Acceptance and Commitment Therapy or “ACT” said as one word is considered one of a new wave of cognitive-behavioral therapies, including Dialectical Behavioral Therapy (DBT), Functional Analytic Psychotherapy (FAP), and others. These treatments largely involve many of the aspects common in traditional cognitive-behavioral therapies but with important technical and theoretical differences (Hayes, Strosahl, & Wilson, 1999). In ACT there is a focus on “accepting” what is out of the client’s control and commit to changing what is in their control, to improve their lives (Orsillo & Roemer, 2005). ACT includes the use of mindfulness, to assist in reaching these goals, which has long been a part of Eastern philosophies such as Buddhism and Taoism. Mindfulness can be explained as being aware of your experiences moment to moment and experiencing them with openness and interest, rather than judgment (Hayes et al., 1999; Orsillo & Roemer, 2005).

ACT is a tradition based on Functional Contextualism (Hayes et al., 1999). Functional contextualism is a form of pragmatism, which states events should be understood as a whole, in context, and as ongoing (Hayes et al., 1999). This is in opposition with most traditional views of behavioral therapies, which are more present-focused and tend to limit their focus to what is appears directly relevant to the presenting problem. Also important in functional contextualism is the following of pragmatic truth criterion. Pragmatic truth criterion refers to judge the effectiveness of our actions based on how they meet our goals rather than their match to some supposed concrete reality. In this line of thought, no ‘truth’ is universal; what is true is only what works in getting a person to their unique goals. This differs from most traditional cognitive-behavioral treatments that might focus on having clients test the validity of their thoughts in quasi scientific manner against reality. In ACT, a person we would tend not to ask a client to test their thoughts regarding fears to see if they are “valid” or “logical” fears. In ACT, the focus is on whether believing the thought constricts or expands the individual’s ability to live a valued life. This is often referred to as “workability” and is a central concept to contextualism. “Context” here refers to how the behavior occurs and what rules govern the behavior (Hayes et al., 1999). Within ACT the context of the behavior, and not the form, of the behavior itself is the focus of change. Thus, symptom reduction is not directly an aim of ACT but rather a side effect (Hayes et al., 1999). From the ACT perspective, suffering is both a necessary and unavoidable part of life, but the way we experience suffering is determined by our understanding of it (Hayes et al., 1999).

Also essential to the foundation of Acceptance and Commitment Therapy is its take on the role of human language in human suffering. Understood through Relational Frame Theory, human language as a process results in destruction, dysfunction, and pathological processes (Hayes et al., 1999). Language is necessary for the advancement of human society and each individual, however; the associations we make through language eventually cause us misery. Relational Frame Theory (RFT) suggests that through behavioral conditioning language itself can affect how we feel. As we learn language, conditioning creates “mutual entailment” or bi-directionality in associations between words, feelings, and things. It is in this way that children learn that words and things are equivalent (Hayes et al., 1999). However, it is his essential feature in learning to communicate with others that can later cause us a great deal of suffering. Since the words we have learned trigger the images and feelings they have been paired with in our past; we are prone to sometimes feel emotional pain unnecessarily. Just as when you think of the word “lemon”, you have an immediate reaction to taste sour you can have a response to the word “anxiety”, such that thinking about the word “anxiety” can make you feel anxious. This creates problems because as most people try to avoid feeling unpleasant feelings; they cause themselves the very feelings they are trying to avoid. For example, to think, “Don’t get anxious!” includes the thought of “anxiety”, and thus feelings of anxiety (Hayes et al., 1999; Orsillo & Roemer, 2005). These conditioned relationships in our minds are the result of often life long patterns of association, and thus are also quite difficult associations to break up. And, in fact, though we can break them up they quite often resurge (Hayes et al., 1999).

Through ACT individuals learn to reduce the impact of conditioned language associations on their feelings and actions. ACT takes the position that because of the way we process language, according to RFT, our typical methods for solving problems logically in the outside world are inappropriate for solving problems with thoughts and feelings. We tend to assume that we must simply determine the reason for some unpleasant feeling or behavior and remove it, to remedy unpleasant feelings or consequences. This leads us to the culturally supported idea that thoughts and feelings are good explanations for what we do. So, though we have the capability to act contrary to our thoughts and feelings, we assume that to control our actions we must control the feelings and thoughts associated with them. However, as RFT indicates, the more we endeavor to control our thoughts the more we will suffer from them. Therefore an important feature of ACT is to reduce experiential avoidance, or the unwillingness to experience certain feelings (Hayes et al., 1999; Orsillo & Roemer, 2005). What we have to realize is that it is perfectly normal to feel unpleasant feelings at times and that the objective to control, reduce, or rid ourselves of these feelings is not a successful approach (Hayes et al., 1999).

ACT suggests that the alternative to experiential avoidance is acceptance, and mindfulness, as in accepting that feeling unpleasant sometimes is a natural and necessary part of life. ACT also suggests that choice and committed action are more appropriate ways to deal with life than avoidance. ACT’s goals include the shift from understanding words as content to context; learning to understand both the benefits of language and how it can affect us negatively when we do not take into account the learning context (Hayes et al., 1999).  ACT seeks to undermine unworkable change agendas, such as experiential avoidance, by helping clients realize their refusal to feel and accept causes more pain. In addition, ACT seeks to help individuals identify and clarify their life direction and goals. ACT therapists endeavor to suspend their own judgment regarding what goals a person should have, because from the ACT perspective, the appropriateness of goals is subjective, and the client should pursue those goals important to them (Hayes et al., 1999).

Therapeutic tools used in ACT, to reach ACT consistent goals, include: the use of metaphors, therapeutic paradox, and experiential exercises (Hayes et al., 1999). Metaphors are used to reduce the impact of literal language and to prevent the client from simply following the requests of the therapist without achieving true understanding. Since metaphors cannot be exactly interpreted, they cannot be exactly followed; the client is forced to experience and understand rather than rely on the therapist’s direction (Hayes et al., 1999). Therapeutic paradox is similarly used to reduce the impact of literal language on the client. The client is given a task where they can experience the consequences of not avoiding their symptoms, which typically includes a reduction in the symptom. Experiential Exercises can also be used to change the verbal context of situations, so that the client can learn to observe and study their feelings without imposing judgment on them. ACT methods include many metaphors and experiential exercises to address different problems and different frames of mind. Another tool used by ACT therapists is creating “hopelessness” in clients by pointing out the failure of previously used methods to control their feelings. This technique motivates the client to accept new ways of understanding their problems and new solutions for them (Hayes et al., 1999). As mentioned above, ACT therapists help clients explore their values and help them learn to lead their lives in accordance with these values. This last phase of treatment is often more behaviorally oriented than other phases of ACT; it includes intense discussion over the client’s values and behavioral strategies to assist the client in reducing discrepancies between their actions and values (Hayes et al., 1999).

Recent years have seen an explosion in ACT-related research and the effectiveness of ACT in many different populations and with many different diagnoses. Hayes and associates continue to conduct training seminars, workshops, and conferences devoted to the promotion and further development of ACT theory and methods. Clinicians also continue to develop a wider variety of useful metaphors and experiential exercises to inspire clients to a new understanding of their problems and motivate them to “ACT” in line with their values (Hayes et al., 1999).