Reflecting on My First Year of Acceptance and Commitment Therapy

I’m a big proponent of counseling and have been in and out of therapy for years. For the first little while, I saw a marriage and family therapist who attended my church, but I eventually stumbled across acceptance and commitment therapy (ACT). I had plans of becoming a mental health counselor, so my knowledge of ACT was at the practitioner level—my introduction to the modality was literally the therapist’s manual. I was looking at it from the practitioner’s perspective, but I was also looking at it from the client’s perspective, informed by my own experiences with mental illness.

I knew ACT would work. Specifically, I knew it would work for me.

I immediately searched for ACT practitioners in the Minneapolis-St. Paul suburbs, and was disappointed when I found only a handful. The closest female therapist was in downtown Minneapolis, a forty-minute drive one way, but I was determined to make it work. ACT would change my life. I knew it would. I just had to figure it out.

That was July 2018. Now, a year into my ACT journey, I find myself having to look for another therapist. Given the choice, I would’ve stayed where I was, even despite the commute, but my therapist changed careers for the sake of health insurance, and it does seem fitting that, after everything that’s happened, the change is occurring right at my one-year anniversary. It’s almost like I planned it or something.

ACT is well-known in the profession, but it’s more or less a hidden gem in the self-help community, so to commemorate my first year with ACT—and my search for a new therapist—I thought I’d do a brief round-up of all the things I’ve learned from therapy, and the changes I’ve seen in my day-to-day life.

 

ACT revolves around the concept of psychological flexibility, “the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends.” Psychological flexibility is achieved through six core processes: acceptance, cognitive defusion, being present, self as context, values, and committed action.

Experiential avoidance was the first ACT concept that hit me hard. ACT teaches that, instead of avoiding what is experientially undesirable, freedom is found in acceptance: “the active and aware embrace of those private events occasioned by one’s history without unnecessary attempts to change their frequency or form.” Instead of ignoring anxiety, or trying to soothe our own discomfort, ACT encourages us to step into the anxiety and feel it fully. This feels illogical at first, but with time and practice, acceptance fosters in us an ability to deal with discomfort.

Acceptance goes hand-in-hand with cognitive defusion, an attempt to “change the way one interacts with or relates to thoughts by creating contexts in which their unhelpful functions are diminished.” In moments of anxiety, for example, it often feels like we will not, or indeed cannot, survive. Years ago, when I struggled with anxiety attacks, I felt sick, nauseous, stuck in the depths of my own mind. There was no way out. I was, for lack of a better term, helpless.

Cognitive defusion recognizes the origin of those feelings and calls them what they are: stories. The brain is a masterful storyteller and, in its free time, comes up with narratives about everything from our situation to our personality and childhood trauma. During an anxiety attack, the brain’s story is simple: You cannot survive. This feeling will last forever. This is where cognitive defusion comes in. Instead of getting caught up in those thoughts, you take a breath. You step back and recognize that story for what it is: a lie, something your brain came up with to explain the physiological symptoms of an anxiety attack (e.g., breathlessness, nausea, fatigue).

Personally, when my brain tries to feed me stories, I rely on my mantra: This will not last forever. That, too, is a story, but even recognizing the multiplicity of what your brain tells you can strip narratives of their power. You can even put words to what your brain is doing: I am having the thought that I cannot survive. My brain is telling me that anxiety will last forever, but I know from experience that it won’t.

Don’t get me wrong. It’s hard. Labeling your thoughts as thoughts, especially in the middle of an anxiety attack, can feel awkward and hopeless. But the more you do it, the easier it becomes to recognize narratives for what they are.

Since starting ACT, I am far more tolerant of discomfort. The anxiety is still there, as is the chronic pain associated with tension headaches. However, I’m more likely to label my brain’s chatter as insignificant. I sit with feelings of anxiety and practice self-love by acknowledging the difficulty of the moment. I speak to myself like I speak to friends and affirm that I deserve better. I even have pet names for myself, which is hilarious now that I think about it, but it does seem to help: I take a moment alone and say, “I know you’re nervous, baby, but you have no choice. You’ve got to do this. And you’re totally capable of it.”

The truth is I’m not always capable. Anxiety is steeped in intuition, so sometimes my brain’s stories are accurate; sometimes things go wrong, catastrophe occurs, and I retreat to lick my wounds. But that’s part of life. We can live in experiential avoidance, dodging anxiety and sadness, grief and pain, or we can recognize that life is ultimately neutral. There are bad things and good things. We will never be free of discomfort, no matter how hard we try.

This realization was instrumental in my diagnosis of chronic tension headaches. I spent over a year at home, medicating with everything from Tylenol to hot compresses, lamenting the fact that I was in so much pain. I would wake up with a headache and complain that my day was already lost. I conflated pain with inactivity—in order to truly live my life, I needed to feel good all the time, meaning the days I felt bad were more or less a waste. There was no point to leaving the house if I was going to be in pain.

Those months were hazy, awful. I didn’t really want to live anymore, not if living meant my head pounding at the base of my skull. But then I found ACT, or ACT found me, and I realized that I had two options.

Excerpt from  Learning ACT: An Acceptance and Commitment Therapy Skills-Training Manual for Therapists  (Luoma, Hayes, & Walser, 2007)

Excerpt from Learning ACT: An Acceptance and Commitment Therapy Skills-Training Manual for Therapists (Luoma, Hayes, & Walser, 2007)

Clients often take the stance that their lives will begin when they finally feel better. This was my philosophy for the first 23 years of my life, but I only recognized it for what it was when I developed chronic pain. I wasn’t living, not really. I was waiting for my circumstances to change, but without any committed action to guide the change, I was treading water. I was sinking.

This is where values and committed action come into play. If you don’t know what you want your life to stand for, you won’t have any reason to enter the discomfort. You won’t have any reason to push forward, to stand in the ache. ACT guides you through the process of unearthing your own values, so when life gets tough, you can fall back on that motivation. Over the past year, I’ve identified my values as community, the power of storytelling, and social justice, all of which you can see in the mission statement I wrote years ago:

To love fearlessly; to love fiercely; to love without remorse. To love people out of corners; to love me out of corners. To rise in love and transcend. To be unbridled in transcendence, in growth and outward movements. To be expansionary. To practice magnificence. To trust. To minimize fear and create. To be love. To be movement and boundless hope. To grace as an action, a verb, a deliberate acceptance of life, love, people, this place. To be mindful of this place, the ground I stand on, the spaces I move through—body and heart.

The thought of finding a new therapist is daunting, for lack of a better word. I don’t want to go through the process of bearing myself to another person; the level of vulnerability required is taxing and, for me, conducive to burnout. But I know how important therapy is. I’ve seen the effects of ACT on my everyday life. I have no doubt that, despite the toll of finding someone new, the rewards will be well worth it.

 
 

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