Acceptance and Commitment Therapy for Fear Based Disorders
Living with anxiety is no easy feat. As fear-based disorders continue to rise, more and more sufferers report feeling drained by endless loops of catastrophic thinking, weighed down by uncomfortable physiological sensations and trapped within a sense of doubt and doom.
While traditional Cognitive Behavioral therapies that have focused on challenging and changing anxious thoughts have shown to be effective, many still find that waging war against uncomfortable thoughts and feelings doesn’t ultimately offer them the freedom from anxiety they are looking for.
What if the path to freedom doesn't lie in fighting your anxious thoughts, but in changing your relationship with them altogether?
Acceptance and Commitment Therapy (ACT) offers a revolutionary perspective on treating anxiety, panic disorder, OCD, and other fear-based conditions. ACT invites us to make room for them while moving toward what truly matters in our lives. This paradigm shift has shown remarkable results for many who previously felt trapped in cycles of fear and avoidance.
What is Acceptance and Commitment Therapy (ACT)?
Acceptance and Commitment Therapy (ACT), created by Steven Hayes, steers away from focusing on the content of our thoughts as proposed by the second wave of Cognitive-Behavioral Therapy (CBT). ACT works under the belief that counteracting cognition through mental processes increases rumination patterns. Unlike CBT, ACT does not debate the truth of clients' thoughts and perceptions but rather supports them to pursue action steps that align with the values they have chosen to live by.
Fundamental Components of ACT
Acceptance: The first goal, which leads to psychological flexibility, is achieved by practicing acceptance and mindfulness skills. According to Hayes (2004), acceptance is "the active non-judgmental embracing of experience in the here and now."
Commitment in the Direction of Your Values and Goals: Clients are prompted to reflect on what values they want to live by and create goals that align with those values.
Action: Together, the client and therapist form a collaborative relationship where they create action steps congruent with the client's desired values and goals.
Acceptance and Commitment Therapy for Fear-based Disorders
ACT works under the premise that pain is part of the human experience, and putting effort into avoiding pain can only lead to prolonged suffering. Hayes et al. (2012) identify two behavioral patterns that perpetuate suffering: "cognitive fusion" and "experiential avoidance."
Understanding Cognitive Fusion and Experiential Avoidance
To be in a fused state means to be fully engrossed in the literal content of one's thoughts. In this state, we are disengaged from our surroundings, our senses, and the present moment. Experiential avoidance, on the other hand, means allowing anxiety—or other uncomfortable emotions—to take the lead in our lives and dictate what behaviors we engage in.
The Anxiety Loop: How Avoidance Reinforces Fear
For example, someone who feels very anxious in social settings might start withdrawing and isolating, which then leads them to feel lonely and lacking social connection. Here, the person, instead of learning how to effectively cope with their internal discomfort in social settings, chooses to appease their anxiety by avoiding activities and behaviors that may ultimately lead to their wellbeing.
The Impact on Mental Health
The results of cognitive fusion and experiential avoidance are psychological rigidity and withdrawal from experiencing life, which are prominent symptoms in fear-based disorders, such as Generalized Anxiety Disorder and OCD. By continually avoiding or running away from circumstances that trigger anxious feelings, we don't get the opportunity to learn that there is a high probability that not only can we withstand what we fear, but we can even succeed in engaging in activities that might be potentially rewarding (Eifert & Forsyth, 2013).
ACT's Solution: Defusion and Acceptance
The antidotes to these behavioral patterns proposed by ACT are defusion and acceptance. Defusion is the mindful engagement with thoughts and emotions, where one simply takes a step back to notice the mind without becoming entangled with it. Acceptance teaches resilience towards uncomfortable emotions, which leads to a gradual abandonment of avoidance tendencies.
Living According to Values, Not Fear
These tools help clients engage less in rumination and other behaviors that keep them entrenched in the anxiety loop and engage more with what they value most in life. ACT ultimately teaches that exerting control over our anxiety keeps us living within the constraints of fear.
Reconnecting with the Present Moment
By stepping out of our heads and engaging more with our surroundings, we gradually train our minds that constantly engaging with imaginary worries and narratives that pose unwarranted threats only exhausts our nervous system and keeps us from living life fully. Developing techniques that increase our attention span on the present moment can also help us decrease our negative filtering, which is a common cognitive malfunction in disordered anxiety.
Embracing Discomfort on the Path to Healing
ACT offers a profound shift in approaching fear-based disorders—one that acknowledges the inherent challenges of the human experience while creating space for growth and fulfillment. Rather than attempting to eliminate anxiety or uncomfortable thoughts, ACT invites us to change our relationship with these internal experiences.
By embracing the principles of acceptance and mindfulness, developing psychological flexibility, and committing to values-driven action, individuals suffering from anxiety, OCD, and other fear-based disorders can begin to free themselves from the constraints of avoidance and fusion.
As research continues to demonstrate ACT's effectiveness for fear-based disorders, more clinicians and clients are discovering that paradoxically, it is often through accepting our discomfort—rather than fighting against it—that we find our greatest freedom. When we stop allowing fear to dictate our choices and instead orient our lives around our deepest values, we reclaim our ability to live rich, meaningful lives even in the presence of difficult emotions.
The path forward may not always be easy, but with practice and support, those struggling with fear-based disorders can develop the skills needed to step out of the anxiety loop and into a life defined not by fear, but by purpose, connection, and authenticity.
References:
Eifert, G. H., & Forsyth, J. P. (2013). Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance and values-based behavior change strategies. Oakland, CA: New Harbinger Publications.
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral therapy. Behavioral Therapy 35, 639-665.
Hayes, S.C. (2004) Acceptance and commitment therapy and the new behavior therapies: Mindfulness, acceptance and relationship. In S.C. Hayes, U.M. Follette, M. M. Lineham (2004) (Eds.), Mindfulness and Acceptance: Expanding the cognitive behavioral tradition (pp 1-29). New York, NY: Guilford
Hayes, S.C., Strosahl, K. D., & Wilson K.G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd Ed). New York, NY: Guilford.
Hayes, S.C., Pankey, J. & Gregg, J. (2002) Acceptance and Commitment Therapy. In R.A. Ditomasso, E.A. Gosch (2007) (Eds.) Anxiety Disorder: A Practitioner’s Guide to Comparative Treatments (pp 137-159) New York, NY: Springer