As advances in psychology occur, new ways of formulating psychotherapeutic intervention tools are emerging. This is what has happened with the shift from the cognitive-behavioral model to third generation therapies.
Among these new therapies, one of the most interesting is the Acceptance and Commitment Therapy . Let’s see what it consists of from the testimony of an expert in the use of this kind of psychological intervention.
Interview with Triana Sanz: the keys to Acceptance and Commitment Therapy
Psychologist Triana Sanz Font is a General Health Psychologist and Director of Lua Psicología, a psychotherapy centre located in Madrid . Throughout this interview, she explains to us what Acceptance and Commitment Therapy is and how it works, and the reasons why it is one of the most important resources in her work attending to patients.
What exactly does Acceptance and Commitment Therapy consist of, and what is its working philosophy?
The Acceptance and Commitment Therapy or ACT, whose main author is Steven C. Hayes, is included in the so-called Third Generation Therapies, born from the Cognitive-Behavioral Therapy.
It starts from a model of contextual work, since instead of focusing and wanting to change the content, intensity and frequency of thoughts and emotions, it puts the focus on the way each person relates to them, so that they do not control their behavior.
The suffering increases because the strategies and techniques we use to solve our problems are wrong and lead us into our own trap. For this reason, ACT proposes a model that helps people to open up and be more aware of their emotions, thoughts, feelings and bodily sensations, allowing them to learn and attend with greater flexibility to what is inside them and what can be useful without feeling dominated by them.
This model of psychological flexibility can be summarized in three concepts: openness, awareness and commitment. That is, openness to experience without trying to avoid what is unpleasant for us, awareness of the sensations, thoughts, feelings, emotions, memories, images, etc. in the here and now and commitment to carry out behaviour according to what you really want and to commit to those value-based behaviour patterns.
Why did you decide to become an expert in this kind of therapy?
Both in my career and in the subsequent training I have done, the basis has always been Cognitive-Behavioral Therapy and, although it is true that it is a current of which we already know its enormous effectiveness in many psychological problems, it remains lame and we need a new approach.
I found this new approach in ACT, from the moment I started to soak up its foundations, its theoretical framework and its way of working, I realized the enormous potential it had, it proposed something different but at the same time natural and coherent with the way in which we function and live our lives.
Wanting to free ourselves and fight against what makes us suffer is something very common to human beings. We avoid or try to control any thought, emotion, feeling or situation that makes us feel uneasy and to get rid of them, the strategies we use are nothing but traps that we put on and that increase our discomfort. We let ourselves be carried away by our thoughts and emotions, moving away from the life we really want to live.
It’s not about avoiding, fighting, thinking positive, changing unpleasant thoughts or emotions into pleasant ones, it’s about opening up to the experience (both positive and negative), putting it in context and not in the person (to generate distance) and from there, carrying out behaviours or actions (it’s the only thing we really have control over) that are important to us.
All this, so coherent, natural and difficult to carry out, is why I decided to specialize in this type of therapy, not only as a way of working with my patients but as something that I have been incorporating into my personal life.
It is often said that the desire to make the symptoms of a disorder disappear causes patients to become obsessed with that which makes them ill. Does Acceptance and Commitment Therapy help to avoid these dynamics?
Undoubtedly, as I said before, to try to get rid of what makes us uneasy, we put in place control strategies as an attempt to solve it, but the only thing we achieve is to increase the uneasiness. In other words, the solution becomes the problem, entering a vicious circle.
For example, we have skin eczema with its consequent itching (problem) and to solve it we scratch (solution), but in this case, the more we scratch, the worse the itching and irritation increases (problem). The solution has become the problem.
From ACT what we propose is to break this vicious circle realizing the erroneous strategies that we use.
In your opinion as a psychologist, is acceptance a value to be claimed in the face of the imperfections of everyday life, beyond the cases in which there are diagnosable psychological disorders?
In life there is a part of pain that is inevitable, we face situations, thoughts, sensations, emotions and attitudes that are going to generate discomfort. The problem comes when we offer resistance to that pain. We don’t want to feel bad, we fight against that pain and the only thing we get is to increase our suffering. So, what do we do, how do we handle it?
Acceptance allows us to move forward, to keep going and not to get stuck in situations that we cannot change. This attitude of focusing on the things we can do makes us take an active and committed role in our lives.
Let’s take an example, I get fired from a job and my attitude or my coping strategies can go in two directions, one, cursing bosses and company for my dismissal, lamenting my new situation and so on.
However, since I cannot change the situation (the dismissal), the most appropriate thing would be to accept the situation, so that I can move forward and dedicate my time and attention to what I can and want to do. This does not mean that I avoid or repress thoughts and emotions derived from the dismissal, which is inevitable, but that I can decide not to get caught up in the vicious circles we were talking about.
It is important to distinguish between acceptance and resignation. When we resign ourselves, there is no progress, there is stagnation, there is rumination, there is a fight against that malaise. We end up thinking that we cannot do anything to change the situation, we adopt a passive role and our unease increases because we believe that we are not capable of getting out of the situation. We need to accept ourselves, with our thoughts, our emotions, our way of being… and, only in this way, can we move forward.
Do you think that Acceptance and Commitment Therapy combines well with other forms of psychotherapy?
We have said that ACT is a form of experiential, behavioral and cognitive psychotherapy and that by belonging to the Third Generation Therapies, derived from Cognitive Behavioral Therapy, it can be perfectly combined with it.
Moreover, the fact of opening ourselves to the experience, paying attention and realizing our thoughts, emotions and feelings, is closely linked to full attention and the present moment, derived from Mindfulness.
In general it combines well with the rest of Third Generation Therapies, because of the basic principles they share.
Surely many patients must learn to distinguish between what they must accept and what they must strive to change and improve. Is this process also worked out in the therapy sessions?
When patients begin to know and incorporate acceptance into their daily lives as a way of dealing with experiences related to emotional pain and commit themselves to carrying out actions that are really useful and important, they are already changing and/or improving, they are learning to live with that situation in the best possible way. In other words, they are trying to find a balance between their personal well-being and what they have been through.
Each of us works on our process of acceptance in order to move forward, change and stop suffering. For there to be change, there has to be acceptance.
For example, in a couple’s relationship, we often want the other partner to change instead of accepting what he or she is like, which can lead to friction, arguments, etc. Another situation is to accept that the continuity of the couple is not possible at that time and only then, from acceptance, we will be more able to see reality and things with more tranquility, to make decisions and carry out the changes we want.
By this, I mean that there may be a time in our lives when we decide that we no longer want to live the way we are. But this change refers to oneself, to the direction of our life, not to a change on the outside.
What are the first signs that the therapeutic intervention is working? How do patients notice it?
What I have observed in the patients is that, as they work with ACT, they discover a new way of relating to emotional pain and suffering that is different and, as I said, at the same time easy and natural to incorporate into their lives.
The first signs come mainly when they start to be able to defuse their thoughts (defusion is one of the 6 pillars of ACT), that is, they start to take distance from the thoughts, to realize how their mind is working, not to get carried away by it and to see the thoughts for what they are, words in their head.
Our mind is like a TV that’s on 24 hours a day. We cannot turn it off, we cannot do anything to make our thoughts appear in our mind against our will.
However, if we can decide whether to pay attention to it or not, if we have the TV in the background (our mind) without paying attention to it and doing what we really care about, or if we give it our full attention and let ourselves be drawn into its stories.
The second signal comes in another of the ACT pillars we have already talked about and that is acceptance.
I would say that the first signs come from these two principles, cognitive defusion and acceptance, but the other 4 pillars of ACT (the observing self, present moment, values and committed action), are also present and influencing each other, since without an openness to experience, thanks to the attention to the present moment and to that observing self that allows us to separate from our thinking self, we would not be able to undertake committed actions in accordance with our values.
That is why I consider ACT not only an effective therapy, but a new way of living.