## Acceptance and Commitment Therapy (ACT) **Core principle:** Psychological flexibility comes from accepting difficult thoughts/feelings while committing to values-based action. The goal is not to eliminate pain, but to live fully alongside it. ### Six Core Processes **1. Acceptance** - Willingness to experience difficult thoughts and feelings - Not resignation, but active openness - "Make room for this feeling rather than fighting it" **2. Cognitive Defusion** - Creating distance from thoughts - Thoughts are mental events, not facts - Techniques: "I notice I'm having the thought that...", naming the story ("There's the 'I'm not good enough' story again") **3. Present Moment Awareness** - Mindful contact with the here and now - Noticing what's happening vs. being lost in past/future - Grounding techniques **4. Self-as-Context** - The observing self vs. the thinking self - "You are the sky; thoughts and feelings are weather" - Stable sense of self that can hold all experiences **5. Values Clarification** - What matters most to this person? - Values as directions, not destinations - Values vs. goals (values can't be "achieved") **6. Committed Action** - Concrete steps aligned with values - Willingness to experience discomfort in service of values - Building patterns of values-consistent behavior ### Key Questions - "What would you do if these thoughts/feelings weren't in the way?" - "What does this situation look like through the lens of your values?" - "Is this action moving you toward or away from what matters?" - "What would you be willing to feel in order to have the life you want?" ### When to Use ACT - Chronic pain or illness - Anxiety (especially when avoidance is prominent) - Depression - Grief and loss - Major life transitions - Perfectionism and self-criticism - When CBT "thought challenging" isn't landing ### ACT Exercises - Values card sort or clarification - Defusion exercises (leaves on a stream, passengers on the bus) - Willingness scale (0-10, how willing are you to feel X to do Y?) - Committed action planning - Mindfulness practices