In the last in this series exploring third wave cognitive behavioural approaches,
Jonathan Passmore and Sarah Leach examine Acceptance and Commitment Therapy (ACT) and how the approach is being adapted for use in coaching.
Acceptance and Commitment Therapy (ACT) is a behaviour therapy that’s evolved from the work of behaviourists such as Pavlov, Skinner and Watson. ACT emerged in the 1980s from work by psychologist, Steven C Hayes.
Like other third wave cognitive behavioural approaches, its focus is on enabling individuals to take committed action guided by their core values and to develop psychological flexibility (Harris, 2019; Hayes, 2019).
In addition to more traditional behavioural approaches, ACT places a strong emphasis on mindfulness, acceptance, and self-compassion (Harris, 2019). However, unlike other cognitive behavioural approaches, ACT doesn’t attempt to change the way clients think or feel about a situation but attempts to help individuals change the relationship they have with their thoughts and feelings.
It encourages people to mindfully notice, allow and accept those thoughts, feelings, urges and sensations, and carry them lightly (Anstiss, 2021). Thus, allowing people to consciously choose committed values-based action that move them towards a more fulfilling life.
Psychological flexibility
The core concept within ACT, psychological flexibility, is “the ability to feel and think with openness, to attend voluntarily to your experience of the present moment, and to move your life in directions that are important to you, building habits that allow you to live life in accordance with your values and aspirations” (Harris, 2019: 5). This is in contrast to psychological inflexibility where behaviour is rigidly guided by internal psychological reactions.
Underlying principles
ACT has two underlying principles: a theory of cognition called relational frame theory (RFT) and functional contextualism.
RFT considers people’s ability to relate ideas, objects and concepts to each other using different ‘frames’ where things are either the same or different, are happening now or then (frame of time), and either here or there (frame of space). As people grow up, their minds start to use language to understand the complexity of the world around them.
Humans create meaning and relationships between things, relationships which may not be fact-based, but more abstract and even imagined (Hayes, 2019). One specific unhelpful creation is comparison, for example: ‘they are a much better person than me.’ This begins to trap us. In so doing, we start to feed our ‘inner critic’.
Hayes (2004) states that ACT is explicitly contextual. This brings us to the second underlying principle of ACT: functional contextualism. This is about noticing what works. The focus here lies in the function (or effect) of the behaviour, rather than the behaviour itself. As a coach there’s no interest in evaluating or judging whether the behaviour is right or wrong, just whether the behaviour is ‘workable’, enabling a life of the client’s choosing. If not, it’s considered ‘unworkable’.
In developing psychological flexibility and working with the core principles of RFT and functional contextualism, ACT enables clients to pragmatically focus attention on the idea of ‘workability’. What steps will help clients achieve a more fulfilled life based on their values? There are six processes coaches can use to support their clients in moving towards psychological flexibility:
• Values-based living
ACT focuses on enabling values-based living by helping clients to understand what matters most to them, what they stand for, and how they want to behave. Much like a compass, values give people direction (Harris, 2019). In clarifying their values, people start to see how a more meaningful and purposeful life, full of vitality and wellbeing, can be achieved by living in alignment with their values (Anstiss & Blonna, 2014).
Values are personal to the individual, not imposed or chosen by others. They’re not goals, but a helpful way of checking the individual is on course and heading in the right direction. Valued living is an ongoing process, not an outcome (Anstiss & Blonna, 2014). Harris (2019: 217) says “pursue your values vigorously, but hold them lightly”. Values shouldn’t restrict our clients or become rules they feel they must obey, however the coach will notice that clients truly connected to their values will come alive and be fully engaged.
•Committed action
Committed action or “doing what it takes” (Harris, 2019: 7) is about enabling purposeful behaviour change, aligned to our core values. This is action – both physical and psychological – an individual takes with a willingness to accept any thoughts, feeling or reactions that appear as a result (Anstiss, 2021). It means taking action even when your mind might be saying “you will fail”, “everyone will laugh at you”, or “you can always do it later”.
ACT encourages clients to commit to the action they know will serve them best in the long term, rather than taking steps that might feel easier in the short term and cause them to fall into the experiential avoidance trap.
•Defusion
Defusion encourages clients to step back or detach from thoughts, images and memories, seeing them for nothing more than they are: that of words or pictures (Harris, 2019).
Defusion allows clients to observe and notice their thoughts, rather than get entangled with them. It helps to create a space between thoughts and actions, allowing other behavioural influences, such as values, to intervene (Hill & Oliver, 2019). Defusion begins with noticing a thought, then naming it and then neutralising it by understanding how ‘workable’ it is in relation to the life your client wants to lead (Harris, 2019).
• Acceptance
Acceptance is about welcoming, noticing and letting go of unwanted private experiences, rather than trying to control, fight or resist them (Hayes et al., 2006). The focus is not on removing or changing the thought but to change the client’s response to and relationship with their thoughts and feelings.
Experiential avoidance is considered to be at the core of many people’s issues (Hayes, 2004). The idea that people struggle with, avoid, control, or suppress unwanted thoughts to be able to cope with life, rather than acknowledge, accept and accommodate (Harris, 2019) the thoughts to move on. Some psycho-education may be useful to help clients understand that it is the things they are doing to avoid or control their experiences that are holding them back from the life they want to live (Anstiss & Blonna, 2014).
•Present moment awareness
ACT encourages clients to pay attention to what they are experiencing in the present moment, mindful that too much time spent looking forward may result in anxiety or hopelessness, while too much time spent looking backwards may result in guilt or shame, for example (Anstiss, 2021). The focus is on developing flexible attention to the world around us or the psychological world within us (Harris, 2019). When we become fused to a thought, our present moment awareness drops, and we become more rigid and inflexible. Consequently, experiential avoidance is more than likely
to occur.
•Self as context
The observing self notices what we are thinking, feeling or doing in any moment, without being engaged with it. Becoming overly attached to ourselves as content can greatly reduce flexibility (Hill & Oliver, 2019). Holding on to our own stories can provide a sense of security, safety and certainty which becomes very appealing when we’re feeling particularly uncomfortable or challenged, however it can restrict us significantly from taking committed values-based action. Self as context also allows us to see things differently or, in ACT terminology, adapt a behaviour known as flexible perspective taking (FPT). This means we have the mindfulness skills to notice and accept, and the thinking skills to understand alternative perspectives on a topic or situation (Harris, 2019). You may ask your client, for instance, “If you were in his shoes, how would you feel?” to help them develop this way of thinking.
It is important to note that ACT places a large emphasis on compassion for self, as well as compassion for others. This encourages us to consciously acknowledge suffering but instead of dismissing or ignoring it, to remain open and curious about it and respond with kindness rather than judgment (Harris, 2019). This is not something that comes easily to many of us and requires us to develop our capacity for compassion.
Research evidence
Thousands of studies have examined ACT across almost all areas of human functioning. ACT has been applied across a wide range of traditional mental health areas to help clients manage depression, anxiety and substance abuse, as well as with topics such as coping with disease, managing relationships, minimising stress, playing competitive sports and improving work performance (Hayes, 2019).
The evidence base for ACT has grown rapidly. A meta-meta-analysis by Gloster et al. (2020) reviewed 20 meta-analyses of ACT and found that ACT was as effective as CBT for all conditions studied, including anxiety, depression and pain, and superior to inactive controls, normal treatment, and other active interventions.
As with most coaching approaches, there is little literature and no randomised control trial (RCT) studies focusing on ACT in coaching relationships to date.
Acceptance and Commitment Coaching (ACC)
Acceptance and Commitment Coaching (ACC) differentiates itself from other coaching interventions by addressing the other contextual barriers that can hinder behavioural change by developing psychological flexibility (Moran, 2011).
This idea is supported in research by Skews and Palmer (2016) who identify three key benefits for coaching:
- First, it addresses psychological barriers and remains goal focused.
- Second, it supports other mindfulness based coaching approaches to reduce the impact of emotional reactions and increase acceptance.
- Finally, it is highly adaptable to different populations.
Many of these concepts can be brought alive through tools such as passengers on a bus, leaves on a stream, sky and weather and other metaphors (Passmore et al, 2021; 2022).
Conclusion
This article has briefly outlined the theory of ACT and reviewed both the evidence and application of ACT through its six processes. ACT is a complementary approach to other mindfulness and compassion-based coaching approaches and is part of a wider series of third wave approaches which over the past 30 years have built a strong evidence base within therapy. In our view, ACT should form part of the experienced coaches’ repertoire of approaches.
References
- T Anstiss, ‘Acceptance and Commitment Coaching’, in Passmore, J. (ed.), The Coaches’ Handbook: The Complete Practitioner Guide for Professional Coaches, Abingdon: Routledge, pp301-313, 2021
- T Anstiss and R Blonna, Acceptance and Commitment Coaching. In Passmore, J (ed.), Mastery in Coaching: A Complete Psychological Toolkit for Advanced Coaching, London: Kogan Page, pp253-281, 2014
- A T Gloster, N Walder, M Levin, M Twohig, and M Karekla, ‘The empirical status of acceptance and commitment therapy: A review of meta-analyses’, in Journal of Contextual Behavioral Science, 18, 181-192, 2020
- R Harris, ACT made simple: An easy-to-read primer on Acceptance and Commitment Therapy (2nd ed). California: New Harbinger, 2019
- S Hayes, ‘Acceptance and Commitment Therapy, Relational Frame Theory, and the third wave of behavioral and cognitive therapies’, in Behavior Therapy, 35, 639-65. 2004: https://doi.org/10.1016/S0005-7894(04)80013-3
- S C Hayes, A Liberated Mind: The essential guide to ACT. Transform your thinking & find freedom from stress, anxiety, depression & addiction. London: Penguin Random House UK, 2019
- J Passmore and S Leach, Third Wave Cognitive Behavioural Coaching, London: Libre Publishing. 2022
- J Passmore, C Day, J Flower, M Grieve, and J J Moon, Coaching Tools: Volume 1. London: Libre Publishing, 2021
- J Passmore, C Day, J Flower, M Grieve, and J J Moon, Coaching Tools: Volume 2. London: Libre Publishing, 2022
- R Skews and S Palmer, ‘Acceptance and commitment coaching: Making the case for an ACT based approach to coaching, in Coaching Psychology International, 9(1), 24-28, 2016
- This article is based on a chapter in J Passmore and S Leach: Third Wave Cognitive Behavioural Approaches (2022)
- Dr Rachael Skews will be delivering a Coaching at Work masterclass on ACT on 12 September: http://bit.ly/3SCX4Js