ACT Therapy for Anxiety Disorders

Article By Dr. Irma Campos, Ph.D.

Acceptance and Commitment Therapy (Hayes, 2004) is a behavioral therapy has helped children, teens, and adults address anxiety disorders, depressive disorders, externalizing behaviors, ADHD, high functioning Autism, and other mental health concerns. ACT therapy has been found to effectively treat a range of anxiety disorders, including Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Specific Phobia, Separation Anxiety Disorder, and other related disorders (Arch et al., 2012).

Anxiety disorders are the most common mental health concerns, with an estimated lifetime prevalence of 30% among U.S. adults (see this link for more information on this: https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders). Anxiety Disorders are hypothesized to occur due to genetic/biological predispositions that interact with environmental factors. The etiology, or causes, of anxiety disorders are complex and cannot be reduced to a few causal factors.

Although the etiology of anxiety disorders is complex, effective treatment can result in improvements in symptoms and functioning. It is recommended that your physician ‘rule-out’ physical health conditions that may be playing a role in your symptoms. In fact, some symptoms of physical health conditions may mimic or underlie anxiety symptoms.

If you or your child are diagnosed by a trained mental health professional with an anxiety disorder, psychological theories based on empirical research have been developed to inform different treatment approaches. As an example, the Two-factor Theory of Fear and Avoidance (Mowrer, 1951) purports that individuals with anxiety symptoms automatically anticipate anxiety in the face of specific environmental stimuli that have previously triggered anxiety or been associated with a trigger (note: this is called classical conditioning). Naturally, these potentially triggering stimuli or situations are avoided. However, avoiding the situations or stimuli only leads to further avoidance because the individual feels ‘better’ and not anxious by avoiding the stimuli or situation. So avoiding the anxiety reinforces avoidance of the situation or stimuli in the future (note: this is called operant conditioning). Another helpful theory to consider is the Cognitive Theory of Avoidance Learning (Seligman & Johnston, 1973), which proposes that from a cognitive perspective, individuals learn to expect in their minds anxiety and fear if they do not avoid triggering stimuli or situations even after an ‘aversive’ response stops occurring. For anxiety disorders, evidence-based treatments like Cognitive Behavioral Therapy and Acceptance and Commitment Therapy attempt to remove avoidance of anxiety-inducing stimuli or situations and faulty expectations about negative events that may occur without avoidance.

Acceptance and Commitment Therapy’s primary goal is to help you develop psychological flexibility, or the ability to respond with openness and acceptance to your emotions, thoughts, and external situations while still living a life according to your core values. ACT proposes that we will all experience pain and suffering, but the relationship we have to that pain is what determines our mental health outcomes. For those experiencing anxiety disorders, symptoms can often be debilitating, resulting in impairments in interpersonal relationships, occupations, and academics. Behaviors or decisions may occur to prevent or avoid anxiety symptoms rather than to confront them. As noted, the more anxiety-triggering situations or stimuli are avoided, the more the avoidance response is reinforced. ACT therapy incorporates six skills that can target avoidance strategies and allow you to live life as you ideally would want to. The six ACT skills include: 1) Being present, 2) Knowing your core values, 3) Committing to your values through specific behaviors or actions, 4) Seeing yourself as a transcendent self, 5) Defusing or not identifying with thoughts, and 6) Accepting your entire internal experience.

In terms of specifically addressing anxiety disorders, an ACT therapist may begin with teaching you the concept and skill of Acceptance, which may include to fully allow the precise sensations of anxiety to be as they are without engaging in experiential avoidance. In treatment, different strategies can help you learn how to acknowledge and fully accept (without any internal resistance) the physical sensations of anxiety (e.g., panic, fleeting thoughts, dizziness, tightness in the chest, pressure) however discomforting they may be. It is also important for safety behaviors, or internal or external behaviors aimed at reducing anxiety while facing it, not to occur. Additionally, Committing to your values would incorporate confronting situations that may have been avoided due to anxiety. If you have experienced a stressful event while driving, you may avoid driving due to anxiety symptoms reexperienced while driving. ACT therapy would help you implement your core values (perhaps of independence and autonomy) by progressively regaining the ability to drive. In doing so, the anxiety is confronted in a way that is congruent with core values.

ACT’s principle of the Transcendent self also allows for you to view yourself as more than emerging and transient thoughts, emotions, or experiences, and instead, as pure awareness. This concept can be difficult to grasp, but it is connected to spiritual texts and philosophies, such as Buddhist philosophy and Vedantic philosophy. As one example of a related philosophy, Vedantic philosophy proposes that the self is pure and connected to all else in the infinite universe (https://vedanta.org/what-is-vedanta/). Put another way, the self is consciousness connected to everything else, which is much more than a single thought, emotion, or experience.

References

Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology, 80(5), 750–765. https://doi.org/10.1037/a0028310

Hayes, S. C. (2004). Acceptance and Commitment Therapy and the new behavior therapies: Mindfulness, acceptance and relationship. In S. C. Hayes, V. M. Follette, & M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition (pp. 1-29). New York: Guilford.

Mowrer, O. H. (1951). Two-factor learning theory: summary and comment. Psychological Review, 58(5), 350–354. https://doi.org/10.1037/h0058956

Seligman M. E. P., Johnston J. C. (1973). “A cognitive theory of avoidance learning,” in Contemporary Approaches to Conditioning and Learning, eds McGuigan F. J., Lumsden D. B. (Washington, DC: Winston & Sons Inc; ), 69–110

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