Acceptance and Commitment Therapy and Values-Based Addiction Recovery

Many of the men who enter treatment with us are tired of battling their thoughts and feelings. Years of fighting against cravings, battling anxiety, avoiding painful memories and self-criticism, and turning to drugs and alcohol for relief can leave a person feeling hopelessly stuck.

But acceptance and commitment therapy (ACT) provides a very different perspective. While traditional therapies focus on eliminating or reducing difficult thoughts and feelings, ACT focuses on teaching clients how to develop a new relationship with their thoughts and feelings. It helps clients make choices, despite those thoughts and feelings, and commit to the goals they want for their lives. At Forward Motion Health, ACT is one of the most practical, lasting tools we offer in the work of recovery.

 

What is Acceptance and Commitment Therapy?

Acceptance and commitment therapy ( ACT) is an evidence-backed form of psychotherapy developed by Steven C. Hayes, Kirk Strosahl, and others during the late 1980s.[1] 

ACT is included in the “third wave” of cognitive-behavioral therapies, along with dialectical behavior therapy (DBT) and mindfulness-based approaches. It is grounded in relational frame theory, and there is extensive research supporting its effectiveness across a variety of mental health and behavioral conditions.[2] 

ACT is delivered by trained mental health professionals, including licensed therapists, psychologists, social workers, and counselors, either in individual therapy or in a group setting. ACT typically involves weekly sessions over the course of several months. ACT is suitable for adults with substance use disorders, anxiety, depression, chronic pain, post-traumatic stress disorder (PTSD), eating disorders, psychosis, and numerous other mental health and behavioral issues.

At Forward Motion Health, ACT is incorporated into the treatment plan for each client. Our clinicians incorporate elements of ACT into both individual sessions and group sessions — using experiential exercises, practicing mindfulness techniques, and engaging in value-based work designed to encourage our clients to transition from avoidant and reactive behaviors to deliberate, committed action.

How (and Why) Acceptance and Commitment Therapy Works

Acceptance and commitment therapy works by enhancing what clinicians refer to as psychological flexibility — the ability to remain present, open to experiences, and committed to actions aligned with your values regardless of distressing thoughts or feelings.[3] The therapy is rooted in six core processes, often called the ACT hexaflex: 

• Acceptance
• Cognitive defusion
• Present-moment awareness
• Self as context
• Values
• Committed action. 

Each of these processes works collectively to enable clients to stop fighting their internal experiences and instead begin to build lives that are meaningful.

This is particularly important for people with substance use disorders. Many aspects of addiction stem from experiential avoidance — the human tendency to avoid unpleasantness like pain, anxiety, loss, grief, or shame through whatever means reduces that discomfort, no matter how short-term. Drugs and alcohol are two of the most effective, though self-destructive, methods of short-term avoidance, which is a major reason why deciding to stop using is so difficult. Rather than attempting to suppress or eliminate undesirable internal experiences, ACT shows clients how to recognize that they can experience a troubling thought or painful emotion and still behave consistently with their desired values. That single change — from avoidance to acceptance and committed action — can facilitate long-lasting changes in behavior.

At Forward Motion Health, our clinicians are trained in contextual behavioral therapies and incorporate elements of ACT throughout the entire treatment planning process. During individual sessions, we facilitate engagement in ACT exercises, in group sessions, we teach cognitive defusion and mindfulness skills, and our clients use those skills to address real-world challenges in recovering from their addiction.

Who is Acceptance and Commitment Therapy Best For?

ACT can benefit many different people; however, it appears to serve some types of people and situations better than others. ACT may be the right choice for you if:

• You’ve tried other methods like traditional cognitive behavioral therapy or 12-Step Programs, and were left feeling that something was lacking
• You use substances as a means of escaping unpleasant thoughts, feelings, or memories.

• You are “stuck” in patterns of self-criticism or rumination, or feel like you are “lost in your mind.”
• You no longer connect with what you truly value or what you want your life to be like.
• You struggle with chronic pain, anxiety, depression, or PTSD in addition to substance use.
• You’ve had therapy before, but still feel disconnected from a meaningful life.

ACT is generally less concerned with reducing diagnostic-specific symptoms and focuses on helping develop a flexible life driven by values. For patients interested in developing practical tools that can help with addressing nearly all forms of internal struggle, this modality can be helpful.

 

Efficacy of Acceptance and Commitment Therapy

ACT has a large body of research demonstrating its effectiveness across a wide range of conditions. 

• Research has found ACT to be beneficial for a variety of mental health conditions, including depression, anxiety, chronic pain, OCD, and substance use disorders.[4] 
• Multiple meta-analyses have found ACT to be an effective treatment compared to control conditions, with some studies even showing gains maintained at follow-up.[5]
• Research has examined ACT as either a stand-alone treatment or as part of an integrated treatment model, with studies consistently demonstrating reduced levels of substance use, increased retention rates in treatment, and better overall outcomes for patients presenting with co-occurring mental health issues.[6] 
• One randomized controlled study demonstrated the efficacy of ACT with polysubstance-using methadone patients, resulting in improvement maintained through a six-month follow-up.[7] 
• Studies have also supported the efficacy of ACT for helping users abstain from alcohol, opioids, and cigarettes.[8]
• ACT also shows evidence for treating conditions that frequently co-occur with substance use, such as anxiety, depression, PTSD, eating disorders, and chronic pain. [9]

What to Expect from Acceptance and Commitment Therapy

Many patients find ACT sessions to be action-oriented and engaging. While discussions of problematic behaviors are certainly a component of ACT sessions, the majority of the session is spent working on shifting how the participant interacts with their thoughts and emotions.

During an average ACT session, you may experience the following:

• Mindfulness exercise that allows you to become aware of your present state without attempting to change it.
• Cognitive defusion activities that help you understand your thoughts as thoughts rather than truth.
• Examining your values and assessing how your current behaviors align with or differ from those values.
• Developing committed actions — taking small, specific steps to move toward the life you want.
• Exercises designed to enhance psychological flexibility rather than simply discuss it.

Many patients describe their ACT experiences as simultaneously challenging and clarifying. Avoiding unpleasantness is hard work. However, many patients eventually describe themselves as less influenced by internal processes and more capable of showing up for aspects of their lives that they find meaningful — family, friends, work, hobbies, and recovery.

Acceptance and Commitment Therapy at Forward Motion Health

Forward Motion Health offers ACT as part of an individualized treatment plan along with multiple other evidence-based modalities. Our therapists are trained in contextual behavioral therapies and skilled at combining ACT with other therapeutic frameworks to meet each client exactly where they are. 

We emphasize application over theoretical constructs. Our intention is for patients to leave with skills they can use in times of craving, conflict, stress, and everyday life, so they can build the life they want one decision at a time.