Acceptance and Commitment Therapy, also known as ACT, is a mindfulness-based counseling approach used to help individuals maximize their potential for a rich, full, meaningful life through values-based living. This presentation will cover practical skills utilizing ACT for dealing with anxiety.

This webinar is facilitated by Kelsey Engdorf, an LPC- Associate supervised by Heather Dunn.

Watch a replay of the presentation here.

Learn more about anxiety and Acceptance and Commitment Therapy (ACT).

Here is a transcript of the webinar:

Hi, everybody! Today, we’re going to talk about a specific type of therapy known as Acceptance and Commitment Therapy (ACT). We’re going to be specifically talking about that type of therapy as it relates to anxiety and how it can help us to better manage our anxiety, and live our lives more fully while we’re dealing with some stress or some anxiety. 

My name is Kelsey Engdorf. I am a Licensed Professional Counselor associate (LPC-A) at Eddins Counseling Group. I noticed there are some people from different cities, even different countries, which is really exciting. I’m in Houston, Texas. I work at our Sugar Land office (if people are from the area). 

I picked this topic because I have some additional training with this specific type of therapy, and I’ve used it with quite a few clients. They’ve mostly found it very helpful, and I have personally found it to be really helpful too. 

I’m assuming that because you all came to this talk (well, you may or may not be a clinician),  you probably struggle with anxiety yourself. Feelings of anxiousness, stress, feeling overwhelmed. 

Does anybody feel like their anxiety has gotten to the point at times where it really gets in the way of how they want to live? 

Anxiety really limits what you feel like you can do:

• Maybe you want to start dating again, but you feel too anxious?
• Maybe you want to start a business?
• Maybe you just feel like you can’t really be present because of all your anxious thoughts?

Hopefully, we can help out with a little bit of that today.

This is part of a free monthly webinar series on a variety of mental health topics that Eddins Counseling Group offers once a month on a variety of mental health topics. 

Objectives

Learn practical tools for handling anxiety using the acceptance and commitment therapy framework:

• Values & committed actions
• Cognitive defusion skills
• Willingness skills
• Attention to present moment activities (mindfulness activities)

Here are a couple of objectives, that we’re going to be talking about in the presentation.

We’re going to learn practical tools for handling anxiety using the Acceptance and Commitment therapy framework.

Talking about values and committed actions, something called cognitive defusion/diffusion, skills for that, willingness skills, and attention to present moment activities, otherwise known as mindfulness activities. 

Acceptance and Commitment Therapy (ACT)

• Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.
• “3rd wave” cognitive behavioral therapy; based on relational frame theory
• What makes ACT unique from other types of therapies:
  • Pain is part of being human
  • It’s about moving toward the life you want to live with your problems
  • Symptom reduction is not the focus

Just a little brief information about Acceptance and Commitment Therapy (ACT):

ACT is a unique, empirically based psychological intervention that uses acceptance and mindful strategies together with commitment and behavior change strategies to increase something called psychological flexibility.

Now, that’s a lot of words. Basically just means a few things. 

Psychological flexibility means remaining in the present moment, staying open to whatever thoughts and feelings show up (good or bad), and taking action in service of our values. 

It’s a type of third-wave cognitive behavioral therapy or CBT. It was developed in the 80s, so it’s a little bit newer. There’s a good amount of research showing the effectiveness in treating a variety of mental health concerns and brief information on relational frame theory. So that’s what it’s based on. It’s a pretty complex theory. 

One thing that the RFT or relational frame theory says is that our brains are a bunch of different connections. So we might be able to form connections from any seemingly unrelated objects. And sometimes that happens in the way of opposites. 

I’m sure this has happened to quite a few people. You might have had a happy moment where everything seems good, and then your mind immediately goes to something sad or sadness.

I wish this person was here with me, or I know this happiness can’t last forever. So based on relational frame theory, one reason for this is that happiness is the opposite of sadness.

So our brains sometimes automatically go to feeling sad when we’re feeling happy. That’s part of the theory. 

What Makes ACT Different from Other Types of Therapies? 

One thing that is a little bit different is Acceptance and Commitment Therapy or ACT says that pain is just part of being human, and this includes emotional pain, unfortunately.

It’s really how we relate to or handle the pain is the part of it we can control because oftentimes we can’t control our pain. It’s about moving toward the life you want to live with your problems. So not necessarily despite your problems or once you get better, once you get over your anxiety, you’re going to start living. It’s about trying to live right now with your anxiety. 

One way to think about that, is you can think of yourself as a bus driver.

On your bus of life, you have a lot of different passengers.

• You have anxiety on the bus.
• So, you have sadness,
• You have pain, but
• You also have happiness.
• You have relationships with others,
• Your career, and
• so many different things.

Even though you might want to kick anxiety off the bus, you might want to kick pain off the bus. It’s about living your life.

It’s about driving your bus, even with all those negative inner experiences, and all those negative emotions that come up from time to time. 

Symptom reduction is not the key. It’s not the focus of Acceptance and Commitment Therapy or ACT. Symptoms reduction is definitely a byproduct and it definitely tends to happen, but it’s not the direct focus.

We’re not going to talk about how we can control our anxiety or lessen it, but how we can live, how we want to live, even with our anxiety present at times. 

Anxiety – Adaptive or Problematic?

When Is It Helpful? When Is It Unhelpful?

• Anxiety – a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.  
• While anxiety and stress are different, they are often used interchangeably
• Workability – is it helpful?

Anxiety is, in one definition, a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.

So anxiety is a really normal part of life when you look at it like that. In fact, anxiety can be really helpful at times. If we didn’t have any worries about the future, we would probably put ourselves in some dangerous situations. 

Like back in the day, we may have gotten too close to an animal that could attack us. Nowadays, anxiety can help us in a variety of ways. We’re worried about failing a test that might give us the motivation to study. 

But I’m sure as a lot of you know, it can become very problematic and start interfering in our lives in a really negative way.

Let’s say, for example, you have driving anxiety. That’s definitely problematic. It can feel paralyzing.

It can be caused by a variety of factors not limited to biology, such as our neurotransmitters, trauma, current life situations, lack of resources, lack of sleep, and just so many different things that can contribute to our anxiety. 

According to Acceptance Commitment Therapy ACT, one of the major ways that anxiety becomes problematic is that:

• the more we attempt to control our negative feelings, …
• the more we’re fused with our thoughts, …
• the more we’re pushed around by our thoughts, …
• the more our thoughts dictate our behavior and in the ACT framework, …
• that’s where the problems arise.

While Anxiety and Stress Are Different, They Are Often Used Interchangeably. 

We’ll use them interchangeably here because I’m not too much of a stickler for the differences.

So one big concept in Acceptance and Commitment Therapy ACT is the concept of workability. Is it helpful?

Is what we’re doing, what we’re thinking, and how we’re acting, is it pushing us toward the life that we want to live, or is it pushing us away from the life we want to live?

And that’s basically what workability means. 

ACTions That Can Improve Mental Well-being

• Sleep
• Eating patterns
• Exercise 
• Close social ties
• Processing past traumas
• Getting out in nature

So before we get into the more ACT-specific type of things, I wanted to talk especially on anxiety, and I want to talk about a few things just in general that can improve mental well-being.

Some of these might be obvious, but I wanted to go over them briefly. As I said, Acceptance and Commitment Therapy ACT is not about symptom reduction specifically or about necessarily decreasing anxiety.

However, there are things we can do to help overall with our mental health that in turn are possibly or most likely going to reduce our anxiety. 

Sleep

So the first one is sleep. I’m sure everybody knows that pretty much, but I really feel like that’s the foundation of mental health.

If we’re not getting sleep, our anxiety is going to be worse.

We’re probably going to feel more depressed. We’re not going to be able to concentrate. But I know this is so hard at times because of stress, because of current life circumstances, biology, and just all the things that interfere with our sleep.

There is a book listed called “Why We Sleep”. So that talks all about sleep and how to get better sleep, hopefully.

Eating Patterns

The next one is eating patterns.

There’s more and more research being done that shows what types of food we eat, and how they contribute to our mental health and our overall well-being.

Nutrition research is pretty messy. But what we do seem to know is that processed foods tend to be correlated with poor mental health.

Also, eating enough protein and healthy fats tends to be correlated with more positive mental health. I know there are so many different diets out there, but that seems to be what we know. 

Exercise

Exercise has been studied pretty extensively. There’s some mixed research out there, but overall, that’s something that in the research really tends to reduce our stress and help us feel overall better. 

Close Social Ties

Having close social ties. We’re social beings, so if we’re isolated, that can really contribute to poor mental health.

However, this is another area that’s really, really tough. If we struggle with social anxiety or we have to move around a lot, those types of things. 

Processing Past Traumas

Processing past traumas is the next action that can improve your mental health. I believe that one’s hugely important and that can be a direct contributor to our anxiety or other problems.

And it doesn’t necessarily mean that it’s a huge thing like a horrible car accident or fighting in a war.

It can be smaller things like maybe a parent who wasn’t really there for you as a kid or being bullied in school, those things.

And those things are worked out best, I believe, with a trained trauma therapist or somebody who’s specialized in training. 

Getting Out into Nature

Getting out into nature, that’s another one.

The research tends to be pretty clear that that can reduce our stress and just improve our mental health overall.

I just wanted to go over those things. So now we’ll get on to more act-specific type things. 

Values

How We Know Where We Want to Go

Values are a way of clarifying our direction and purpose. They are how we decide what is important to us, and what is not so important.

One way to define values is to think of them like a compass. They are there to guide our behavior, on an ongoing basis, to achieve our goals and live a more meaningful life. 

Values are a huge part of Acceptance and Commitment Therapy ACT. One of the key parts of it is focusing on our values. So it’s how we know where we want to go.

They’re a way of clarifying our direction and purpose. They’re how we decide what is important to us and what’s not so important. 

One way to define values is to think of them like a compass. They’re there to guide our behavior on an ongoing basis to achieve goals and live a more meaningful life.

As I said, they’re like a compass. They’re different from goals. A goal is something that we can accomplish, like graduating from college. Once we accomplish that, we can check it off. It’s done. That’s behind us. Values are never complete. They’re ongoing.

So if we wanted to head to Louisiana, that would be our goal. And our value, in that case, would be heading east from Texas. And if we got off track a little bit, all we would have to do is head back east to get back on track to our goal. We can arrive in Louisiana, that’s the goal, but we can never arrive east. So in that scenario, east would be the value.

Our values may change over time. As we get older, they might become very different. 

So go ahead and take a look at this list of values.

It’s certainly not all the values in the world, but it is a pretty good, comprehensive list. 

Values Exercises

• Pick 3-5 values from the previous slide (or any others that come to mind)
• Write down why they are important to you
• At the end of the day, list each top value. Then write one way you lived out that value. 
• For example, if one of your top values is family, you might write that you had a family dinner or called a parent that day. 

Pick 3-5 Values 

What I want us to do is do a little exercise. Go ahead and take a look at this list or any others that come to mind. If you can pick out 3-5 that you feel really resonate with you the most at this current stage of life. Which ones do you feel are really the most meaningful to you? 

Write Down Why They Are Important

One exercise you can do is take a moment right now or maybe later, and think about or write down, ideally, why these values are so important to you. What they mean to you, and why they are something that you would like to live your life based on. 

List Each Top Value

The third part of that exercise, at the end of the day, just list out your values. So list out love, passion, acceptance, or independence, and write down one way that you lived off that value that day.

Or if you’re more of a morning person, you can do: which values you intend to live out that day and how you intend to do that. So for example, if one of your values is family, you might say that you had a family dinner or you called a parent that day. 

I know that seems very simple, and you might be like, how does this really help?

There’s been a lot of research focusing on values and how much that can really help us feel a lot more in control of our lives.

It can feel like we have a lot more meaning in our lives. It can feel like we’re a lot more fulfilled, like we’re really moving toward the life we want. 

This is something to keep in mind, not just now, but ongoing. Keep in mind: “Based on my values, what life do I want to live? What type of life do I want to live? Or how am I currently acting on my values?”

And a lot of times, as I’m sure everybody knows, it can be pretty difficult to act on our values sometimes, especially when we’re having a lot of anxiety or other concerns.

Committed Action

Committed action is another big part of Acceptance and Commitment Therapy ACT, and that’s the commitment part from “acceptance and commitment therapy”.

Behavior in the service of chosen values.

Basically just means that we’re acting in line with our values. 

I put a couple of sample values up here.

Connection: what might one’s behaviors be? And then how might anxiety get in the way of that? Social anxiety, obviously, is a big one.

Health: We all know how much stress can affect us in making healthy decisions. If we had a really tough day, we might want to eat some sweets and not really be focusing on our health. So that is definitely a struggle.

Fusion vs. Defusion

• Fusion: When our thoughts dictate our behavior; when we believe our thoughts are 100% true
• Defusion: Looking at thoughts rather than from thoughts; Noticing thoughts rather than becoming caught up in thoughts; Letting thoughts come and go rather than holding on to them

I know I was talking about how difficult it is sometimes to live out our values and do committed actions based on the values, like making healthy choices if health is one of our values.

It can be really tough, especially when we are what is called fused with our thoughts, being hooked by our thoughts, being pushed around by our thoughts.

This is something that might be new information, hopefully, to some people. Acceptance and Commitment Therapy ACT has a different way of looking at the thought.

In traditional cognitive behavioral therapy, the focus is on changing our thoughts. We have a thought: “I’m useless”. Your therapist might work with you to change that to: “I am powerful”, or whatever the opposite of useless would be.

In ACT, that’s not really the goal. The goal is to look at our thoughts for more of what they are. They’re just thoughts, which I know is very much easier said than done. 

Fusion means that we are fused with our thoughts. We’re hooked by our thoughts. It’s when our thoughts dictate our behavior when we believe our thoughts are 100 % true, which is pretty easy to do because they’re coming from ourselves.

We’re having these thoughts, we’re thinking “I’m useless”. It’s pretty easy to believe. 

Diffusion 

(noun) A skill or technique that is primarily used to detach, separate, or get some distance from our thoughts and emotions. (@thepsychologygroup)

Diffusion, it’s a technique creating some distance from our thoughts.

Diffusion is more of the idea of taking a step back, looking at our thoughts rather than from our thoughts, noticing our thoughts rather than becoming caught up in them, and letting them come and go rather than holding on to them.

When we are fused with our thoughts, we might believe them, like I said, as absolute truth. And when we believe our thoughts as absolute truth, they’re probably going to dictate a rule or behavior.

So believing thoughts such as “I’m useless” is not helpful, typically, and not conducive to living the life we want. 

Defusion Techniques

Decrease the influence of thoughts on our behaviors and experiences; Increase our ability to be present and take effective action.

How do we get some space from our thoughts? How do we separate our observing mind from our thinking mind? Here are a couple of diffusion techniques: 

• ”I’m noticing I’m having the thought that…”
• Thank your mind
• Repeating the word until it loses meaning
• Say it in a silly voice or sing it
• Name it
• Place the thought on a cloud, leaf, etc.

The purpose of diffusion techniques is to decrease the influence of thoughts on our behaviors and experiences and increase our ability to be present and to take effective action. 

So to do those things that we want to do that help us live out our values.

One that’s probably the most common one is “I’m having the thought that ____”, or “I’m noticing I’m having the thought _____”.

Let’s switch it up.

• Let’s say you’re having the “I’m stupid.” 
• You might tell yourself: “Okay, I’m noticing I’m having the thought that I’m stupid.” 

That might not seem too different, but if you practice it with maybe an intrusive thought that comes to mind, saying out loud:

• “I’m useless”, and then saying out loud,
• “I’m noticing I’m having the thought that I’m useless”.

Oftentimes, you can feel a little bit that it has a little bit less pull over you. Nothing’s a magic bullet, but that tends to switch things a little bit. 

Thanking your mind, saying “thank you”. If your mind is worrying about the future, you can say: “Thank you, mind”. Very helpful. Kind of like talking to yourself.

Repeating the word until it loses its meaning is a big one. With the example: “I’m stupid”, you could repeat the word “stupid” for 30 seconds until it just seems silly or seems like a silly word and it loses its power a little bit. 

Say it in a silly voice or sing it. Name it. Say that old “I’m a loser” story again.

Place the thought on a cloud, leaf, or something like that.

This is more of a visualization, a mindfulness meditation-type exercise where you might envision a stream and just you might envision placing your thought on a leaf and the leaf floating down the stream. That could be an example of that.

Defusion 

Hold language lightly

• Pick and choose when to defuse
• The goal is not to “feel better” but to give us more space to move toward our values
• Defusion is not an attempt to avoid or suppress thoughts
• Although not the direct goal, it can help lower overall stress and anxiety

A few more thoughts about diffusion. The idea really of diffusion is just to hold language lightly. Pick and choose one to diffuse. We have so many thoughts all the time. Our minds are pretty much constantly going. There’s absolutely no way we can diffuse from every thought, catch every thought by any means. 

When it is helpful to diffuse from our thought is when it’s unhelpful or when it’s something that’s moving us away from the life we want to live instead of toward it.

The goal is not to “feel better” but to give us more space to move toward the things that we want to do based on values. 

It’s not an attempt to avoid or suppress thought. I know that’s definitely the natural thing to do is when we’re having negative thoughts, and when we’re having a hard time. Our automatic thing is to suppress it.

We want to avoid those thoughts, which is not the worst thing to do in the world.

However, research does suggest that the more we do that, that actually tends to make those thoughts typically come up more in the future.

It might help temporarily, but overall, as a long-term strategy, it’s not really the most helpful thing to do. And although it’s not the direct goal, it can help lower overall stress and anxiety. 

Steps For Defusion

Let’s go over some steps for diffusion. 

1. Identify thought
2. Allow yourself to have the thought (ideally without judgment)
3. Use defusion technique

First, you want to identify the thought.

Is it something helpful or is it not? For example, let’s say you’re worried that you’re going to get fired from your job. Is this thought helpful?

Well, maybe in some situations it is because maybe you’re doing something that your job you shouldn’t be doing, or maybe you need to work a little bit harder or talk to your boss or something. So in that situation, it can be helpful.

However, if you think you’re doing everything pretty much okay and you are very worried about getting fired for almost no reason, or it’s something you really have no control over, then maybe this would be a good thought to try diffusion techniques with. 

Second, would be to allow yourself to have the thought, ideally without judgment. I know that’s something easier said than done, but just notice: “I’m going to get fired”. 

Third, use the diffusion technique. For example, you could say: “Hey, I’m noticing I’m having the thought that I’m going to get fired”, or “Thank you, mind, for telling me that again”. 

Then step 4 and 5, go back to whatever you were doing.

I know this is a hard thing to do at night when we’re trying to fall asleep because there’s really not much to get back to what we’re doing. If we use diffusion techniques, the thought might come up again. You can always diffuse again or use a different technique. 

As we know, there’s really no magic bullet, unfortunately. Sometimes these techniques work better than other times, but they tend to be pretty helpful for the most part. 

Experiential Avoidance vs. Willingness

Drop the rope

• Experiential avoidance: To avoid, suppress, or get rid of unwanted private experiences, even when it’s harmful, costly, or ineffective to do so
• Oftentimes, the more we try to control our inner experiences, the more intense or problematic they become
• Experiential avoidance is correlated with many negative outcomes including higher anxiety, more depressive symptoms, and lower quality of life. 
• Willingness (aka Acceptance): Actively contacting psychological experiences directly, fully, and without needless defense

We’ll talk about another couple of Acceptance and Commitment Therapy ACT concepts.

So we’re going to talk about something called Experiential Avoidance versus Willingness and “drop the rope”.

“Drop the rope” is a big metaphor in ACT and Acceptance and Commitment Therapy. It’s really something meant to represent a metaphor for how we struggle with our emotions. 

With anxiety, we feel anxious about something, and we try to push it down. It pulls us back a little bit.

We push away, it pulls us back. So we’re in this tug of war oftentimes with our emotions.

And in ACT, the metaphor is to drop the rope, to drop that struggle with that emotion.

The definition of experiential avoidance is to attempt to avoid, suppress, or get rid of unwanted private experiences. 

So thoughts, feelings, and emotions, even when it’s harmful, costly, or ineffective to do so. In the tug-of-war scenario, this is when we’re pushing away our negative emotions.

Oftentimes (this is what research tends to suggest, and this is one of the things that Acceptance and Commitment Therapy or ACT frameworks are based on), the more we try to control our inner experiences, meaning emotions specifically, the more intense or problematic they become.

Experiential avoidance, meaning, trying to control, suppress, and push down any sadness, anxiety, or any negative emotions are correlated with many negative outcomes, including higher anxiety, more depressive symptoms, and overall lower quality of life. 

Even though it seems counterintuitive, that tends to be what the research suggests. So the opposite of that is something called, I like to call “willingness”.

A lot of people call it willingness, but acceptance is the ACT-specific term for it. I think willingness has become a very popular term too, but it’s the acceptance in the Acceptance and Commitment therapy. 

Acceptance does not mean that we’re accepting the life we have and not trying to make any changes. 

That’s not at all what it means. So that’s why I prefer the word willingness.

It means actively contacting our psychological experiences directly, fully, and without needless defense. In that metaphor, it’s dropping the rope, essentially allowing ourselves to feel our feelings. 

A caveat on that, of course, there are times when avoidance or pushing down our feelings might be helpful:

• If we’re at work, or
• If we’re having to do something, or
• If we had just extreme traumatic experiences in the past…

… that’s understandable until you get with a good therapist to not necessarily open those things up by yourself.

It’s also the other part of that. You can definitely go too far with willingness, too, because it’s not adaptive to sit around and feel sad all the time either. So there’s definitely a balance.

But the key is always pushing everything away, never allowing ourselves to feel our feelings, or