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Acceptance And Commitment Therapy (ACT) For Addiction: Meaning And Benefits

Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that focuses on enhancing psychological flexibility by using acceptance and mindfulness strategies alongside commitment and behavior-change techniques. Developed by clinical psychologist Steven C. Hayes in the 1980s, ACT aims to help individuals live a life aligned with their values while effectively managing distressing thoughts and emotions. Unlike traditional cognitive-behavioral therapies that emphasize altering the content of thoughts, ACT encourages acceptance of all thoughts and feelings, promoting a more adaptive and resilient approach to life’s challenges.

One of the most significant benefits of ACT is its effectiveness in treating addiction. By emphasizing acceptance of cravings and emotions, cognitive defusion to detach from unhelpful thoughts, and value clarification to guide purposeful action, ACT provides a comprehensive framework for addressing the psychological aspects of addiction. This approach helps individuals develop healthier coping strategies, reduce the risk of relapse, and build a life rich in meaning and fulfillment, ultimately supporting long-term recovery.

What Is Acceptance And Commitment Therapy (Act)?

Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that has gained significant recognition for its effectiveness in treating a wide range of mental health issues, including addiction. Rooted in mindfulness, acceptance, and behavior change, ACT aims to cultivate psychological flexibility in individuals, empowering them to live a life aligned with their values despite challenges, as discussed by Hayes S., Strosahl K., and Wilson K. et al. 2012, “Acceptance and Commitment Therapy: The Process and Practice of Mindful Change.”

History of Acceptance and Commitment Therapy

Clinical psychologist Steven C. Hayes and his colleagues developed ACT in the early 1980s. Building upon Relational Frame Therapy (RFT), ACT emerged as a third-generation behavioral therapy emphasizing acceptance, mindfulness, and values-based action (Hayes S. et al. 2005, “Acceptance and commitment therapy, relational frame theory, and the third wave. Of behavioral and cognitive therapies”).

Core Components of ACT

components of acceptance and commitment therapy
  1. Creative Hopelessness: This component involves individuals reflecting on past attempts to alleviate their pain and recognizing the futility of these efforts. By embracing the uncertainty of what to do next, individuals open themselves to exploring new strategies for improvement.
  2. Mindfulness: Central to ACT is the practice of mindfulness, which involves being fully present and aware of one’s thoughts, emotions, and sensations without judgment. Mindfulness allows individuals to observe their experiences without becoming entangled in them.
  3. Psychological Flexibility: Psychological flexibility is the cornerstone of ACT, enabling individuals to adapt to life’s challenges while staying committed to their values. It involves accepting difficult thoughts and emotions, defusing unhelpful cognitive patterns, and taking purposeful action.

These core components of ACT work synergistically to help individuals develop greater resilience, cope with distressing thoughts and emotions, and live a more meaningful life aligned with their values.

Who Needs Acceptance And Commitment Therapy (Act)?

Acceptance and Commitment Therapy (ACT) is a versatile therapeutic approach that benefits a wide range of individuals facing various mental health challenges. While ACT is not limited to any specific demographic, certain groups find it particularly beneficial due to its focus on promoting psychological flexibility and values-based living.

1. Anxiety Disorders and Depression

ACT has shown promise in treating anxiety disorders and depression by helping individuals develop acceptance skills and mindfulness techniques to manage distressing thoughts and emotions. According to Fernández C., González S., Coto R., Cot R., Pedrosa L., et al. 2020, “Behavioral Activation and Acceptance and Commitment Therapy in the Treatment of Anxiety and Depression in Cancer Survivors: a randomized clinical trial,” There are statistically significant changes, indicating a reduction in inflexible avoidance of painful thoughts, feelings, and memories.

2. Addiction

Substance use disorders often stem from the inability to cope with painful experiences or emotions. ACT helps individuals struggling with addiction develop healthier coping strategies and commit to actions aligned with their values, reducing the risk of relapse. According to Osaji, J., & Ojimba, C. et al. 2020, “The use of Acceptance and Commitment Therapy in substance use disorders: A review of literature,” ACT proves to be effective as monotherapy or in combination with other therapies in the treatment of individuals with SUD.

3. Chronic Pain

Chronic pain significantly impacts one’s quality of life. ACT teaches individuals how to accept pain while focusing on activities that bring meaning and fulfillment, leading to improved pain management and overall well-being. ACT can effectively lead to improved health outcomes, as discussed by Feliu-Soler A, Montesinos F, Gutiérrez-Martínez O, Scott W, McCracken LM, Luciano JV., et al. 2018, “Current status of acceptance and commitment therapy for chronic pain: a narrative review.”

4. Stress and Burnout

Many people experience high-stress levels and burnout in today’s fast-paced world. ACT provides tools for managing stress more effectively by promoting mindfulness and helping individuals clarify their values to prioritize self-care and balance.

5. Growth and Development

Even individuals without diagnosed mental health conditions benefit from ACT. The therapy offers valuable insights into managing everyday challenges, enhancing resilience, and living a more purposeful life aligned with one’s values.

What Are The Principles Of The Act And Their Application?

principles of ACT

Acceptance and Commitment Therapy (ACT) is grounded in six core principles that guide individuals toward greater psychological flexibility and well-being. Understanding these principles and their application empowers individuals to navigate life’s challenges with resilience and clarity. According to Li Z, Shang W, Wang C, Yang K, and Guo J. et al. 2022, “Characteristics and trends in acceptance and commitment therapy research: A bibliometric analysis,” the six core principles of ACT are as below:

1. Acceptance

ACT emphasizes the importance of accepting internal experiences, such as thoughts, emotions, and sensations, without judgment or attempts to control them. By practicing acceptance, individuals cultivate a more compassionate and open relationship with their inner world, allowing them to respond to life’s difficulties more easily.

2. Cognitive Defusion

Cognitive defusion involves distancing oneself from unhelpful thoughts and beliefs by recognizing them as mental events rather than facts. Through techniques such as metaphor, humor, or observation, individuals reduce the impact of negative thoughts and gain perspective on their experiences.

3. Being Present

Being present, or mindfulness, is a foundational practice in ACT that involves fully engaging with the present moment without judgment. By cultivating mindfulness, individuals develop greater awareness of their thoughts, feelings, and surroundings, enabling them to respond more skillfully to life’s challenges.

4. Self as Context

Self as context encourages individuals to identify with the observing self, a perspective transcending transient thoughts and emotions. By recognizing themselves as the context in which experiences arise, individuals develop a sense of stability and perspective, allowing them to better navigate difficult situations.

5. Values

Values in ACT refer to the qualities and behaviors individuals deem most important. By clarifying their values, individuals establish a guiding compass for their actions and decisions, creating a sense of purpose and fulfillment.

6. Committed Action

Committed action involves concrete steps toward living a values-driven life, even in discomfort or uncertainty. By aligning their actions with values, individuals overcome barriers and obstacles and move toward a life rich in meaning and vitality.

Applying these principles in ACT involves experiential exercises, mindfulness practices, and guided inquiry to help individuals develop greater psychological flexibility and resilience. Therapists use various techniques to support clients in applying these principles to their unique circumstances, empowering them to live more fully and authentically.

How ACT Help With Addiction Recovery?

Acceptance and Commitment Therapy (ACT) offers a unique approach to addiction recovery by focusing on developing psychological flexibility and fostering a values-driven life. Since addiction recovery is a complex journey that requires addressing not only the physical aspects of dependence but also the underlying psychological and emotional factors that contribute to addictive behavior, ACT is aimed explicitly toward the development of greater psychological flexibility, as discussed by Zhang CQ, Leeming E, Smith P, Chung PK, Hagger MS, Hayes SC., et al. 2018, “Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach.”

1. Acceptance of Internal Experiences

One of the fundamental principles of ACT is acceptance, which involves acknowledging and embracing internal experiences, such as cravings, emotions, and thoughts, without judgment or resistance. By learning to accept these experiences as natural and temporary occurrences, individuals reduce the urge to engage in substance use as a means of avoidance.

2. Cognitive Defusion

Cognitive defusion techniques in ACT help individuals detach from their thoughts and beliefs, reducing their influence over behavior. This is particularly beneficial for individuals struggling with intrusive thoughts related to substance use, allowing them to observe these thoughts without getting entangled in them or feeling compelled to act on them.

3. Mindfulness Practices

Mindfulness, another core component of ACT, encourages individuals to cultivate present-moment awareness and nonjudgmental observation of their experiences. By practicing mindfulness, individuals develop greater self-awareness and emotional regulation, making it easier to cope with cravings and triggers without resorting to substance use.

4. Values Clarification

ACT helps individuals identify their core values and align their actions with those values. By clarifying what truly matters to them, individuals establish meaningful goals and engage in behaviors congruent with their values. This sense of purpose and direction provides motivation and resilience in facing challenges encountered during recovery.

5. Committed Action

Committed action involves taking concrete steps toward a values-driven life, even when faced with discomfort or uncertainty. In addiction recovery, this includes engaging in activities and behaviors that support sobriety and well-being, such as attending support groups, practicing self-care, and building healthy relationships.

6. Coping with Relapse

Relapse is a common and often discouraging aspect of addiction recovery. ACT teaches individuals to view relapse as a setback rather than a failure and encourages them to learn from the experience without self-judgment. By integrating relapse prevention strategies and coping skills learned through ACT, individuals bounce back from setbacks more effectively and continue their journey toward recovery.

What Are The Benefits Of Acceptance And Commitment Therapy?

Acceptance and Commitment Therapy (ACT) is a unique and effective approach to psychotherapy that focuses on enhancing psychological flexibility and fostering a values-driven life. According to Nemati, S., and Pourtaleb N. et al. (2022), “The effectiveness of acceptance and commitment training program on the level of academic stress and academic burnout in students with specific learning disability,” ACT integrates acceptance, mindfulness, and behavior change principles to help individuals manage psychological challenges and improve overall well-being. 

1. Psychological Flexibility

One of the primary goals of ACT is to enhance psychological flexibility, which is the ability to adapt to changing circumstances and respond effectively to various emotional experiences. According to Ciarrochi, J. & Bilich L. et al. 2010, “Psychological flexibility as a mechanism of change in Acceptance and Commitment Therapy,” by increasing psychological flexibility, individuals:

  • Respond adaptively to stressful situations and emotional distress.
  • Navigate life’s challenges with greater ease and resilience.
  • Shift perspectives and embrace new ways of thinking and behaving.

2. Stress and Anxiety Reduction through Acceptance and Mindfulness

ACT emphasizes accepting unpleasant thoughts and feelings rather than trying to suppress or avoid them. These acceptance and mindfulness practices significantly reduce stress and anxiety, as discussed by Teoh, K. B. et al. 2021, “Acceptance and Commitment Therapy in Reducing Burnout Level of an Academician from Malaysian Research University.”

  • Encouraging a non-judgmental awareness of the present moment.
  • Reducing the impact of negative thoughts and emotions on behavior.
  • Promoting a sense of calm and clarity in the face of stressors.

3. Promotion of Mindfulness and Its Role in Emotional Regulation

Mindfulness is a core component of ACT that involves paying attention to the present moment with openness and curiosity. Practicing mindfulness helps individuals:

  • Enhance self-awareness and emotional intelligence.
  • Regulate emotions more effectively by observing them without immediate reaction.
  • Develop a deeper connection with their inner experiences and external environment.

4. Improvement in Relationships and Self-Esteem

ACT’s focus on values and committed action improves relationships and self-esteem, as analyzed by Brem, M. J., Gordon, K. C., & Stuart, G. L. et al. 2020, “Integrating Acceptance and Commitment Therapy with Functional Analytic Psychotherapy: A case study of an adult male with mixed depression and anxiety.” By clarifying and living by their values, individuals:

  • Build stronger, more meaningful relationships based on authenticity and mutual respect.
  • Enhance self-esteem by engaging in behaviors that align with their core values.
  • Foster compassion and empathy towards themselves and others.

5. Regaining Control Over Thoughts, Feelings, and Actions

ACT teaches individuals to observe their thoughts and feelings without becoming entangled. This cognitive defusion process helps individuals:

  • Regain a sense of control over their mental and emotional state.
  • Reduce the influence of negative thoughts on their actions.
  • Make conscious, values-driven choices rather than reacting impulsively.

How long does ACT typically take to show results?

The duration varies, but many individuals start noticing improvements within 8-12 sessions, depending on their issues’ complexity and commitment to practicing ACT principles.

Is ACT suitable for children and adolescents?

Yes, ACT can be adapted for children and adolescents, helping them develop mindfulness and acceptance skills to cope with stress, anxiety, and behavioral issues.

How can Acceptance and Commitment Therapy (ACT) be integrated with Eye Movement Desensitization and Reprocessing (EMDR) Therapy for a comprehensive addiction treatment plan?

Acceptance and Commitment Therapy (ACT) can be integrated with Eye Movement Desensitization and Reprocessing (EMDR) Therapy by addressing both the trauma that may contribute to addiction and the ongoing psychological flexibility needed for recovery. EMDR helps process and resolve traumatic memories that often underlie addictive behaviors, while ACT focuses on accepting difficult emotions, committing to personal values, and taking actionable steps toward recovery. Combining these therapies allows individuals to heal from past traumas through EMDR and develop resilience and adaptive coping strategies through ACT, leading to a more holistic and effective treatment plan for addiction.

How does Acceptance and Commitment Therapy (ACT) enhance the outcomes of Medication-Assisted Treatment (MAT) for individuals struggling with addiction?

Acceptance and Commitment Therapy (ACT) enhances the outcomes of Medication-Assisted Treatment (MAT) by addressing the psychological and emotional aspects of addiction that MAT alone may not fully cover. While MAT helps manage physical withdrawal symptoms and reduces cravings through medications like methadone, buprenorphine, or naltrexone, ACT helps individuals build psychological flexibility and resilience. ACT teaches patients to accept their cravings and distressing thoughts without acting on them, align their actions with personal values, and commit to behaviors that support long-term recovery.

Can ACT be combined with other therapies?

ACT is often used with other therapeutic approaches, such as Cognitive Behavioral Therapy (CBT), to enhance overall treatment effectiveness.

What makes ACT different from traditional CBT?

Unlike traditional CBT, which focuses on changing negative thoughts, ACT emphasizes accepting thoughts and feelings while committing to actions aligned with personal values.

How can I practice ACT techniques at home?

You can practice ACT techniques at home through mindfulness exercises, value clarification activities, and cognitive defusion strategies to manage unhelpful thoughts.

Ryan Wakim MD
Author
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Dr. Wakim is a board-certified psychiatrist with a passion for and expertise in addiction, mood disorders, trauma-related disorders and the subspecialty of interventional psychiatry. He obtained his medical degree from West Virginia University where he also completed his residency training, finishing as chief resident. Dr. Wakim co-founded and served as the CEO of Transformations leading to a successful merger with Shore Capital in May 2021. He is purpose driven towards improving the standard of and removing stigma related to behavioral healthcare. Dr. Wakim enjoys golf, traveling and time spent with his two dogs, Lulu and Rayna.

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