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by Alexandra Frascino, MS, LMFT, Therapist, Enterhealth Outpatient Center of Excellence

For decades, researchers in the field of psychology have worked to develop science-based interventions for people who want to overcome substance abuse. Acceptance and commitment therapy (ACT) was developed as an action-oriented approach to psychotherapy that stems from traditional behavior therapy and cognitive behavioral therapy.

Therapists and other clinicians use ACT to help patients recognize that their attempts to suppress, manage, and/or control emotional experiences with alcohol or drugs create even more challenges. Through ACT, patients learn to stop avoiding, denying, and struggling with their inner emotions and accept that these deeper feelings are appropriate responses to certain situations.

More importantly, patients are guided to identify values important to them, creating a value system that gives them a better understanding of where their thinking was and where it needs to be. With this understanding, patients begin to accept their issues and hardships and commit to making necessary changes in their behavior and how they feel about it. By recognizing and addressing these challenges, patients are better equipped to make decisions that support their well-being. 

The History of Acceptance and Commitment Therapy

ACT is based on relational frame theory (RFT), a school of research focusing on human language and cognition. RFT suggests that the rational skills used by the human mind to solve problems may be ineffective in helping people overcome psychological pain – a common trigger for substance abuse. As a result, ACT was developed to show people that although psychological pain is normal, they can learn ways to live healthier, fuller lives by shifting the way they think about pain.

Beginning in the late 1990s, treatment manuals were developed to outline ways clinicians could use ACT to treat various mental health conditions. This early treatment has been the subject of several empirical studies which support the use of ACT in the treatment of substance abuse, psychosis, anxiety, depression, chronic pain, and eating disorders.

Understanding the Theory Behind ACT

ACT does not classify undesirable emotional experiences as symptoms or problems. Instead, it works by helping people realize the fullness and vitality of life, and that part of realizing this fullness includes accepting the fact that pain will inevitably accompany certain situations.

Accepting things as they come (without trying to evaluate or change them) is a skill developed through mindfulness exercises in and out of therapy sessions. To be clear, ACT techniques do not try to directly change or stop unwanted thoughts and feelings (as cognitive behavioral therapy does); rather, it encourages people to develop new and compassionate relationships with these experiences. This shift in mindset can free people from trying to control their experiences and help them become more open to actions consistent with their personal values. That is because clarifying values and defining values-based goals are key components of ACT.

Values Clarification

Values clarification can help people define what is most important to them so that they can take effective action guided by these values. Clinicians generally employ a variety of exercises to help patients identify specific values.

These values then act as a compass, pointing the patient in the direction of intentional, effective behavior designed to increase their chances for a successful recovery.

Six Core Processes of ACT

Psychological flexibility, the main goal of ACT, typically comes about through several core processes, including:

  1. Cognitive de-fusion: Detaching from inner experiences by interacting or relating to them differently.
  2. Acceptance: Allowing thoughts and feelings to arise without trying to change their form or frequency.
  3. Mindfulness: Retaining contact with the present moment.
  4. Self-understanding: Letting go of concrete and inflexible thoughts or ideas about oneself and moving toward understanding oneself within the context of situations.
  5. Values: Learning what is most important to oneself (family, service, etc.).
  6. Committed action: Empowering behavioral change through effort.

It is important to note that these processes are overlapping and interconnected, not separate.

Mindfulness and Acceptance and Commitment Therapy

Mindfulness, in the context of acceptance and commitment therapy, means keeping your mind in the present moment rather than letting it drift. Mindfulness techniques often increase your awareness of each of the five senses, as well as your thoughts and emotions.

Mindfulness also increases your ability to detach from certain thoughts. Challenges related to painful feelings, urges, or situations are first reduced before eventually being accepted. Acceptance means allowing internal and external experiences to just occur without trying to control or avoid them.

When a patient is experiencing painful emotions, such as anxiety, the clinician might instruct them to open up, breath into, or make “mental space” for the physical feeling of anxiety and allow it to remain there without aggravating or minimizing it.

Why is ACT So Effective in Addiction Treatment?

ACT techniques have been shown to be most effective when used with patients who are looking to cope with symptoms that they believe will persist after treatment. As Enterhealth approaches substance use disorders from the lens of a chronic-disease model, we believe ACT can help patients who are working to accept that symptoms such as cravings, fear of relapse, etc. will need to be managed over time. It is all about how people adjust their attitude toward managing these symptoms.

ACT techniques can help patients identify ways to direct their treatment, and they often help patients relate to their current phase of treatment, rather than becoming fixated on an idea of what their recovery might look like down the road.

How Enterhealth Uses ACT to Improve Recovery Outcomes

Since its inception, Enterhealth has embraced the use of scientific, evidence-based treatments and therapeutic modalities. That is why we offer services such as Medication-Assisted Treatment (MAT), Eye Movement Desensitization and Reprocessing (EMDR), Psychological Testing, and more. In addition, our therapists employ a range of techniques such as cognitive behavioral therapy, Motivational Enhancement Therapy, acceptance and commitment therapy, and more.

By helping patients establish what they value most in order to lead a meaningful life and identify ways they can work these values into their everyday behavior and thinking, acceptance and commitment therapy provides introspection and resource prioritization that can be helpful for many individuals.