If I was going to spend longer on this post, I'd make it more empirical and talk through evidence for/against the effectiveness of ACT.
As it is, I didn't want to spend significantly longer writing it, so I've gone for a summary of the core ideas -- so that readers can assess the vibe and see if it's something that sounds interesting to them.
This might have been the wrong call though.
I did a shallow review of the evidence for ACT last year: "Anxiety defusion and acceptance (acceptance and commitment therapy) Mind Ease’s anxiety defusion exercise is based on acceptance and commitment therapy (ACT), which is backed by the following evidence: Traditional ACT with a therapist: A 2017 review of RCTs of ACT to treat anxiety and depression shows that ACT improves depression relative to no treatment up to 6-months follow-up. (ds = 0.32 to 1.18). Two studies compared ACT with minimally active comparison conditions (expressive writing and minimal support group) and found ACT outperformed comparison conditions on depression at post, but were equivalent at follow-up.[74] A 2020 meta-analysis of 18 studies with 1,088 participants showed that ACT significantly reduced depression as compared with the control group (d= 0.59, 95% CI [0.38, 0.81]).[75] Self-help: Traditionally face-to-face, ACT is also delivered in self-help formats. A meta-analysis shows that ACT self-help showed significant small effect sizes favoring intervention for depression (g=0.34; 95% CIs [0.07, 0.61]; Z=2.49, p=0.01) and anxiety (g=0.35; 95% CIs [0.09, 0.60]; Z=2.66, p=0.008). Higher levels of clinician guidance improved outcomes but intervention format (e.g. book/computer) was unlikely to moderate results.[76] Internet-based ACT (iACT): A systematic review of internet-delivered ACT (iACT) for anxiety[77] showed that 18 out 20 studies reported significant anxiety reduction after treatment. This was observed in studies that delivered iACT with (n=13) or without (n=5) therapist guidance. The average attrition rate during treatment was 19%. In 13 studies participants on average rated their iACT experience with above average to high treatment satisfaction. App-based ACT: A recent RCT of ACT in an app form showed that help-seeking individuals vs. waitlist increased well-being with moderate effect sizes.[78] In aggregate, anxiety defusion and acceptance (acceptance and commitment therapy) seems effective with small to medium effect sizes."
While I have not done a deep dive into the literature and checked the claims in depth, afaik ACT counts as one of the more evidence based psychotherapies with several hundred studies including RCTs demonstrating good effects.
There is also a whole scientific paradigm “contextual behavioral science” based on “functional contextualism” which grounds the development of ACT. This is one of the clearest theoretical foundations for a scientific field I have come across (i.e., it’s a coherent account grounded in Pragmatism) and should be refreshing to have a look at for people interested in philosophy of science as well as behavioral science in general.
I am pretty bullish on ACT and would recommend anyone interested in mental health to have a good look for aspects that might work for them.
What I would maybe add to the post is a short description of the ACT Matrix, which is a thinking tool that can be useful for organizing thoughts about problematic situations. While it certainly depends on the person, some friends I have showed it to found it easy to grasp and very helpful for navigating difficult situations. It’s not a panacea but may be a good starting point for people who appreciate a hands-on learning approach.
I also recommend the tools section in a liberated mind. Should be pretty relatable for people who have done or are generally interested in CFAR workshops / rationality techniques.
Thanks for writing the post!
Thanks for sharing! That's useful to know.
I'll look into adding to the post later today.
ACT = Acceptance and Commitment Therapy (pronounced as the word ‘act’ rather than the letters)
CBT = Cognitive Behavioural Therapy
I started exploring ACT about a month ago, and have found it has significantly increased my mental wellbeing. ACT has been much more powerful and effective for me than other types of CBT I have tried in the past (however, I have engaged with ACT to a deeper level – but this is mostly because it felt exciting and helpful from the beginning).
I haven't heard EAs talk about it publicly before, and wanted to encourage others to explore it as a framework, if any of it resonates. I have been enthusing to friends about ACT, and I’m also writing this to be able to refer people to in future.
My goal here isn't to provide a guide for How To Live According To ACT. It's to offer a brief taster, so that if the ACT framework seems like it could be helpful, you can learn more elsewhere.
Both are behaviour-based therapies, but they differ primarily in their orientation to thoughts. Whereas CBT works by helping you identify and change negative or destructive thoughts, ACT holds that pain and discomfort are a fact of life – something to get comfortable with if we aim to live a happy, fulfilled life. For this reason, ACT encourages you to accept all thoughts rather than trying to change them – both the good and the bad. Note that accepting thoughts is not the same as complacency.
Traditional CBT uses empiricism to guide behaviour change, whereas ACT uses values to guide behaviour change. For example, CBT might ask “Is [anxious thought] empirically true?” If the thought is false, CBT might encourage you realise that, and change the thought pattern accordingly. For me, this approach hasn’t been helpful, as I can intellectually know that a thought is false, but still feel emotionally affected by and “hooked” on it.[1] Alternatively, ACT helps you clarify what you actually care about – your values – and engage in “towards moves” (moves that are towards your values, as opposed to “away moves,” which are moves away from your values). I find the framing of “I am doing this because it’s aligned with my values ” much more powerful as a force to drive behavioural change. ACT could be a good fit for people who are especially values-driven.
Psychological flexibility is defined as being in contact with the present moment, fully aware of emotions, sensations, and thoughts, welcoming them, including the undesired ones, and moving in a pattern of behaviour in the service of chosen values.
More simply, this means accepting our own thoughts and emotions and acting on long-term values rather than short-term impulses, thoughts, and feelings that are often linked to experiential avoidance and a way to control unwanted inner events.[2]
The objective of ACT is not elimination of difficult feelings; rather, it is to be present with what life brings and live in accordance with your values.[3] Fighting against your emotions usually just leads to being stuck in them. Instead, ACT encourages gentle curiosity towards thoughts, feelings, and sensations.
“Acceptance and Commitment Therapy is based on a dramatically different assumption: the normal thinking process of a healthy human mind will naturally lead to psychological suffering. You’re not defective; your mind’s just doing what it evolved to do”.
— Dr. Russ Harris
We’ve not evolved to be happy, or to handle difficult thoughts and feelings effectively. We evolved for an ancestral environment, in which anxiety, sadness, and anger were evolutionarily useful. It takes deliberate practice to live a life where you’re not perpetually struggling against your internal experience. Discomfort is inevitable in a full human life.
ACT encourages you to clarify your values, and then taking actions that support them. It means asking yourself: what is important to me? How do I want to interact with the world? How do I want to interact with others? How do I want to interact with myself?
Sometimes ACT techniques can make you feel happier, but that’s a pleasant side effect and not the goal. ACT is not an attempt to closely control your emotions – the goal isn’t to chase happiness.
In The Happiness Trap, Harris gives a non-standard definition of happiness: “living a rich, full, and meaningful life.” This is different from the standard definition of “feeling good,” because this is a feeling, and feelings don’t last.
The first 4 principles of ACT are mindfulness skills. The last 2 principles are values, and committed action. All this leads to a formula[4] that looks like this: Mindfulness + Values + Committed Action = Psychological Flexibility.
This skill is about learning to perceive thoughts, images, memories and other cognitions for what they are – nothing more than bits of language and images – rather than what they often appear to be: threatening events, rules that must be obeyed, or objective truths and facts.[5]
As you learn to defuse painful and unpleasant thoughts, they often lose their ability to frighten, disturb, worry, stress, or depress you.
Making room for unpleasant feelings and sensations instead of trying to suppress them or push them away. As you open up and make space for these feelings, they will likely bother you less, and “move on” much more rapidly, instead of “hanging around” and disturbing you.
Connecting fully with whatever is happening right here, right now; focusing on and engaging in whatever you’re doing or experiencing. Instead of dwelling on the past or worrying about the future, you are deeply connected with the present moment.
The observing self is the part of you that does not change but experiences, sees, touches, thinks. The observing self does not judge, it does not take any responsibility; it helps you to become aware of what you have done; whereas the thinking self is the part of you that judges, the observing self does not generate any thoughts but simply observes them.
ACT believes that the observing self is like the sky. The thoughts and feelings are like the weather constantly changing and moving but the sky remains blue, regardless of the weather.[6]
ACT teaches that clarifying and connecting with your values is an essential step for making life meaningful. Your values are reflections of what is most important to you: what sort of person you want to be, what is significant and meaningful to you, and what you want to stand for in this life. Your values provide direction for your life and motivate you to make important changes.
A rich and meaningful life is created through taking effective action, guided by and motivated by your values. And in particular, it happens through committed action: action that you persevere with, even through difficulty.
My biggest recommendation is probably to work with a therapist who practices ACT. This is not always possible, but here’s a friendly nudge to book an intro session with a therapist if you think it could help and you’ve been putting it off :)
There is one therapist on the EA Mental Health Navigator who is listed as practising ACT. Here is a list of ACT therapists in England that I found from googling (you can do the same for other countries). If you're aware of any good ACT therapists, it would be helpful if you would share them with me or link to them in the comments.
I believe that there is sometimes funding available from the EA Infrastructure Fund, if funding is a bottleneck to you seeking therapy and you work in an impactful career path. I’m entirely sure about what’s available, and if anyone knows please let me know and I'll be more specific here!
I used definitions and ideas explained in Luc Rolin’s summary of The Happiness Trap throughout this post, with explicit permission from Luc.
Being “hooked” is ACT terminology. When we’re “hooked” our thoughts seem real, true, important and wise, and are experienced as orders or as threats. Therefore, if we are “hooked” we react to thoughts such as “I am useless” as if we actually are useless, and we react to thoughts like “I am going to muck this up” as if failure is a foregone conclusion. Often our thoughts “beat us up”, telling us stories about how stupid, incompetent, and ugly we are. Getting hooked by these kinds of thoughts can lead to anxiety, low self-esteem, depression and so on.
Definition taken loosely from here.
Taken from the book "Acceptance and Commitment Therapy: The Process and Practice of Mindful Change" (2nd ed.). Amazon link here.
Thank you so much for writing this up! I've also found a lot of benefits from ACT, and it seems like there is quite a strong empirical grounding. I'd also second your recommendation that anyone interested seek out the book A Liberated Mind by Steven Hayes, one of the progenitors of ACT.
In that book, Hayes also mentions some research they did on ACT for goal-related outcomes, like improving school grades and chess performance. I don't have the links on hand, but I recall that they saw significant effects from relatively minor interventions, so I think it could be especially promising for people looking to deal not only with larger mental illness issues, but also smaller life goals.
I have found more benefit from ACT than traditional CBT myself. As this post mentions, one of the fundamental differences is that CBT tries to change your thinking about difficult things, whereas ACT simply asks you to accept them wholeheartedly. Because of this, I've sometimes felt like CBT is kind of just gaslighting yourself, which may in fact be effective, but I suspect that ACT might produce more stable long-term improvements — especially for people who have epistemic issues with the idea of simply reframing difficult truths. I think ACT also has many similarities to mindfulness practice and certain forms of Buddhism, and people who find those ideas interesting and helpful will likely see some benefit from ACT.