If you've ever tried to fall asleep, only to lie awake for hours with worrisome thoughts nagging you on an endless loop, you know how frustrating it can be to feel powerless over your own mind. What if, instead of obsessing over what happened in the past or stressing about what could happen in the future, you accepted the thought as just a thought and focused on the present moment? Those anxious thoughts that rob us of valuable sleep are proof that we can't move past our feelings, but—by understanding and managing those thoughts—we can move through them. In learning to confront our negative thoughts and feelings, we can diminish the effect. This is one of the ideas behind Acceptance and Commitment Therapy (ACT), an empowering coping strategy used to help people stop avoiding or denying emotions, accept that certain feelings are okay in certain situations, and move on. According to the Association for Contextual Behavioral Science, Acceptance and Commitment Therapy is "taking the view that trying to change difficult thoughts and feelings as a means of coping can be counter-productive, but new, powerful alternatives are available, including acceptance, mindfulness, cognitive defusion, values, and committed action." Acceptance and Commitment Therapy is a psychological intervention, a way of engaging with painful experiences so people no longer feel as if sadness, fear, anxiety or anger are completely running the show. It's helping people learn acceptance-based strategies and mindfulness to respond to their thoughts and feelings (rather than ignore them, obsess over them, or simply check out). According to Aisling Curtin, registered counseling psychologist and founding director of ACT Now Ireland, this therapy "aims to increase our psychological flexibility. When we are more psychologically flexible, we are more connected in the present moment and to what matters to us, open to our experiences as they are, rather than what they say they are, and engaging in actions that help bring us closer toward who and where we want to be." Unwanted emotions are part of life, she says, but with ACT, "we learn strategies to relate to our emotions in more compassionate ways that allow us to learn from our emotions, rather than see them as something that needs to be feared." She emphasizes:You don't have to feel stuck in the life you have. You can build psychological flexibility by connecting to the present moment, refusing to buy into thoughts that prevent you from leading the life you deserve, maintaining a flexible viewpoint, and knowing and doing what matters. Research in Psychology Today shows that Acceptance and Commitment Therapy has been particularly beneficial in helping those struggling with social anxiety, depression, obsessive-compulsive disorder and substance abuse. We asked clinicians at the Hazelden Betty Ford Foundation to explain this approach and its relation to substance abuse disorders and treatment. How does Acceptance and Commitment Therapy differ from traditional Cognitive Behavioral Therapy? Traditional cognitive behavioral approaches place a greater emphasis on the cognitions and behavioral changes used to help an individual cope and process symptoms. Whereas Cognitive Behavioral Therapy (CBT) would focus on challenging and stopping thoughts or ideas that are believed to contribute to symptoms, Acceptance and Commitment Therapy instead works to change the relationship someone has with the concept of what is causing the symptoms. According to The Art of Wellbeing, "Instead of challenging distressing thoughts by looking for evidence and coming up with a more rational response like in CBT, in ACT you accept the thought, and then defuse it like a bomb. ACT is all about accepting that negative thoughts and emotions are a part of life, and ending the struggle that things can—or should—be any other way. It is pessimism at its most useful." For example, if someone is having trouble sleeping, a CBT approach would look at irrational thoughts related to not being able to sleep by exploring the rationality behind that belief and examine times when the individual has been able to sleep. The goal is getting to a place where someone can see that it might not be that they "never" sleep, but instead that they "sometimes" have difficulty sleeping. In contrast, an ACT approach looks at how the individual relates to the idea of not being able to sleep. Instead of focusing energy on this thought, which can actually cause anxiety and make sleeping more difficult, the idea of acceptance is introduced, helping the individual acknowledge that sometimes they can sleep well and other times they can't. Through this acceptance process, with less emphasis on the challenge, stress and worry around the symptom decreases and, in turn, the frequency of the symptom can also be reduced. When does Acceptance and Commitment Therapy seem to be most effective? Why? Acceptance and Commitment Therapy seems to be most effective when used with individuals who have set beliefs or expectations about the likelihood of their symptoms returning and are therefore looking to cope with symptoms that may persist. When examining substance use disorders from the lens of a chronic disease model, this can help an individual working towards accepting that yes, symptoms such as cravings, risk of return to use, etc. are a reality that will need to be managed over time. It's not whether or not there will be symptoms, but, rather, how to help people adjust their relationship to managing those symptoms. Why do some publications refer to this as a "third wave" of psychotherapy? ACT is considered the "third wave" of behavioralist therapies. The first wave was traditional behavioralist intervention (including classical and operant conditioning), which largely focused on the behaviors rather than trying to analyze any of the thoughts that influenced behaviors. The second wave of behavioralist interventions were approaches including CBT and Rational Emotive Behavior Therapy (REBT), which looked at how irrational thoughts and logic could influence the thought process that then influence both emotions and behaviors. The third wave of behavioralist interventions include approaches such as ACT and Dialectal Behavior Therapy (DBT), which incorporate acceptance, mindfulness, and a willingness to explore the emotions associated with the more rational thoughts introduced in the second wave of behavioralist interventions. How is this therapy used in drug and alcohol addiction treatment? (And what is the specific approach at Hazelden Betty Ford Foundation treatment centers?) Acceptance and Commitment Therapy is often used to help incorporate various forms of mindfulness and acceptance activities. It can also be used to help individuals identify areas of value within their lives, including goals and meaningful relationships. Use of ACT can help patients identify ways they would like to guide their treatment, as well as help them relate to the phase of treatment they are experiencing at the current moment rather than becoming fixated on an idea of what recovery might look like at a certain point in time. What are some techniques? ACT interventions help patients identify what they value most in order to lead a meaningful life: relationships, hobbies, goals, etc., and then explore how those values match their priority of resources. This can be extremely helpful for some individuals. For example, in early recovery, a person might place great value on recovery itself, but the behavioral change—committing time to go to meetings or therapy or recovery activities—may not reflect those values. This kind of introspection can help a person decide if there’s a need to better align how they spend their time.