Dr. who will tell you what you need to hear, and not want to hear, then go to him. He will help you, but you have to want to help yourself! I give him TEN STARS! I appreciate him and his staff more then he will ever know.