Demystifying ACT: A Practical Guide for Therapists
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Acceptance: A Core Process in the ACT Hexagon Model
By DJ Moran, PhD
This presentation is an excerpt from the online course “Demystifying ACT: A Practical Guide for Therapists“.
- One, acceptance means actively contacting psychological experiences directly, fully, without needless defense while behaving effectively.
- Two, the focus of acceptance is on private experiences. So if there are public obstacles that you can work with, the ACT approach would encourage committing to changing what you can.
- And three, experiential avoidance which is on the other side of the spectrum from acceptance actually exacerbates a client’s clinically relevant issues. So acceptance can be used in clinical work for people to learn how to have a new relationship with their emotions and sensations and commit to having a purposeful life.
And in this module, we will be covering the ACT hexagon part 1. This ACT hexagon model is traditionally used to introduce practitioners to Acceptance and Commitment Therapy.
There are six essential components to the ACT approach and they are integrated together to help build psychological flexibility. These six components are acceptance, defusion, self-as-context, values, committed action and contact with the present moment. In this module, we will discuss the first three, acceptance, defusion and self-as-context.
Let’s turn to acceptance. We are starting with acceptance with no other reason than the fact that we have to start somewhere. Acceptance is not the most important out of the six components nor is it the component that clinicians always use first in psychotherapy. We had to start somewhere and I just flexibly chose to select acceptance first.
Now, you might have your own definition about what acceptance is all about but we’re going to define acceptance specific to the ACT environment. The definitions of words are contextually bound, meaning it might change depending upon the situation. For instance, if I say the word bat, that might make you think of a wooden stick if you’re at a baseball game or a winged mammal that sleeps upside down if you’re in a cave. You might even think about how people blink their eyes to attract a mate if you’re standing in a crowded party. The word bat can be used to describe many different things and the context is what is important for helping the listener understand the meaning. Acceptance can be similar. You might have your own definition of the word acceptance but in the context of ACT, it means actively contacting psychological experiences directly, fully, without needless defense while behaving effectively.
Please keep in mind something very specific to the ACT definition of acceptance. The things being accepted are psychological experiences. We are talking about emotions, sensations, urges, flashbacks and other private events. We’re talking about a willingness to have these experiences without trying to control them. It is important to highlight the focus on psychological experiences for acceptance because acceptance can be criticized in a particular way if you don’t understand the ACT definition. I’ve heard criticisms such as someone saying, well, I work in a domestic violence shelter. Are you telling me I have to teach the women that I care about to simply accept getting hurt and beat up by their significant other? And the answer is of course not. There are thousands of great clinicians in the ACT community and of course, none of them are going to think that is a good idea at all.
The idea is to accept the things that you cannot change like your psychological experiences but build the courage to change the things that you can. The idea of ACT is to help impart the wisdom to know the difference. Does anyone feel a prayer coming on right now? Reinhold Niebuhr’s the Serenity Prayer resonates very well with the ACT approach. Accept what you can’t change and change what you can.
And every person would do well to realize whether playing the role of clinician or client it is often very difficult to simply change your emotions outright while still maintaining solid behavioral health. When people are feeling anxious, angry or sad, oftentimes the attempt to get rid of those private events exacerbates the problem.
When people engage in experiential avoidance which is on the other side of the spectrum from acceptance, they are not willing to contact their feelings, sensations or urges and they try to defend against having these experiences and in doing so do not behave effectively on their important values.
Let’s take a look at an example. Suppose someone gets nervous before meeting a group of people. Suppose their heart starts to race and their hands start to shake whenever they’re going to meet up with a lot of folks. Would you diagnose them with social phobia? I would recommend that you don’t. You’d have to diagnose the majority of people on this planet. It’s part of the human condition to get nervous when meeting a group of strangers. Just getting nervous around a lot of people isn’t a clinical issue yet.
But suppose a person gets invited to a family reunion and keep in mind this person really values family relationships and would like to get to know more relatives. And suppose this person gets the invitation to go to a banquet hall and meet over 100 family members at this reunion. The day comes and they’re wearing their most splendid outfit and they walk up to the door of the banquet hall and they hear the din of conversation from inside. And then their heart starts to pound and their limbs start to shake. And then they realize, and this is important, that they have learned through society and their upbringing that they are feeling anxiety and that this is a negative emotion. And they’ve convinced themselves that such experiences should be avoided.
So instead of going inside the banquet hall, they turn on their heels and they head back to their apartment and play video games for the rest of the day. Without going too deeply into the parasympathetic-sympathetic nervous system perspective, such a move will get them back to homeostasis. They’ll feel comfortable again if they leave and they wouldn’t be dealing with any more so-called negative emotions if they do that. This homeostasis is comfortable to them and removes the aversiveness of their heart pounding and their limbs shaking. And it makes them want to continue staying home. In fact, this is a negatively reinforced behavior. Next time they feel nervous, they’ll avoid those private experiences again with a greater probability. The removal of the aversive experiences increases the likelihood of avoiding such social situations. Now, that is social phobia. Keep in mind we said that this person values family but they are letting emotional control lead to experiential avoidance. They are not living a life that they find valuable. And let’s take it a bit further. When the client is at home alone feeling less stress, are they actually learning any of the social skills that would benefit them in order to become a better interacting family member? The answer is no. So experiential avoidance is not only reinforced, not only does it lead to less opportunities to engage in valued behaviors but it also exacerbates the problem. The next time they have an opportunity to do what’s meaningful in their life, they will actually be less likely to do it.
So what can be done? Well, what if the person learned to accept the emotions that come up when committing to doing something of value and meaning. Just allow the feelings to happen. Actively contact them without trying to get rid of them and then behave effectively on your commitment of interacting with loved ones from your family at this reunion. Suppose the client could do something else. Perhaps when they hear that noisy plenary room with over 100 people talking to each other, what if they simply accepted the fact that their heart is pounding and their limbs are shaking and their butt is sweating and they willingly walk into the room even in the presence of those obstacles? And what if they could commit to shaking hands with 15 people at that family reunion? And during their first few handshakes, they might even feel even more nervous and stumble upon their words. But what if they stayed committed to doing what they value in the face of these emotional reactions without avoiding them? What would happen is their commitment would more likely help them build better social skills so they could engage in those meaningful behaviors and their acceptance approach would help them stay in that provocative environment for a longer period of time which would counter-condition the anxious responses and perhaps help them get back to that similar homeostasis we talked about if they avoided the event. Human beings don’t panic forever. They’d potentially get back to a more moderated state but accepting how they feel has to happen first.
And getting back to the moderated state isn’t the primary objective. Engaging in valued behaviors is.
The results of this approach help the client have more vitality because they are following through on the purposeful actions in their life and learning to engage in behaviors even in the presence of private events that society taught them to perceive as negative.
ACT is not about symptom reduction as a primary goal. It is about living a life of meaning and purpose in the present moment. And when you do that, you develop a different relationship with emotions and sensations. The symptomatology so to speak is actually not symptoms. They’re part of the human condition that we all experience. But this human condition that we’re talking about will likely be viewed in a more workable manner and the person will move forward with what they care about in their life. They will become more psychologically flexible which is related to reducing suffering and improving quality of living.
There are 3 key points in this module. One, acceptance means actively contacting psychological experiences directly, fully, without needless defense while behaving effectively. Two, the focus of acceptance is on private experiences. So if there are public obstacles that you can work with, the ACT approach would encourage committing to changing what you can.
And three, experiential avoidance which is on the other side of the spectrum from acceptance actually exacerbates a client’s clinically relevant issues. So acceptance can be used in clinical work for people to learn how to have a new relationship with their emotions and sensations and commit to having a purposeful life.
More ACT presentations
- ACT Case Conceptualization: Assessing the 6 Core Processes
- Contact With the Present Moment: A Core Process in the ACT Hexaflex Model
- Defusion: A Core Process in the ACT Hexagon Model
- Self-As-Context: A Core Process in the ACT Hexagon Model
- The Inflexahex Model and ACT: 6 Converse Dyads to Understand Psychological Inflexibility
- The Inflexahex Model in ACT: Acceptance vs Experiential Avoidance
- The Journey of Life: A Metaphor for Values in ACT
- Values and Committed Actions in ACT
- What Is Acceptance and Commitment Therapy?
- Psychological Flexibility in ACT: The Hockey Goalie Metaphor
- What Is the Relationship Between ACT and Mindfulness?
- ACT Is an Empirically-Supported Therapy: Background and Clinical Evidence
- Why Is Psychological Flexibility Important in ACT?