Acceptance and Commitment Therapy for Anxiety
Last month’s blog introduced Acceptance & Commitment Therapy (ACT), an action-oriented psychotherapeutic approach grounded in traditional behavioral therapy, cognitive behavioral therapy, and Eastern traditions. ACT advocates accepting the entirety our inner landscape – the uncomfortable and challenging along with the comfortable – so that we can create our most vital and meaningful lives. It suggests that the avoidance of this inner environment – our attempts to escape or control the challenging and uncomfortable – leads to distress and suffering. ACT proffers a dance between inner acceptance and thoughtful behavioral change with an ultimate goal of psychological flexibility. This month’s blog applies ACT more directly in the context of anxiety, by exploring what its approach might look like and what skills and exercises it can offer.
Anxiety is by definition future oriented. We get anxious about things that have yet to happen, which can manifest in a variety of ways: i.e. worry, a sense of foreboding, bodily sensations such as muscle tension. Anxiety is necessary for survival. It helps keep us safe by identifying potentially harmful situations and calling us to action to protect against them. This automatic process is also learned with the assistance of language. For instance, if someone were to say to you “this building is on fire” you would know by those words to leave the building! Undoubtedly, this is helpful information to lead us to safety: we take action to get out of there. However, our minds are not always such accurate problem identifiers and solvers, particularly when it comes to our inner world. We make associations via language that lead us to believe that we are or could be in danger when we are not. There is a threshold at which anxiety shifts from healthy to becoming an anxiety disorder. A key determinant across the spectrum of these disorders is if anxiety causes clinically significant distress and impairment in important areas of functioning. There are a range of anxiety disorders, but they all share common undercurrents of avoiding discomfort – using worry as a form of temporary relief or suppression to prevent painful memories or emotions form resurfacing.
When our anxiety enters into the maladaptive category, our thoughts, beliefs, emotions and other internal sensations begin to feel scary in and of themselves – they masquerade as the very thing that we fear, and we buy into them. They’re often fused with associations of past experiences. Not surprisingly, our mind springs to action to try to escape them. This is where the difficulty lies: our inner worlds don’t work the same as the external world. We can run out of a burning building, but we can’t run from ourselves. But we try, again and again, believing if we just do things a little bit differently or work a little bit harder then we will be victorious. Unfortunately, this struggle can’t and won’t take away anxiety. In fact, it typically does the opposite. Let your experience (not your mind) be your guide here: reflect on your attempts to manage or escape anxiety and ask yourself if they have actually worked for you.
An ACT approach would seek to understand the core nature of what turns your particular fear, anxiety, trauma, obsession, phobia etc. into a life altering problem. Rather than living in diagnostic labels, your unique experience comes center stage and guides treatment. You might take stock of the ways that avoidance has kept you from missing out on things in your life that you care about. For instance, someone with a phobia of planes might identify how avoiding flying has kept them from traveling to countries they’ve long dreamed of seeing. This exploration can lead to dialogue around acceptance: what happens if you allow for the anxiety to be there without needing to “fix it?” What happens if you engage in a valued action and accept that anxiety might come along for the ride? Acceptance does not mean that you need to like your anxiety. It is a choice to “take what is offered” (the literal meaning of the word) and to acknowledge things as they are.
Acceptance prompts us to become observers of our minds rather than participants. Can you notice your anxious thoughts in this moment and allow them to be, without buying into them or trying to alter them? There are a variety of ways to call yourself to mindful observance in the present moment. A formal seated meditation is a traditional example of this. You can try the following ACT meditative exercise called “Leaves on a Stream” to shift into an observer state: https://www.youtube.com/watch?v=vjKltKKSur8
When we are able to witness our thoughts as observer, we become much bigger than them. Not only that, but we realize that thoughts are just thoughts and storylines are just storylines; they’re nothing more and nothing less. They’re not reality. With practice and intention, we can cultivate a warm and welcoming space for the totality of our experience. We can open to the pain that lingers beneath anxiety and recognize that perhaps it isn’t as bad as we feared. We can be with it and still be okay.
This willingness to “have what we already have” can be a freeing choice. It gives us space to move forward in our lives in ways that are meaningful to us. You might ask yourself: “if I wasn’t spending so much time trying to control my anxiety, what would I be doing?” Take stock of that answer – it likely reveals clues to what you value and what you actually want your life to be about. Values speak to what matter to you and they are uniquely yours. Goals move us in the direction of our values. Values are a lifelong process while goals are tangible, actionable items that you can check off a list. An ACT approach would encourage you to identify what your values are and to live them out. Rather than waiting for your anxiety/phobia/OCD etc. to “go away” before taking action, you take action now. You make a commitment to act on the goals that are in service of your values, making room for the inevitable psychological barriers that will arise along the way. The idea is that you can take action AND feel discomfort, vs. wanting to take action BUT not feeling able to because of [insert personal reason here].
So, in a nutshell, an ACT approach to anxiety invites us to enter into a different relationship with our inner experience, accepting the totality of what it offers us in this moment and watching our minds as observers rather than participants. The less we buy into our thoughts and let them be, the more psychological flexibility we create, which is the ultimate goal of ACT. We also identify our values and allow them to lead us to action and to our most meaningful, vital life.
Of course, no blog will be able to cover the totality of a treatment or to personalize it to you. This is a broad overview of some of the high-level tenets of this approach. In psychotherapeutic work, it becomes tailored to who you are and where you are at, meeting the nuances and uniqueness of your experience along the way. If this introduction and the goals of ACT speak to you, you might consider reaching out to a trusted professional to help you on your journey.
To hear Steve Hayes, the founder of ACT, share his own personal story and speak to the meaning of psychological flexibility, you can check out his TEDx talk here: https://www.youtube.com/watch?v=o79_gmO5ppg
