Coastal Center for Anxiety Treatment

Name card of Dr. Eric goodman.

When Your Anxiety ACTs Up: Acceptance and Commitment Therapy

“I WANT MY ANXIETY GONE NOW!!!! Not only do I want it gone, but I DEMAND it and will fight it till my dying breath!!!!!”

This is a common sentiment among anxiety disorder sufferers—especially when they are standing face to face with their anxiety at its loudest (on the plane, in the car, or before the speech).

At best, it is futile to struggle against anxiety. At worst, struggling actually increases anxious suffering.

Acceptance and Commitment Therapy (ACT) is a type of cognitive-behavioral therapy focuses on fostering an acceptance of the thoughts and feelings associated with anxiety while marching ever onward towards a life filled with your most cherished and valued behaviors.

For example:

  • Being an active parent
  • Fostering a good relationship with your spouse
  • Seeking out friendships
  • Helping others

By moving towards your values in spite of unpleasant thoughts and sensations, you can maximize your sense of purpose and have a life well-lived—rather than a life of brief, narrow, and unfettered comfort and avoidance.

While ACT does not focus on symptom reduction, symptom reduction often occurs. Imagine that you have a nasty case of insomnia. It is three in the morning and you have a big presentation in the office at eight. You lay in bed struggling to sleep:

“I must get to sleep! Come on sleep…right now…come on…NOW!”

The end result being even more insomnia with a heaping serving of suffering tossed in.

What if, instead, you surrendered the urgent demand to sleep and simply let go of the struggle—just lay there resting your body. If you sleep, fine; if not, rest is also good. Let go of the struggle in your legs, torso, arms, and face. See how much struggle can simply be set aside while appreciating the restful feelings of softer muscles and decreased tension.

Under which scenario are you more likely to sleep?

Here’s the catch…you must, for that moment, be willing to truly let yourself rest without fighting for sleep or struggling to reduce the menacing thoughts about sleep deprivation. You just softly coexist with the insomnia and anxiety. You rest gently within the storm.

The Six Core Processes of ACT

  1. Acceptance: Allow yourself to feel what you are feeling at this moment, understanding that struggling, hating, and fighting is likely making things worse
  2. Defusion: Learn to live with unpleasant thoughts and feelings by not merging with them—you are not your thoughts or bodily sensations
  3. Values Clarification: Identify what is truly important for you to pursue in your life
  4. Commitment: Commit yourself to behaving in ways consistent with your values—live life the way YOU want to live it
  5. Contact with the present moment: Learn to live nonjudgmentally in the present—ACT encourages daily mindfulness practice to aid in this
  6. Recognizing self-in-context: Know that you are not your anxiety, but you are the experiencer of your anxiety—the observer of what your brain and body present to you

While ACT does not like to talk about symptom reduction, there is substantial evidence that ACT does in fact aid in symptom reduction. Their belief is that if you focus so much on symptom reduction (“I MUST sleep!!!!”) that you inadvertently increase your symptoms.

Unlike traditional CBT that focuses on changing maladaptive thinking patterns, ACT focuses exclusively on acceptance and defusion. I think that both changing thoughts and acceptance and defusion from thoughts are good tools. There are many instances where addressing a maladaptive belief (for example, “turbulence is dangerous for airplanes”) is beneficial. Once the belief is no longer so solid (“I can see now that turbulence is safe, but I still don’t like it!”) then taking an accepting and defusion-based approach is a great way to cope with residual anxiety.

Integrating ACT principles with good CBT practice can turbo-charge clinical outcomes and I would encourage people with stubborn anxiety disorders to check into ACT.

Sometimes letting go of the struggle against anxiety is half the battle to end one’s suffering with anxiety!

Eric Goodman, Ph.D.