ACT and its central concepts
Acceptance & Commitment Therapy (ACT) is taught in Singapore University of Social Sciences (SUSS), and widely practiced in our local private psychotherapists and social service organization like Shan You, Thrive and Promises. It is regarded as an effective treatment for a wide range of mental health conditions, including stress, anxiety disorders, depression, substance addictions, PTSD, OCD, anorexia, chronic physical pain and psychosis. ACT is commonly referred to as the ‘third wave’ of Cognitive Behavior Therapy (CBT) alongside Dialectical Behavior Therapy (DBT), Mindfulness Based Cognitive Therapy (MBCT), and Compassion-Focus Therapy (CFT).[i] ACT is developed in the 1980s by Steven C. Hayes, Kelly G. Wilson and Kirk Strosahl. It is promoted as an evidence-based psychotherapeutic intervention to help those suffering psychologically. Its developmental history traces back to Comprehensive Distancing, which focuses on awareness in one’s thought.[ii] ACT is essentially about accepting what is beyond one’s control and committing to actions or habits that will serve to enrich one’s quality of life and personal values. While CBT primarily teaches people to better control their thoughts, feelings and memories, ACT teaches people to accept and embrace them. There are three key aspects to ACT:
Firstly, the starting position of ACT is the rejection of the idea that a healthy and happy life is our default state and any deviation from it is wrong and needs to be fixed. ACT argues that human experience shows that real life is not healthy and not happy. Hayes famously opens his first book on ACT stating, ‘The single most remarkable fact about human existence it how hard it is for humans to be happy’. ACT believes that a normal human mind generates thoughts that are often destructive and creates psychological suffering. Hence ACT aims not to eliminate difficult feelings and pains but to be in the present and make contact with what life brings, and teach people to just ‘notice, accept and embrace’ these unpleasant feelings and not overreact or avoid them. Symptom reduction is not a goal in ACT therapy.
Secondly, the underpinning philosophical world view adopted in ACT is Functional Contextualism, which understands behavior as an ‘act in context’. This view holds that our behavior can only be properly explained in its situational and historical context. This tenet leads ACT to pursue deep understanding of an act in its context. And its goal is not just to appreciate the factors involved but to ‘predict and influence behavior with precision, scope and depth’.
Thirdly, ACT is based on the idea that psychological rigidity is a root cause of a wide range of clinical problems. Hence ACT’s general goal is to increase psychological flexibility – the ability to contact the present moment while being aware of your present thoughts and emotions without trying to change or be controlled by them. ACT uses one’s personal values to influence behavioral change, utilizing acceptance and mindfulness strategies along with commitment and behavior change strategies to increase one’s psychological flexibility. There are six core processes in ACT through which this psychological flexibility is cultivated – acceptance, defusion, contact with the present moment (mindfulness), self-awareness, values, and committed action.
This paper focuses on exploring the stated 3 key aspects of ACT and its claim as an explanatory framework for understanding human suffering. ACT’s 6 processes aren’t merely information gathering tool. They aim to lead counselees to reinterpret their experience. While appreciating the common grace observed through ACT’s processes, this paper also analyses areas of blinkering and distortions.
Framework for examining ACT
In this essay, I will adopt David Powlison’s approach as taught in Theology & Secular Psychology (PT243). Some of the questions Powlison posed while assessing a secular model include: At what level does the theory capture the human condition? What valuable extra-biblical information does the theory provide? How does the theory interpret the information it deems important? What does the theory ‘blinker out’? How would a biblical worldview fill in what’s missing? What interventions for change emanate from the theory’s interpretation?
Common grace element in ACT
In God’s kindness, He has providentially allowed unbelievers to observe how the fallen created world works. They glean from God’s wisdom in-built into the fabric of creation. This leads them to operate in ways that is closer to the state of affairs of the created but fallen world. Here are 4 common grace elements observed in ACT.
Firstly, ACT differs from other kinds of CBT in that it doesn’t try to teach people to better control their thoughts, feelings, memories, and other private events. CBT’s strategy is to help counselee change negative thoughts and beliefs and develop new and realistic beliefs. But ACT recognizes that such modification of thoughts hardly works in the long term. In God’s kindness, He has allowed ACT to capture something of the human condition and to point out that there is more to a human being than cognitive thoughts. While ACT may not fully understand that humans are embodied soul (body, mind and spirit) with our heart’s desire as the control center, ACT rightly espouses that there is something deeper in humanity, beyond cognition. This observation echoes the biblical understanding of behavior and heart. Luke 6:43-45 teaches that it is ‘out of the abundance of the heart that the mouth speaks’. ACT is compelled to go beyond CBT’s cognitive focus. This eventually leads them to a focus on personal values, which involves clarifying what is most important, deep in one’s heart.
Secondly, Hayes’ opening line in his first book on ACT was unintentionally but theologically spot on about the nature of our Fallen world. He opened the second edition with such an equally grim outlook of human suffering that he echoes the biblical verdict of fallen humanity (Romans 1:8-32). When Hayes reflected on the observable data of human suffering, such as statistics from WHO on psychiatric disorder, he cannot but concludes that ‘human beings inflict misery to one another continually’ and ‘psychological suffering is a basic characteristic of human life’. This led Hayes to criticize Western behavioral and medical science to have a well-developed myopia for truths that don’t fit neatly into their accepted paradigms.[iii] To observe and admit that our world is inherently broken is a huge step for anyone to take. And in God’s mercy, He has allowed ACT to articulate and champion this profound truth about our world and ourselves.
Thirdly, not only does ACT assumes that the default human mind often generates destructive thoughts, ACT traces the root of this suffering to human language. [iv] It argues that the complex set of cognitive processes in day-to-day life (e.g. analyzing, evaluating, planning) relies on language. And language can affect us both positively and negatively. With it, humanity have imagined and created useful things. But with it, humanity have also used it to lie, manipulate, deceive, slander, incite hatred, judge, criticize, condemn and invented destructive things. ACTS accurately observes what God has revealed to us in His Word. The Book of James reflects this immense power of human language – how great a forest is set ablaze by such a small fire i.e. our tongue (James 3:1-12).
In God’s providence, ACT makes observations of human beings and the world (though it bypasses God) that is very close to the real state of affairs. It diagnoses humanity more accurately than many other models and complements biblical truths. As a tool, ACT has good starting points and helps frame human suffering as inevitable. Its Functional Contextualism approach brings genuine curiosity, compassion and empathy into the counselling room.
ACT and blinkers about humanity
While ACT says a lot that somewhat conforms to a biblical view, it nevertheless has blind spots as a secular theory to explain the human condition holistically.
ACT aims to achieve a rich and meaningful life, while accepting suffering, by clarifying and allowing our deepest values to motivate us. From a biblically-enlightened standpoint, Christians can see why this is a futile search for answers from within. Having accepted that the world and humanity, including the human’s mind is self-defeating and self-destructive, ACT still goes back to the human mind to find a rich and meaningful life. Hayes spoke extensively and explicitly about the depravity of the human mind, capable of immense evil. And yet he posits that humans can find good values that will motivate us towards a rich and meaningful life. Ecclesiastes bluntly but accurately depicts ACT’s undertaking as ‘chasing after the wind’. Perhaps theologically-speaking, ACT could see that human is somewhat depraved but not totally depraved. Only by God’s grace, can one see that humanity needs help from outside of ourselves i.e. we need divine intervention. Without divine revelation, ACT is blinkered in finding good values and subsequently a meaningful life. Only the Creator of humanity of the world can offer this insight – because all things were made in, through and for Christ (Colossians 1:16).
ACT claims that when one observes our private experiences with openness and receptiveness, ‘even the most painful thoughts, feelings, sensations and memories can seem less threatening or unbearable’.[v] One of ACT’s core principles, cognitive defusion, calls one to ‘step back’ and observe that our thoughts are just ‘bits of language’, nothing more or less than transient stream of words. One possible outbox of this defusing approach in counselling methodology is to get the counselees to imagine their painful thought as just words on a Karaoke screen with a bouncing ball. Now, this comprehensive distancing strategy doesn’t seem to sufficiently recognize the degree of evil that may have been involved – an abuse or rape victim, or a mother whose child was murdered has been outrightly sinned against and really did suffered deeply. No matter how open or receptive these victims are to observe their private experiences, it is still undeniably raw evil and hurt, and it ought to hurt. It is right to cry and lament in the face of evil and real suffering. Evil and suffering is not ‘just words’. While ACT dampens the evil and its effect, the Bible is real in talking about evil – calling it out for what it is (Psalm 10, Isaiah 13:11), and recognizes the depth of pain it causes (Psalm 6).
Another of ACT’s core principles is acceptance. While ACT aims to develop an acceptance of unwanted private experiences which are out of personal control, it fails to give strong reasons for acceptance. ACT’s simple answer seems to be – ‘Accept that that’s just the way the world is, live with it’. From a biblically-enlightened standpoint, this explanation falls really short. A simple follow up question ‘But why is the world this way?’ would quickly expose ACT’s blinker. ACT as a model lacks depth and explanatory power. Through mindfulness techniques, ACT seeks to reorientate the counselee, ‘Whatever emotion shows up, no matter how unpleasant, we don’t struggle with it. If anxiety shows up, it’s not a problem. It’s unpleasant but it’s nothing terrible.’ Without a robust explanation for evil and suffering in the world, ACT simply cannot properly reorientate the counselees. The Bible on the other hand offers a much more comprehensive treatment of evil and suffering. Above all it introduces to us a God who is not distant, for He Himself is acquainted with suffering (Isaiah 53).
Mindfulness or contact with the present moment also plays an important role in ACT. Mindfulness exercises aim to help the counselees focus their attention on the present situation rather than drifting into being fixated on their own thoughts and feelings. While ACT recognizes that when people are fixated on themselves, it leads to negative psychological effects, it fails to see that it is human (fallen) to be fixated on themselves. Humans need more than self-will to take our focus off ourselves and our suffering. In contrast to Jesus Christ the perfect man who looks not to his own interest but the interest of others (Philippians 2), fallen humanity are inclined to self-centeredness, in one form or another. ACT’s mindfulness exercises to focus on shower, brushing teeth or washing the dishes may be effective as a short-term distraction strategy, but it is shallow compared to the biblical imperative to ‘put on and put off’ (Colossians 3). Christians are given reasons to ‘stop this’ and ‘do this’. It is rooted in what Christ has done and achieved for his people. It is empowered by the Spirit. The present has meaning for Christians when it is set in context of God’s sovereign salvation plan. And hence we can focus on it, while giving due acknowledgement to past hurts and looking forward to renewal and restoration in the future.
ACT’s core principle of Observing Self can be helpful is distinguishing between one’s thoughts and oneself. It teaches that ‘You are not your thoughts, feelings, memories, urges, or sensation. These are not the essence of who you are’. There is a proper place for the recognition of how intricately our physical well-being affects our mind and emotion. Sometimes our thoughts and emotions may not accurately reflect us. For example, a person suffering from hyperthyroidism may experience depressive moods and immersed with negative thoughts – being able to recognize that these emotions and thoughts are physiologically induced can help to cope. Having said that, ACT blinkered in two ways on this point. Firstly, if these are not the ‘essence’ of who one is, then what is? Where is one’s essence and true worth found? ACT has no place to go to locate and articulate the true worth of a person. God’s revelation on the other hand reveals that humans are made in God’s image – that’s our intrinsic value. Furthermore, Christ’s sacrificial death for his people shows our worth before God. Secondly it is not universally true that our thoughts and feelings don’t reflect who we are. In fact it is more often the case that they do reflect who we are! And they are a precious insight into our hearts (Luke 6:43-45, James 4:1-4). We are responsible moral beings.
ACT assumes that when we help people to clarify their values, what is most important, deep in their heart, what sort of person they want to be, what is significant and meaningful to them – they will find good aspirations and values. This is not universally true. While common grace will lead us to find some goodness in humanity (e.g. some aspire to make the world a better place), our fallen state and our rejection of our good Creator means that we are essentially blind and lost as to what is truly good for ourselves and mankind. Humanity’s rejection of our Creator means that we are always replacing the Creator with created things. We love, pursue and worship created things rather than the Creator (Romans 1:18-226).
A Biblical Reinterpretation
As a secular theory, ACT does well in recognizing and articulating the inherent brokenness of our world which God’s word also teaches. The ground data ACT observes reinforces the biblical diagnosis of the fallen and sinful world. ACT forces people to confront the world for what it is when humanity alienates ourselves from God – it is broken. The apostle Paul found it necessary to establish this point right at the start of his long letter to the Roman Christians (Romans 1-2), before he begins explaining the good news (Romans 3:21-25). Present sufferings can only be truly embraced in view of God’s mercies i.e. His salvific plan in Jesus Christ. ACT clearly falls short in offering a solution to the human predicament it has identified. Also, while ACT manages to observe the effects of sin in the world, it fails to account for the various ways in which sin manifests and bring harm. Powlison’s ‘Heat’ in his Three-Tree Diagram (Dynamics of Biblical Change Lectures) gives a much more comprehensive account of the different sufferings that come at us, as a result of humanity’s individual and collective rejection of God e.g. general hardship due to a cursed creation, being sinned against, observing others’ suffering, and human differences.
The goal of ACT is to achieve a valued life, as determined by the individual, rather than by God. As observed above, the six processes in ACT’s counselling methodology can be helpful and simple processes to reorientate a person to achieve this valued life. But without God, it is ultimately a futile godless effort. A biblical counsellor may consider adopting these processes but they need to be heavily supplemented with a biblical framework, with each process reinterpreted through biblical lens. For example, a biblical version of cognitive defusion must not only help the counselees identify their thoughts, it must also locate and ‘distant’ that thought within a biblical framework. A counselee who is absorbed with ‘I’m a worthless’ after suffering marital unfaithfulness, must be guided to ‘distant’ that thought and allowed it to be corrected by how God views her and her situation.
Russell Harris’ title to his article on ACT encapsulates this model well – Embrace your demons and follow your heart. ACT aims to make therapy no longer about getting rid of bad feelings or getting over old trauma. Instead, it is about creating a rich, full and meaningful life. ACT is essentially a self-help approach which contradicts the Christian’s response to suffering and pain. Christian sufferers bring our pains to Jesus and ask for help, trusting in the Spirit’s wisdom, love and redeeming power. Christians don’t rely of self-will. Instead Christians know a God who cares about our suffering and our self-destructive nature, and He concretely intervened to rescue us through the person of Jesus. Jesus died to rescue us from our ‘demons and evil heart’. We are freed now not to embrace our demons and follow our hearts. We can now follow Jesus our King with a Spirit-filled heart. We bring to Jesus what we learn about our suffering through counselling and ask for help, awaiting His redeeming transformation.
Christians can accept pain and can commit to change because ‘we know that the whole creation has been groaning as in the pains of childbirth right up to the present time. Not only so, but we ourselves, who have the first fruits of the Spirit, groan inwardly as we wait eagerly for our adoption to sonship, the redemption of our bodies’. (Romans 8:22-23). Real change and growth in counselling can only take place through the sanctifying work of the Spirit through the wisdom of God’s Word. This short essay has argued for the value of ACT while showing its weaknesses given its secular nature.
Cloud, John. The Third Wave of Therapy: What’s the best form of psychotherapy? How can you overcome sadness? Controversial psychologist Steven Hayes has an answer: embrace the pain. The Time Magazine Story, 2006.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press, 2012.
Harris, Russell. ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment. Oakland, CA: New Harbinger Publications, 2019
Harris, Russell. Embracing Your Demons: An Overview of Acceptance and Commitment Therapy. Psychotherapy in Australia, Vol.12, No.4, August 2006.
Zettle, Robert D. The Evolution of a Contextual Approach to Therapy: From Comprehensive Distancing to ACT. The International Journal of Behavioral Consultation and Therapy 2001, Vol.7, No.1, 78-84.
[i] Cloud, John. The Third Wave of Therapy.
[ii] Zettle, Robert D. The Evolution of a Contextual Approach to Therapy
[iii] Hayes, S. C., Strosahl, K. D., & Wilson, K. G. Acceptance and commitment therapy, Page 4.
[iv] Hayes, S. C., Strosahl, K. D., & Wilson, K. G. Acceptance and commitment therapy, Page 16.
[v] Harris, Russell. Embracing Your Demons, Page 2.