I'm interested in (1) hearing from anyone with experience of ACT, (2) if anyone has tried both ACT and other types of CBT and a comparison (especially if you prefer other types of CBT), and (3) evidence for/against ACT.
ACT = Acceptance and Commitment Therapy (pronounced as the word ‘act’ rather than the letters)
CBT = Cognitive Behavioural Therapy
- I have found Acceptance and Commitment Therapy (ACT) much more useful as a framework than other types of CBT.
- Traditional CBT focuses on helping you identify and change negative thoughts, whereas ACT focuses on accepting them. It holds that fighting against your emotions usually just leads to being stuck in them.
- Other types of CBT often ask “is this thought true?” to encourage behaviour change, whereas ACT uses values to encourage behaviour change (explained better in the full text). ACT could be a good fit for people who are especially values-driven.
- ACT has a strong focus on values and mindfulness. Other key ideas:
- Psychological flexibility: being in contact with the present moment, fully aware of emotions, and thoughts, welcoming them, including the undesired ones, and moving in a pattern of behaviour in the service of chosen values;
- Encouraging gentle curiosity towards thoughts, feelings, and sensations, instead of trying to change them;
- The normal thinking process of a healthy human mind will naturally lead to psychological suffering. We have not evolved to be happy, and we are not deficient for experiencing difficult thoughts and feelings;
- The goal isn’t to chase happiness or otherwise try and control our internal state.
- The six principles of ACT:
- Learning the skill of defusing your thoughts and feelings, so they have much less influence over you;
- Making room for unpleasant feelings instead of trying to push them away (expansion);
- Connecting with whatever you’re doing or experiencing in the present moment;
- Becoming familiar with the "observing self," the part of you that experiences, sees, touches, and doesn't judge or take responsibility;
- Clarifying and connecting with your values;
- Taking action motivated by your values.
- This leads to a formula of: Mindfulness + Values + Committed Action = Psychological Flexibility
- If you’d like to learn more, I recommend reading the book The Happiness Trap, or this book summary of it, or watching this Tedx talk. If you want to engage more seriously, I'd really recommend seeking a therapist who practises ACT.
I started exploring ACT about a month ago, and have found it has significantly increased my mental wellbeing. ACT has been much more powerful and effective for me than other types of CBT I have tried in the past (however, I have engaged with ACT to a deeper level – but this is mostly because it felt exciting and helpful from the beginning).
I haven't heard EAs talk about it publicly before (but there's a bit on LW), and wanted to encourage others to explore it as a framework, if any of it resonates. I have been enthusing to friends about ACT, and I’m also writing this to be able to refer people to in future.
My goal here isn't to provide a guide for How To Live According To ACT. It's to offer a brief taster, so that if the ACT framework seems like it could be helpful, you can learn more elsewhere.
Some benefits I’ve experienced
- Struggling against my internal experience less – and instead approaching it with compassion and acceptance;
- More ability to be present with my experience in the moment, by developing the ability to notice when I’m “hooked” on a string of thoughts, and skills to reconnect with the present moment;
- Less self-criticism and more self-compassion (in a way that feels non-coercive and authentic);
- More accepting of the fact that it’s normal to have difficult thoughts and feelings – I’m not bad or deficient for experiencing them;
- More clarity on my values and how I want to treat myself;
- Feeling more empowered and less hopeless around mental health.
How is ACT different from traditional CBT?
Both are behaviour-based therapies, but they differ primarily in their orientation to thoughts. Whereas CBT works by helping you identify and change negative or destructive thoughts, ACT holds that pain and discomfort are a fact of life – something to get comfortable with if we aim to live a happy, fulfilled life. For this reason, ACT encourages you to accept all thoughts rather than trying to change them – both the good and the bad. Note that accepting thoughts is not the same as complacency.
Traditional CBT uses empiricism to guide behaviour change, whereas ACT uses values to guide behaviour change. For example, CBT might ask “Is [anxious thought] empirically true?” If the thought is false, CBT might encourage you realise that, and change the thought pattern accordingly. For me, this approach hasn’t been helpful, as I can intellectually know that a thought is false, but still feel emotionally affected by and “hooked” on it. Alternatively, ACT helps you clarify what you actually care about – your values – and engage in “towards moves” (moves that are towards your values, as opposed to “away moves,” which are moves away from your values). I find the framing of “I am doing this because it’s aligned with my values ” much more powerful as a force to drive behavioural change. ACT could be a good fit for people who are especially values-driven.
Some key ideas behind ACT
Psychological flexibility is defined as being in contact with the present moment, fully aware of emotions, sensations, and thoughts, welcoming them, including the undesired ones, and moving in a pattern of behaviour in the service of chosen values.
More simply, this means accepting our own thoughts and emotions and acting on long-term values rather than short-term impulses, thoughts, and feelings that are often linked to experiential avoidance and a way to control unwanted inner events.
Acceptance of our internal experience
The objective of ACT is not elimination of difficult feelings; rather, it is to be present with what life brings and live in accordance with your values. Fighting against your emotions usually just leads to being stuck in them. Instead, ACT encourages gentle curiosity towards thoughts, feelings, and sensations.
Happiness is not the natural state for human beings
“Acceptance and Commitment Therapy is based on a dramatically different assumption: the normal thinking process of a healthy human mind will naturally lead to psychological suffering. You’re not defective; your mind’s just doing what it evolved to do”.
— Dr. Russ Harris
We’ve not evolved to be happy, or to handle difficult thoughts and feelings effectively. We evolved for an ancestral environment, in which anxiety, sadness, and anger were evolutionarily useful. It takes deliberate practice to live a life where you’re not perpetually struggling against your internal experience. Discomfort is inevitable in a full human life.
The focus on values
ACT encourages you to clarify your values, and then taking actions that support them. It means asking yourself: what is important to me? How do I want to interact with the world? How do I want to interact with others? How do I want to interact with myself?
Pleasant feelings aren’t the goal
Sometimes ACT techniques can make you feel happier, but that’s a pleasant side effect and not the goal. ACT is not an attempt to closely control your emotions – the goal isn’t to chase happiness.
In The Happiness Trap, Harris gives a non-standard definition of happiness: “living a rich, full, and meaningful life.” This is different from the standard definition of “feeling good,” because this is a feeling, and feelings don’t last.
The six principles of ACT
The first 4 principles of ACT are mindfulness skills. The last 2 principles are values, and committed action. All this leads to a formula that looks like this: Mindfulness + Values + Committed Action = Psychological Flexibility.
This skill is about learning to perceive thoughts, images, memories and other cognitions for what they are – nothing more than bits of language and images – rather than what they often appear to be: threatening events, rules that must be obeyed, or objective truths and facts.
As you learn to defuse painful and unpleasant thoughts, they often lose their ability to frighten, disturb, worry, stress, or depress you.
Making room for unpleasant feelings and sensations instead of trying to suppress them or push them away. As you open up and make space for these feelings, they will likely bother you less, and “move on” much more rapidly, instead of “hanging around” and disturbing you.
Connecting fully with whatever is happening right here, right now; focusing on and engaging in whatever you’re doing or experiencing. Instead of dwelling on the past or worrying about the future, you are deeply connected with the present moment.
The Observing Self
The observing self is the part of you that does not change but experiences, sees, touches, thinks. The observing self does not judge, it does not take any responsibility; it helps you to become aware of what you have done; whereas the thinking self is the part of you that judges, the observing self does not generate any thoughts but simply observes them.
ACT believes that the observing self is like the sky. The thoughts and feelings are like the weather constantly changing and moving but the sky remains blue, regardless of the weather.
ACT teaches that clarifying and connecting with your values is an essential step for making life meaningful. Your values are reflections of what is most important to you: what sort of person you want to be, what is significant and meaningful to you, and what you want to stand for in this life. Your values provide direction for your life and motivate you to make important changes.
A rich and meaningful life is created through taking effective action, guided by and motivated by your values. And in particular, it happens through committed action: action that you persevere with, even through difficulty.
- Read The Happiness Trap or listen to the audiobook (12 hours).
- A 20 min book summary (skim this if you only have a few minutes).
- A 19 min Tedx talk by Steven Hayes (the creator of ACT) about psychological flexibility. Gives a narrative of his experience of panic attacks, his journey of creating ACT, and some of the core ideas of ACT. He’s a captivating public speaker and I found this moving to watch.
- The Happiness Trap 8 week online programme (I've not tried this so can't comment on how good it is).
- Some free resources created by Dr. Russ Harris. I’m not sure how useful these will be by themselves, and think it would be better to use them alongside reading one of his books.
- The book A Liberated Mind is targeted at professionals, and is more advanced than The Happiness Trap (its more empirical and scientific).
My biggest recommendation is probably to work with a therapist who practices ACT. This is not always possible, but here’s a friendly nudge to book an intro session with a therapist if you think it could help and you’ve been putting it off :)
There is one therapist on the EA Mental Health Navigator who is listed as practising ACT. Here is a list of ACT therapists in England that I found from googling (you can do the same for other countries). If you're aware of any good ACT therapists, it would be helpful if you would share them with me or link to them in the comments.
I believe that there is sometimes funding available from the EA Infrastructure Fund, if funding is a bottleneck to you seeking therapy and you work in an impactful career path. I’m entirely sure about what’s available, and if anyone knows please let me know and I'll be more specific here!
Other mental health resources
- Slate Star Codex posts Things that sometimes work if you have anxiety and Things that sometimes help if you have depression. These are summaries of the lifestyle, professional, pharmaceutical, and last resort interventions you can try.
- Resources On Mental Health And Finding A Therapist
- I am not a therapist, and I am relatively new to these ideas, so take everything I say with a pinch of salt.
- I wrote this over the course of an afternoon, and by the end I was quite sleepy; I'm sure I will have made mistakes, and feel free to let me know if that's the case.
- Other types of CBT probably work brilliantly for some people, and it’s probably worth trying both. I wrote this because I’ve not seen any EAs publicly talk about ACT, and I think it could be a better approach for some people (it definitely was for me).
- When I’ve made statements throughout this post, I have not been making truth-claims, but instead present them as useful framings. For example, I’m not asserting that the claim “discomfort is inevitable in a full human life,” is a ground truth, but that it is a useful frame that often reflects reality.
I used definitions and ideas explained in Luc Rolin’s summary of The Happiness Trap throughout this post, with explicit permission from Luc.
Being “hooked” is ACT terminology. When we’re “hooked” our thoughts seem real, true, important and wise, and are experienced as orders or as threats. Therefore, if we are “hooked” we react to thoughts such as “I am useless” as if we actually are useless, and we react to thoughts like “I am going to muck this up” as if failure is a foregone conclusion. Often our thoughts “beat us up”, telling us stories about how stupid, incompetent, and ugly we are. Getting hooked by these kinds of thoughts can lead to anxiety, low self-esteem, depression and so on.
Definition taken loosely from here.
Taken from the book "Acceptance and Commitment Therapy: The Process and Practice of Mindful Change" (2nd ed.). Amazon link here.
Formula taken from here.
Parts of the definition taken from here.
Definition taken from here.
For any of those who are not big fans of CBT, ACT is very different
My gripe with CBT is that it tends to resolve to telling yourself that your feelings are irrational, make no sense etc. This is OK if your problem is primarily due to thoughts that are just merely cognitively wrong but I find this is rarely true. The problem is usually at the emotional level and in that situation CBT basically only papers over the problem.
One extreme case of this was a relative of mine who was given CBT for an anxiety condition, which turned out to be due to a cortisol-secreting tumour. It had virtually no benefit as you might expect. A problem needs to be addressed in terms of the causal structure that creates and maintains it.
ACT on the other hand does work at the emotional level - helping you to accept 'bad' feelings and deal with them, and then decide on / commit to your goals and accept that working on them will likely come with bad feelings like boredom, frustration etc.
So to my mind ACT is far more powerful and deep than CBT.
Other techniques that work at deeper levels that I found useful include Internal Family Systems Therapy, Memory Reconsolidation techniques (book "Unlocking the emotional brain") , Holotropic Breathwork*, and Trauma Release Exercises.
*inb4 woo woo
If I was going to spend longer on this post, I'd make it more empirical and talk through evidence for/against the effectiveness of ACT.
As it is, I didn't want to spend significantly longer writing it, so I've gone for a summary of the core ideas -- so that readers can assess the vibe and see if it's something that sounds interesting to them.
This might have been the wrong call though.
(Also from the EA Forum. Someone on the forum commented that they thought ACT is one of the more evidence based psychotherapies).