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Acceptance and commitment therapy (ACT) is a type of psychotherapy that emphasizes acceptance as a way to deal with negative thoughts, feelings, symptoms, or circumstances. It also encourages increased commitment to healthy, constructive activities that uphold your values or goals.

ACT therapists operate under a theory that suggests that increasing acceptance can lead to increased psychological flexibility. This approach carries a host of benefits, and it may help people stop habitually avoiding certain thoughts or emotional experiences, which can lead to further probflems[1-6].

Techniques

Unlike cognitive behavioral therapy (CBT), the goal of ACT is not to reduce the frequency or severity of unpleasant internal experiences like upsetting cognitive distortions, emotions, or urges. Rather, the goal is to reduce your struggle to control or eliminate these experiences while simultaneously increasing your involvement in meaningful life activities (i.e., those activities that are consistent with your personal values).

This process involves six components

Acceptance: This means allowing your inner thoughts and feelings to occur without trying to change them or ignore them. Acceptance is an active process[7-12].

Cognitive diffusion: Cognitive diffusion is the process of separating yourself from your inner experiences. This allows you to see thoughts simply as thoughts, stripped of the importance that your mind adds to them.

Self as context: This involves learning to see your thoughts about yourself as separate from your actions.

Being present: ACT encourages you to stay mindful of your surroundings and learn to shift your attention away from internal thoughts and feelings.

Values: These are the areas of your life that are important enough to you to motivate action.

Commitment: This process involves changing your behavior based on principles covered in therapy.

During ACT, your therapist will help you learn how to apply these concepts to your life. They may teach you how to practice acceptance and cognitive defusion, or they may help you develop a different sense of yourself that’s distinct from your thoughts and feelings.

Sessions can also include mindfulness exercises designed to foster nonjudgmental, healthy awareness of thoughts, feelings, sensations, and memories that you have otherwise avoided. Your therapist may also help highlight moments when your actions didn't fit your values while helping you understand which behaviors would fit.

Your therapist may assign homework to practice between sessions, such as mindfulness, cognitive, or values clarification exercises. The homework is agreed upon between you and your therapist and can be modified to make it as personal and useful as possible.

What ACT Can Help With

ACT may be effective in treating:

• Anxiety

• Depression

• Eating disorders

• Obsessive-compulsive disorder (OCD)4

• Stress

• Substance use

• Psychosis

Research has shown that ACT can improve symptoms for people with generalized anxiety disorder (GAD), and it may also be a particularly good fit for older adults with the condition.

Benefits of ACT

One core benefit of ACT is the impact it has on psychological flexibility. Psychological flexibility is the ability to embrace your thoughts and feelings when they are useful and to set them aside when they are not. This allows you to thoughtfully respond to your inner experience and avoid short-term, impulsive actions, focusing instead on living a meaningful life.

Psychological flexibility can improve your ability to accept and function with symptoms of conditions like anxiety or depression. Often, those symptoms may lessen significantly as a result of this increase in psychological flexibility.

Effectiveness

ACT is sometimes referred to as a "third wave" or "new wave" psychotherapy. The term "third wave" treatment refers to a broad spectrum of psychotherapies that also includes:

• Dialectical behavioral therapy (DBT)

• Schema therapy

• Mindfulness-based cognitive therapy (MBCT)

Historically, third-wave treatments were seen as particularly appropriate for people who were not benefiting from pre-existing treatments like classical CBT. However, it is now believed that for some individuals, a third-wave therapy option may make sense as a first-line treatment.

Research shows ACT to be effective at treating a wide range of conditions, including some that span several diagnoses. ACT also appears to improve quality of life, and it may help people deal with physical conditions and chronic pain.

Overview

Aim to examine whether treatment as usual or treatment with ACT was more effective for stigma and shame among substance use disorders (SUD’s).

A double blind, parallel assignment was conducted with 60 adults aged 18–35 years with SUD’s had sought care at one of four clinical centers in Rawalpindi and Islamabad, Pakistan. Patients were randomly assigned (1:1) to receive treatment with ACT or treatment as usual. All participants received ACT, delivered by therapists in 6-hour sessions and attended interviews at baseline. Primary outcomes stigma (enacted, anticipated, internalized)and shame, whereas secondary outcomes such as general health, quality of life, Acceptance and action questionnaire, multidimensional social support all were assessed at pre, post and follow up period with the help of research assistants.

A two-way factorial ANOVA between subjects were performed, scores showed a significant difference between two groups at primary outcomes which are stigma (F=60.10, p=.000, η_p² = .389) and shame (F=31.04, P=.000, η_p² =.247) which all are significant at timeline model while slight difference were shown at secondary measures.

Results suggest that combined treatment with ACT was more effective for stigma and shame than treatment as usual for SUD’s. This study could serve as a model for designing future RCTs with ACTrelated interventions[12-15].

Consort

The consolidated standards of reporting trials (CONSORT) was used for reporting of parallel group randomized controlled trials (Figure 1).

Figure 1: Consort flow diagram.

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