Sep 26, 2018
What is Acceptance & Commitment Therapy and what's it like to have it?
How can we live a life in line with our most important values?
Dr Joe Oliver, Gary Bridgeman, Dr Graciela Rovner and Dr Eric Morris talk to Dr Lucy Maddox.
Show Notes and Transcript:
If you’re interested in finding out more about the British Association for Behavioural and Cognitive Psychotherapies, or about Acceptance and Commitment Therapy here are some resources:
babcp.com is the British Association for Behavioural and Cognitive Psychotherapies website and it links to the CBT register of accredited CBT therapists in the UK (or go straight to cbtregisteruk.com). BABCP also has an ACT special interest group which members can join.
https://www.actmindfully.com.au/free-stuff/ is a resource page on Russ Harris' website. Russ Harris has also written books on ACT (see below).
https://contextualconsulting.co.uk/resources houses some of the resources that Joe Oliver refers to in the podcast including some youtube video links.
https://contextualscience.org/clinical_resources houses some ACT resources for clinicians and has more information about trainings.
https://www.babcp.com/Therapists/Compassion-Fatigue.aspx has some extra resources if you're a therapist feeling in need of support.
Oliver, J., Hill, J. & Morris, E. (2015) ACTivate Your Life: Using acceptance and mindfulness to build a life that is rich, fulfilling and fun. Robinson.
Harris, R. (2011). The happiness trap. ReadHowYouWant. com.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press.
Hayes, S. C. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.
Jackson Brown, F. & Gillard, D. (2016) Acceptance and Commitment Therapy for Dummies. Wiley.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44(1), 1-25.
There are also several podcasts about ACT - if you search for acceptance and commitment therapy podcast you will come up with a few different ones.
Lucy: This is Let’s Talk About CBT and I’m Dr Lucy Maddox.
This series of podcasts, brought to you by the BABCP, explores cognitive behavioural therapy or CBT. What it is, what it’s not, and how it can useful.
Today we’re thinking about acceptance and commitment therapy or ACT. This is one of the wider family of CBTs.
For this episode, like the others in this series, I tried to find people who’ve experienced having acceptance and commitment therapy for themselves as well as people who are used to delivering ACT.
We’ve got that but unusually in this episode lots of the people who volunteered to speak about what it’s like to have ACT are also ACT therapists. I don’t think this is a coincidence. There’s something about this approach where experiencing using the concepts in your own life is an important part of being a therapist.
I started off by meeting with Dr Joe Oliver, clinical psychologist, co-director for UCL CBT for psychosis postgraduate diploma and director of Contextual Consulting which is an ACT based consultancy.
I started off by asking him what is ACT?
Joe: The acronym starts to unpack a little bit of what it is. So that the key piece about acceptance and then sitting right alongside commitment when things get really big and feel overwhelming. Very instinctual perhaps to try and want to push those experiences away or not have them.
So the acceptance part is helping us to make room and space for, breathe into and allow those experiences. Crucially so that we can do the commitment bit, which is to take action, to do things as we might choose to based on things that are important to us, things that matter to us.
Lucy: So like if you’re feeling really sad, for example, would ACT say that there’s something about trying to accept that you're feeling sad? Is that the sort of experience that you’re talking about?
Joe: Yeah, exactly, yeah. It’s kind of it’s a tricky word, right, like particularly feelings like sadness or maybe anxiety that if most of us were being honest with ourselves we wouldn’t say we necessarily warm to.
Lucy: No, rather not have it. Yeah.
Joe: Rather not have them. Yeah, exactly. But at the same time there’s a piece of this model talks about making room and space for the parts of those experiences that are natural, the human part of experience. Which is to say when things, of course, in life don’t go as we want them to or important relationships end or people move away from us. Those feelings that arrive, including things like sadness, how, as much as perhaps we might want to push them away, there’s a recognition of the normalness, the naturalness of those experiences.
Lucy: And so is there something about, does ACT think that it’s actually more helpful to accept and that in some ways it can help us to feel that less, paradoxically or…?
Joe: Yeah. Paradoxically is a perfect word for it. Perfect because like a busy problem-solving mind could go, “Oh, ha, I know what I need to do. I need to accept it. And then I’ll have it less.” And yet it’s not kind of quite that. It is and it isn’t. Like it is, of course, that probably when we have a relationship to things like sadness that’s more based on breathing into, metaphorically, or creating room and space for, or acceptance technically. That it’s likely that we’ll allow that to move through more to if it were like a stream or a river that rather than blocking it and damming it up we create some space and it allows us to move through of its own accord.
Of course that might mean sometimes that acceptance and turning towards may even in the short-term increase that feeling. But at the heart that we’re helping people to have a more skilful response to those feelings, a more workable response.
It’s also something for me personally that really resonates. And I don’t know whether necessarily like that’s always the metric for what’s a good therapy. But I think for most of us that when we’re living and breathing life we want things that we find are helpful and useful and do have a sense of resonance.
For me in my own life having an approach that helps me to recognise that sometimes struggle and fighting against and not having is a little less helpful versus just allowing emotions to be there or difficult experiences.
When I first came across that that was a really – it was a revelationary experience for me. It was something…
Lucy: Was it?
Joe: Yeah. Completely out of the blue. It hadn’t really occurred to me that perhaps the way forward was not to not have these experiences but perhaps that they could kind of come with me.
Lucy: I guess it’s a bit of a relief actually if we’re not feeling like we have to push them away all the time. There’s a bit of a sense of relief there as well.
Joe: Yeah. Exactly. So like a relief which is, well number one, maybe I don’t need to use all that energy to not have it. And then number two maybe it’s kind of okay for it to be there. It doesn’t mean there’s something missing or wrong or that we’re broken for having these experiences. That it’s just, it’s a recognition, like a real deep recognition. “Hey, this is perhaps a part of, a normal part of human existence.”
Lucy: How do you think, in your experience of working with people, it’s most helpful? Are there particular problems that it particularly helps with or kind of particular situations that can be tricky?
Joe: So the model is versatile. Or also known as transdiagnostic. So it identifies a small set of key processes for understanding how we humans work. And particularly for where we as humans get stuck in life. Out there in the research world you see it get applied in all sorts of different areas. It’s really like really, really broad. It’s one of the hallmark features of ACT that people across the world in all sorts of settings will pick the model up, take these core set of processes and run with it in all sorts of interesting ways.
There’s a couple of key things I think that are really important where ACT really applies. One, it asks questions about like what matters in life. It helps people to slow down for a moment and think about the things that they really care about. So and there’s a good range of people I find that just either haven’t had the opportunity to really think about that because life hasn’t really afforded them that chance. Or it’s been too busy or pain and suffering has been too great.
So those kind of people I think really, really appreciate that time for a real slowness and a steadiness where there’s a deep curiosity about things that really matter to them. But not just like in an abstract way. Where someone’s genuinely really interested in the things that matter, then I’ll ask them to take action towards those. And that’s quite a… for people I find it’s both really scary because it’s like a real new way of doing things, but at the same time really, really exhilarating. So that’s for one group of people I think it’s really, really important.
There’s the other group too, I think for folks where they get really stuck in life. So it might be the case that they do know what’s important to them. When I sit down and ask them, they will say, “Yeah, the relationships in my life really matter to me.” Or, “Contributing in work is really, really meaningful to me and I’m doing that purposefully, I care about.”
But the place they get stuck in is when unwanted feelings bubble up. Or thoughts that they really struggle with. And they’re automatic pilot response that perhaps they’ve learned from way back when, growing up, or it’s just the way they’ve always done things and the people they know, the culture they find themselves in, that happens to engender a way that just gets them stuck.
So that’s the other kind of group of people I’d say broadly where I think they’re stuck. Helping them to catch it a little. So mindfully slow down for a moment, notice what they’re doing, and respond differently.
Lucy: What’s the evidence base like for ACT?
Joe: Now there’s been about 200 RCTs that have been done broadly showing good support for ACT.
Lucy: And is that sort of transdiagnostically again? So across lots of different types of tricky problem?
Joe: Yeah, lots of different types. So some of the best data is with chronic pain. So helping people who experience pain that doesn’t respond to medication, that doesn’t easily go away, that’s one of the best places. Or at least certainly where there’s the largest amount of evidence, number of studies so far. So that’s an interesting place.
Another interesting place is really good evidence is at the moment for work stress. And then across the board like with things like depression, anxiety as you’d expect. And for me personally a lot of work has been with people with distressing psychosis. So there’s now five or six trials now that have been done that have got some really, really promising results. You know, helping people get back on their feet after episodes of psychosis.
Lucy: Is there anything else you think people should know about ACT?
Joe: One of the things that I hear time and time again is that people feel very grateful for the resources that are out there that people are very free in sharing of things. So for those people who want to take it a little further or are interested there’s a wealth of information to go out there and explore and try out. And of course books to read, but animations to watch or videos and things to check out on YouTube and people to connect with. There’s a friendly Twitter space too with ACT, friendly people there.
Lucy: That sounds good.
Joe: Yeah. All sorts to things like that.
Lucy: I also spoke to Gary Bridgeman. Gary is himself an ACT coach who lives in Brussels and he’s also had ACT himself.
I asked Gary what it was like to experience acceptance and commitment therapy.
Gary: It’s really about exploring emotional roadblocks. It’s really about understanding your thoughts and your emotions and fears. It’s really about being in the moment rather than looking at the past or the future in great detail. And it feels very much in the moment, so rather than discussing lots of past events in my life it’s more about how I’m feeling right now and what’s going on for me right now.
There was one particular session where it was particularly kind of perspective changing for me. And I could feel a shift happen after the session. But also then after the session I could feel that shift happening for a couple of weeks that I kept going back to thinking about things in a different way.
And then from that point onwards, it’s not like you can’t sort of come to one session, walk out and think, “Right, everything’s fine.” But it was a perception shift that I started to look at the way that I was approaching life in a completely different way. And then from that then it kind of snowballed onwards.
We kind of built a metaphor together for how I was feeling. I kind of had this empty feeling inside. And I’d always tied that empty feeling to a loss of a parent when I was young. So and just talking about how that felt and how it felt in terms of what was that emptiness like. It was like a hole and going down into the hole and talking about I filled the hole up with things and how I could fill the hole differently from the inside rather than the outside.
I think the thinking had become locked in a particular story of myself. And locked in a particular way of trying to solve the feelings around that emptiness. But it enabled me just to look at it from a different way, that I could actually solve that emptiness from coming from the inside rather than it going from the outside.
It’s not easy because in terms of the, you do sometimes have to sort of be prepared to face some emotional roadblocks that you have and some emotions that you have and not particularly… and some of the ones that you don’t want, that you want to avoid. So sometimes it can be particularly draining and I felt sort of drained after a couple of sessions.
But equally it was still perspective shifting. I think with a good therapist who’s doing ACT well can take you to a place that you don’t realise you're going to go but also it feels safe.
It’s an organising principle, it’s a way to live your life which can cope with that kind of chaotic messiness that life has. So it becomes easier for you to cope with the peaks and troughs that life throws at you.
It doesn’t mean that you get up and every day you're feeling great. I mean you still have those ups and downs. But I still get up and have a sense of wellbeing and even days where you have a bit of a low mood it’s like, “Okay, well I have a little bit of low mood but because I’m using the principles of well my mood’s going to change, I can understand it, I can just go and explore it and feel it and see what’s happening. But I’m still just going to take an action base and a value that I’ve defined.”
You feel more open. And you feel more able to engage and be with people.
For me now it’s like my experiences like my thoughts are in my head but it’s like they’re in the room with me but they're at the other side of the room. It’s like a conversation two people are having. And if I wanted to I could tune into them. I can go, “Oh that’s… there we go, I can pay attention to that.” Or I don’t have to.
And because of that it just makes you a little bit more kind of willing to engage with people and be open towards them and share things with them because you make a connection then. And you’re not so caught up in your own anxieties about that, making that connection. Thoughts are just thoughts and emotions are just emotions. And we really don’t have to put any meaning around them unless we want to.
Lucy: I asked Gary about some of the exercises he thinks are most helpful.
Gary: Yeah, one of my favourite ones is trying to sort of look at your emotion and just really examine it with some curiosity and then change it, give it colours, shapes, give it some sort of physical form. And then take it outside your body and visualise it outside and then bring it back in again.
And I did that with myself, I do that kind of exercise quite a bit because of looking at some of the emotions I struggled with. It’s very difficult to bring the emotion back into your body once you’ve visualised it being outside. But that process of bringing it back in is really the bit about teaching you how to accept and open up to your emotional experience rather than trying to fight it or struggle with it, that you can kind of sit with it. So that’s one of my favourite ones for using.
Lucy: Another metaphor Gary liked was the chessboard.
Gary: Still being myself in several different contexts and I kind of explained that with a nice chessboard metaphor of your sense of self as the chessboard and everything, all the pieces of your life, all your drama and your struggles and your thoughts and feelings and everything going on are all the pieces. And they can wage that battle. But I can just sit back and look at it a little bit detached from it.
Lucy: I asked Gary what he thought the impact of having had acceptance and commitment therapy has been for his life.
Gary: So it enabled me to say, “Right, now this is the way I want to live my life now so I’m going to start living my life.” You suddenly don’t become some sort of guru or Buddha. I mean it still doesn’t mean you don’t react emotionally, you don’t have emotional reactions. And sometimes you do react with emotion and sometimes you do say things and you think, “Right, that’s just pure emotion coming out there. That’s not me speaking the way that I’d like to speak.”
But it’s not as bad as it would be. I mean I noticed that with my partner when we have the usual arguments that partners have. When she says something and I’m like, “That’s really triggered me,” and I say something back. And I go, “Hold on a second.” But you can catch it quicker rather than getting caught in that kind of spiralling negative argument that you sometimes have where you’re just reacting to what the last person said.
Lucy: I asked Gary if he had any advice for someone who was thinking about having ACT.
Gary: I think really just try it. If you’ve tried other things, because I tried lots of different approaches. And some of them worked and some are successful. But I never really kind of solved this, the kind of feelings that I had about myself inside.
Meditation and mindfulness worked. They kind of reduced my anxiety but I still had the kind of emptiness feelings inside. I hadn’t really resolved it yet.
And, yeah, if you haven’t tried anything else then try it and see if it works. And experience it because you have to experience it to see the kind of shifts that you can make. And you can make those shifts quite quickly if you commit to doing the process.
Lucy: I also spoke to Graciela Rovner. President of the ACT Association in Sweden, Graciela is also a physiotherapist and ACT trainer and she has recently had ACT couples therapy with her husband, Stefan.
Graciela told me about her and her husband’s experience of having this online ACT-based couples therapy including her initial doubts about the process.
Graciela: Of course you enter such a couple thing like, “Okay, is this going to help or is this not going to help? Are we going to have more discussions?” You know? It’s like explaining, “Okay, where do you get stuck or with yourself or with your partner?” But there was quite quickly very normalising. And I think it’s one point in ACT that you never feel that someone is talking to you from up there. So we are like more in the level.
So this was a sort of feeling like, “Okay. Nice.” I think it was a lot of work about how to communicate. But I think it’s also how to communicate what happened in a soft way, open way, with more perspective, looking to myself and my part on it in a very soft and empathetic way and compassionate way.
And also with that open for the same empathy and compassion for the short comings that we always see the other one, right? So it was a very nice opening and taking perspective of the situation and they talk about soft emotions, and soft feelings, and soft words and being more aware about how can we still communicate but in a soft way. A more loving way.
It’s a really minimal intervention I would say but still it opens up a new way to see things. Being more aware of what’s going on and seeing the situation from a different perspective.
For me it has been a really very, very interesting experience. Both of us, the partner in my marriage is 30 years old. So it is not that – I mean it’s quite interesting to know that you can have such a little intervention and help quite an old relationship with children and so.
And it’s always like okay, like sometimes we can wonder who helps the therapist? We help others and then sometimes when we need help it’s difficult to find it.
Until I found ACT and acceptance and commitment therapy and this kind of line of therapy that is really non-stigmatising and more normalising that we all suffer in a certain way. So before that it was very difficult to ask for help.
Everyone suffers. Even the one that will look up and say, “Wow, such a successful person.” But this person may be suffering as much as we are suffering and we know that. I mean so why do we really need to hide that? Why can’t…?
I mean the real meeting between us is when we can show ourselves vulnerable, right? So I think that to open up to your own vulnerability and then recognise that, “Okay, if I feel alone with this or I feel stuck with this, there is help to get.”
To go to a psychologist is not because we are crazy. It’s because we just need a couple of tools more in our toolbox I will say. A relationship, a marriage of 30 years can get support over such a short intervention. I mean, try it. (Laughs) Do it. If you’re stuck, yeah.
Lucy: Finally I spoke to Eric Morris, clinical psychologist and ACT therapist. Eric now lives in Australia. This is a pretty international episode.
Eric agreed that there’s something a bit different about ACT which might mean it’s even more likely that ACT therapists will also be open to using the techniques a lot for themselves.
Eric: So what I like about the ACT model is it’s not a model of dysfunction and disorder. It’s really a model of what humans have in common. As a model of like helping people psychologically, there’s no othering in it. It’s like I participate and I experience many of the same things that my clients do in terms of the process.
And sure, some of the folk I help have had more than their fair share of pain and trauma. And yet some of what amplifies and intensifies their problems are the same things that can do that for me too.
Lucy: Eric remembered talking to Joe Oliver who we met at the start of this episode about ACT.
Eric: And so looping back to why I was keen to talk about this with friends like Joe is like, “Wow, this is different. One exciting piece there was, ‘Ah, it’s a model for me too.’”
Lucy: I asked Eric about the effects of ACT on his own life. I knew it had played a part in making his decision to move to Australia. But he also told me about another big life decision it had impacted on.
Eric: Yeah. Well, I mean the model has enabled me to make a number of big decisions in my life. Well, big and small decisions. I mean it is also because of the ACT model, being open to uncertainty and doubt that I leant into becoming a parent. I mean that also for me with my history. I honestly was afraid of becoming a father. And parenthood has its moments. Continues to, you know? (Laughs)
But it was because I was at an ACT workshop and I connected with my fears and doubts about myself at that time and that I turned toward, yeah, as a direction. And it wasn’t, “No, I don’t want to have children.” It was, “I won’t be good enough.” And I found a way of being with those fears. They didn’t have to disappear. I mean I’m still afraid but I’m not running away.
So moving to Australia was, yeah, another big thing. That was a funny one because probably out of the members of my family I was the one least keen to move back to Australia. I mean I loved living in the United Kingdom and I loved living in London and I was very caught up with my job and the opportunities that it afforded and, yeah, and status and things like that.
And so letting go of that deliberately, choosing to step into who knows what, the ACT model helped with that.
Lucy: Eric talked about the stories that we have about ourselves.
Eric: Yeah, that process of being invited to brood and ruminate and really be lost in a story about yourself that, yeah, you enjoy, but also it can be sort of like sort of chains upon you.
We love stories as humans and like some of those stories are great and then, or great for a while in the way they outlive their usefulness and they don’t go away. Can you step out of the stories that you have? Or the stories other people have that they’ve given you. Can you be with what this feels like now?
And, of course, noticing that may not necessarily feel good. As you let go and you are where you are. Yeah, I mean I got to be a really engaged father with my son who was four. And I worked less for a while and I really got to spend some time with him that I wouldn’t have in the old story.
You can change, I guess, your relationship with your sense of vulnerability. And you might find in a number of circumstances that actually what looked like a threat to you, being vulnerable, might actually be a strength.
Lucy: Acceptance and commitment therapy tries to help us feel less caught up with some of the stories that we have about ourselves. And one of the things it does is to try to help us identify what our most important values are in how we want to live our lives.
Eric: Who are you? What are you about? And for me it stripped back some of those layers of stories and I discovered new things that I was about. By being willing to be where I was.
Lucy: I hope that’s helped give a flavour about ACT. There’s lots more information in the show notes about this. And there’s also a special link for therapists if you might be feeling in need of support.
Next time we’ll be thinking about another member of the wider CBT family. So do tune in for that.
This podcast is brought to you by the British Association of Behavioural and Cognitive Psychotherapies or BABCP.
For more information about BABCP and about cognitive behavioural therapies in general, including a list of BABCP accredited therapists, check out BABCP.com.
Thanks to Gabriel Stebbing for the title music, Dr Turtle for the incidental music, Joe Oliver, Graciela Rovner, Gary Bridgeman and Eric Morris for speaking to me, and Eliza Lomas for editing consultation.
Any feedback or ideas, please do let us know. And please rate us iTunes if you’ve enjoyed the show.
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