When people encounter mental health struggles in life, such as anxiety, depression, managing stress, or coping with an illness, Cognitive Behavioral Therapy (CBT) is widely used to help with these conditions. Techniques used in CBT include training an individual to reframe negative thoughts or stories they may be telling themselves when they’re in the midst of challenging circumstances.
Acceptance and Commitment Therapy (ACT) is an alternate treatment that may prove beneficial to individuals that are not seeing results with CBT. It can also be helpful for changes in life that prove to be trying such as handling grief or loss, transitioning to a new role like parent or caregiver, or managing pain. ACT shares some common themes with CBT but relies on a unique idea that there are some things that we can't change, and for those situations, it’s possible to change our attitude towards these struggles. ACT sessions utilize the practice of mindful attention to observe thoughts and feelings in the present moment, label these experiences, and treat them with an attitude of non-judgment.
Bruna Martins-Klein, clinical psychologist and assistant professor of psychological and brain sciences, is both the ACT Team Leader within the UMass Amherst Psychological Services Center and practitioner of ACT for older-adult groups in the community. She became interested in ACT during graduate school where she worked with older adults who were experiencing difficulties with conditions like chronic pain or illness. These ailments were tough to treat with CBT by means of altering one’s perspective because people’s experiences were very physically as well as mentally challenging.
Martins-Klein describes how practicing ACT is built of two main components, “first teaching skills that help us identify what emotions we're feeling, what body sensations we feel, and to be able to identify the thoughts that come up for us naturally. There's this mindfulness component of being with what is present in the moment, without trying to change it, without trying to judge it.
“The second component teaches skills that move from mindfulness to a place of being able to hold these thoughts, these emotions, these feelings, but still act in a way that's aligned with the kind of lifestyle that we want to have. For example, thinking about what we value and continuing to make strides to be active in our lives even if we're holding difficult pain or difficult anxieties while we go about our day.”
Taking a neutral stance when faced with troublesome feelings or emotions can allow us to be more compassionate with ourselves. Without adding any negative layers of judgement, we can experience what comes up and not feel pressured to act a certain way or try to make the feelings go away.
Martins-Klein relates, “it's not just about noticing pain and I think a lot of people ask me ‘how will I get better if all I'm doing is noticing things that don't feel good’ and the idea is that we can both notice the things that don't feel good but also make active motions towards the sort of actions that help us feel connected to who we are.”
For example, a runner may greatly value being outside in nature, but if they injure their leg, they may have to stop running outdoors for some time. A new attitude they can adopt is to be flexible about what they can do to connect with nature. They could watch a sunrise over the mountains, enjoy an ocean breeze at the beach, or create a scrapbook about past nature adventures and begin to plan a new trip. This ability to pivot our actions while keeping in touch with what is meaningful to us is vital to overcoming challenges we encounter.
ACT therapists also employ mindfulness exercises that guide participants using metaphors or mental imagery to address challenging subjects like experiencing strong emotions. For instance, if an individual is fighting with their emotions and trying to make them go away, this could be visualized as being stuck in a pile of quicksand. The more someone fights their emotions, the deeper and more trapped they seem to get.
“There's this mind-body connection in a lot of the work that involves thinking abstractly and forming connections between vivid metaphors and what's going on in your life. This can sometimes be a window to access connections that you might not be able to otherwise,” says Martins-Klein.
ACT can be helpful for many different diagnoses because it focuses less on specific symptoms and more on the functional impact of our behaviors—what they are giving or taking away from our lives. The therapy teaches us to change the way we cope. Perhaps instead of trying to avoid pain or emotions, we can increase awareness and the willingness to experience emotions that arise.
Martins-Klein’s team of clinical psychology graduate student trainees are currently offering individual telehealth therapy through the Psychological Services Center. Her team has also organized an ACT group for community seniors through the Amherst Senior Center, which has been very successful as a pilot program. They have helped many older adults who were struggling with both age-related and pandemic-related stressors. The therapy team finds their work very rewarding and are excited to organize more outreach programs in the future.