Acceptance and Commitment Therapy

Acceptance and Commitment Therapy

Today, most mental illnesses are treated with medication, antidepressants, antipsychotics, anxiolytics, etc. However, aside from pharmacotherapy, other therapies such as Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT). ACT may be used for a variety of mental illnesses, including schizophrenia. The goal of ACT is to recognize and accept unwanted experiences rather than trying to change them. For example, schizophrenia is characterized by delusions and hallucinations, such as hearing voices. ACT states that one needs to accept the fact that one hears these anxiety provoking voices, and instead must act on one’s personal values. The process may also be described as mindfulness.

Understanding one’s own values is critical for ACT. Image: Megan Jorgensen (Elena)

Thus, ACT has as its core a shift of attention from the disruptive experiences one cannot control, towards goals and values one wants to pursue and attain. A popular metaphor in ACT is that of a bus driver. A patient is asked to imagine he or she is driving a bus. On the bus, there are several rough, tough and noisy passengers who keep threatening, harassing and yelling at the driver. They also attempt to make the driver change direction. A lot of them are on the bus and it is very hard to ignore them. The patient is made aware that one of the only ways he or she could stop the harassment is to throw them off the bus, which would be hard to do because they are stronger, and because the bus needs to be stopped in order for that to happen. Therefore, by stopping the bus the driver gives up control instead of gaining it. The healthier choice would be to focus on the direction of the bus the driver wants to follow.

Most therapies have their limitations. Image: Megan Jorgensen (Elena)

While certainly an efficient therapy in some cases, ACT has its limitations. For instance, many believe that the bus driver model is too passive. Some maintain that instead of ignoring the voices, it may be more beneficial to confront them, but in a caring, accepting and compassionate manner.