Therapy Provides New Ways to ACT on Emotional Distress

For many, psychological and emotional suffering can be a gateway to substance use. Whereas patients often try to fight off these feelings and thoughts, John Forsyth, PhD, University at Albany professor of psychology and director of the anxiety disorders research program in the SUNY Department of Psychology, embraces a different therapeutic approach: acceptance and commitment.

Forsyth, who will present on Acceptance and Commitment Therapy (ACT) at Freud Meets Buddha: An NCAD Meeting, March 6-9 in Chicago, spoke with Addiction Professional about ACT’s approach to suffering and psychological health, the ways in which it differs from mainstream therapy philosophies, and ways therapists can incorporate its concepts into their existing practices.

How does ACT view human suffering and psychological health, and how is this different from mainstream views?

In mental health practices, there’s a tendency to focus on symptoms. People experience disturbing thoughts, tense emotions, no emotion, sadness, despair, anger. Much of the mental health establishment, including the culture writ large, views the presence of unpleasant thoughts and emotions are problems that must be overcome, eliminated, or reduced in some way. Many people come into therapy because they also see the presence of unwanted thoughts, feelings and memories as problems. ACT takes a different view that it’s not the presence of psychological, emotional or physical pain that is the problem necessarily. It’s how we relate with this stuff. We know life invites obstacles, problems and pain. There is no escaping that truth as long as you are alive. Suffering is different than the presence of pain. That’s important for people to understand. Pain is part of life.  If that is so, then we need to ask what flips pain on its head and turns it into suffering? Science now is showing it’s our entanglement with pain, our resistance to pain in all its forms, our struggle with it and avoidance of it that actually amplifies the pain. It’s like trying not to think about a pink elephant. That’s all you’re going to think about. I’ve never seen anybody come into a mental health setting saying, ‘I’m really open to my painful thoughts, memories and feelings.’ It’s usually like dodgeball in that they’re trying to get away from it.

How does ACT help patients face those thoughts and emotions they frequently struggle with?

What ACT is really about is changing our relationship with the things we already carry. Instead of trying to run from ourselves and the situations that bring up unpleasant thoughts, memories, physical sensations and emotions, we learn to basically drop the rope in this tug of war and open up to what life is offering and learn to see it just as it is. It doesn’t mean people like it. Rather, we need to look at how all the resistance and struggle with genuine aspects of our experience makes things worse – like trying to put a fire out with gasoline.

What ACT does is focus on changing our relationship with this stuff. You can still think the thought and learn to get some perspective with it so that it no longer controls you. We know from neuroscience there is no healthy way to get rid of unpleasant thoughts, feelings, or memories. Our nervous systems are additive, not subtractive. ACT is about teaching skills to help people be more open and present about what’s going on, less caught up in struggle and resistance. It doesn’t mean people like feeling this stuff, but in that space, we can learn to respond to what our mind, body and history give us in a new way. ACT teaches people to be more mindful, less engaged with whatever thoughts and feelings show up in the service of doing more of that really matters to them in this life.

How can therapists incorporate these concepts into their practice?

One thing about ACT that a lot of therapists find interesting is they can readily integrate that into the work they already do now. It might take some tweaks, but they can pull some of these skills and concepts into their current practice. They don’t have to drop everything they’re doing to become an ACT therapist.

Freud Meets Buddha: An NCAD Meeting, March 6-9 in Chicago, explores the intersection of traditional psychotherapeutic techniques with Eastern concepts such as mindfulness to provide patients with an evidence-based, holistic approach to addressing their mental health needs.