Acceptance and Commitment Therapy for GAD: What to Expect

An introduction to a "third-wave" psychotherapy, ACT.

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Acceptance and commitment therapy (ACT) is a type of psychotherapy gaining popularity in the treatment of anxiety disorders like generalized anxiety disorder (GAD). It is also used to treat other conditions including depression, eating disorders, chronic pain, and substance use disorders.

ACT is sometimes referred to as a “third wave” or “new wave” psychotherapy. In this context, the "first wave" refers to classical conditioning and operant learning-based behavioral approaches developed in the 1950s.

The "second wave" therapies additionally focused on information processing - and more specifically, cognitive processes - as well as behavioral learning principles. "Third wave" treatments share a lineage with these earlier approaches but extend in other directions depending on the type.

The term "third wave" treatment refers a broad spectrum of psychotherapies – including ACT, dialectical behavioral therapy (DBT), schema therapy, and mindfulness-based cognitive therapy – that have been shown to be helpful for many individuals.

Historically, third-wave treatments were conceptualized as particularly appropriate for patients who were not benefiting from pre-existing treatments such as classical cognitive behavioral therapy (CBT). However, it is now believed that for some individuals, a third-wave therapy option may make sense as a first-line treatment.

Research has shown that ACT can produce symptom improvement in people with GAD, and it may also be a particularly good fit for older adults.

What exactly is ACT?

ACT is a talk therapy that emphasizes the ways in which we use our words to battle whatever is going on inside of our heads. The approach focuses – as the name implies – on acceptance. The theory suggests that increasing acceptance of your circumstance, the thoughts constantly running through your mind, and your struggle with symptoms can lead to increased psychological flexibility.

Acceptance is theorized to protect against the avoidance of certain thoughts or emotional experiences and ineffective coping.

Overall, this type of therapy encourages gaining insight into patterns of thinking, patterns of avoidance, and the presence or absence of action that is in line with chosen life values.

How is it different from traditional CBT?

Unlike CBT, the goal of ACT is not to reduce the frequency or severity of unpleasant internal experiences (such as upsetting cognitive distortions, emotions or urges). Rather, the goal is to reduce your struggle to control or do away with these experiences and simultaneously to increase involvement in meaningful life activities (i.e., those activities that are consistent with personal values).

Who provides ACT?

Clinicians who have been specifically trained in this type of psychotherapy typically offer ACT. An ACT therapist will be both an active, empathic listener and an active guide, encouraging deeper exploration and non-judgmental awareness, during the sessions.

An ACT therapist could be a psychiatrist, psychologist, social worker, or mental health counselor. If you are interested in learning more about this approach, you might ask about your treatment provider’s training background with it or seek out an experienced ACT practitioner.

What happens in an ACT session?

The main components of ACT are psycho-education about the key mechanisms of the treatment theory, mindfulness, cognitive defusion, and values clarification.

Sessions can include the practice of mindfulness exercises designed to foster nonjudgmental, healthy awareness of thoughts, feelings, sensations, and memories that have otherwise been avoided. Once the content of your innermost experience is identified, the therapist uses discussion and cognitive exercises to help you recontextualize or make different sense of the narrative and then accept it as your personal experience. To the extent that your actions are inconsistent with your personal values of what makes for a meaningful life, the therapist will help highlight discrepancies and engage you in a conversation about your values and the actions that might move you closer to them.

ACT therapists may assign homework to practice between sessions, such as mindfulness, cognitive, or values clarification exercises. The homework is agreed upon between you and your therapist and can be modified to make it as personal and useful as possible.

Where can I learn more?

To learn more about the ACT approach, check out these free podcasts, worksheets, and mindfulness exercises.

For help finding an ACT therapist, try referral sources such as The Association for Contextual Behavioral Science, Psychology Today, or The Association for Behavioral and Cognitive Therapies.

References

Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: Diagnosis and treatmentBritish Medical Journal 2012; 345:e7500.

Kahl KG, Winter L, Schweiger U. The third wave of cognitive behavioural therapies: What is new and what is effective? Current Opinion Psychiatry 2012; 25:522–528.

Roemer L, Orsillo SM. An open trial of an acceptance-based behavior therapy for generalized anxiety disorder. Behavior Therapy 2007; 38:72–85.

Roemer L, Orsillo SM, Salters-Pedneault K. Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology 2008; 76:1083–1089.

Wetherell JL, Afari N, Ayers CR, et al. Acceptance and commitment therapy for generalized anxiety disorder in older adults: a preliminary report. Behavior Therapy 2011; 42:127–134.

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