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  • Writer's pictureElliot Smith

Acceptance and commitment therapy: Mindfulness for change

Acceptance and commitment therapy

Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that combines mindfulness and acceptance strategies with commitment and behaviour change strategies. It aims to help individuals effectively deal with psychological distress and make meaningful changes in their lives.

The central premise of ACT is that suffering is a normal part of the human experience, and attempts to avoid or eliminate it often lead to further distress and psychological problems. Instead of trying to control or suppress unwanted thoughts, emotions, or sensations, ACT encourages individuals to develop psychological flexibility by accepting them and learning to live a valued and meaningful life despite their presence.

The ACT Hexaflex is a visual representation of the six core processes or components of Acceptance and Commitment Therapy (ACT). It provides a framework for understanding and applying ACT principles. The Hexaflex model illustrates how these processes interact and support psychological flexibility, which is a key goal of ACT. Here are the six components of the ACT Hexaflex:

1. Acceptance: Acceptance involves making room for and allowing difficult thoughts, emotions, sensations, and urges to arise without judgment or resistance. It is about acknowledging and embracing all aspects of your experience, both pleasant and unpleasant, rather than trying to avoid or control them.

2. Cognitive Defusion: Cognitive defusion refers to changing the way you relate to your thoughts. It involves creating distance from unhelpful thoughts and beliefs by recognizing that they are not necessarily true or accurate reflections of reality. By defusing from your thoughts, you can reduce their impact and influence on your behaviour.

3. Present Moment Awareness: Present moment awareness is the practice of being fully present and engaged in the here and now, without being caught up in past regrets or future worries. It involves using mindfulness techniques to observe your thoughts, emotions, and sensations with curiosity and non-judgmental awareness.

4. Self-as-Context: Self-as-context is the aspect of you that remains constant and observes your thoughts, emotions, and experiences. It is the perspective from which you can observe and hold your thoughts and feelings without becoming overly identified with them. Recognizing the observing self helps you develop a more stable and compassionate sense of self.

5. Values: Values are the qualities, principles, and domains of life that are deeply important and meaningful to you. They provide direction and purpose, guiding your actions and choices. Identifying and clarifying your values helps you make decisions that align with what truly matters to you.

6. Committed Action: Committed action involves taking purposeful and values-driven action in line with your identified values. It involves persistently engaging in behaviours that are consistent with what you deeply care about, even in the face of challenging thoughts and emotions. Committed action moves you toward a meaningful and valued life.

The ACT Hexaflex model represents the interconnectedness of these processes, with psychological flexibility as the overarching goal. Each component supports and reinforces the others, and together they contribute to greater well-being and the ability to live a meaningful and fulfilling life.

ACT is based on six core processes that work together to foster psychological flexibility:

1. Acceptance: ACT encourages individuals to acknowledge and accept their inner experiences, including difficult thoughts, feelings, and sensations, without judgment or the need to change them. Acceptance involves letting go of attempts to control or avoid these experiences.

2. Cognitive Defusion: This process helps individuals distance themselves from their thoughts and see them as what they are—just thoughts and not necessarily accurate reflections of reality. It involves learning to observe thoughts without getting entangled in them or believing them as absolute truths.

3. Being Present: ACT emphasizes the importance of being fully present and engaged in the current moment, rather than being caught up in regrets about the past or worries about the future. Mindfulness techniques are used to cultivate present-moment awareness and help individuals connect with their experiences without getting overwhelmed by them.

4. Self-as-Context: This process involves recognizing that one's sense of self is not fixed or defined by thoughts, emotions, or external circumstances. It encourages individuals to observe their experiences from a larger perspective, often described as the "observing self" or "pure awareness."

5. Values: ACT emphasizes the identification and clarification of personal values—what truly matters to an individual in life. By aligning actions and behaviours with these values, individuals can cultivate a sense of purpose and meaning.

6. Committed Action: This process involves taking purposeful and value-driven actions that align with one's identified values. It encourages individuals to set realistic goals and actively engage in behaviours that move them toward a fulfilling life, even in the face of discomfort or challenging emotions.

ACT is an evidence-based therapy used to treat various psychological conditions, including anxiety disorders, depression, substance abuse, chronic pain, and eating disorders. It can be delivered in individual or group therapy settings and employs a range of techniques such as mindfulness exercises, metaphors, and experiential exercises to help individuals develop psychological flexibility and lead more meaningful lives.

Acceptance, in the context of Acceptance and Commitment Therapy (ACT), refers to a willingness to fully experience and embrace one's thoughts, emotions, bodily sensations, and external circumstances without judgment or resistance. It involves acknowledging the reality of what is in the present moment, rather than struggling against it or trying to change it.

Practicing acceptance can be challenging, especially when faced with difficult or unwanted experiences. Here are some key principles and strategies to help cultivate acceptance:

1. Mindfulness: Mindfulness is the foundation of acceptance. It involves intentionally paying attention to the present moment with an open and non-judgmental attitude. By practicing mindfulness, you can observe your thoughts, emotions, and sensations as they arise without getting caught up in them or trying to push them away.

2. Acknowledge and Label: When unwanted thoughts, emotions, or sensations arise, acknowledge their presence and label them without judgment. For example, if you're feeling anxious, simply recognize it as "anxiety" rather than getting caught up in a narrative about why you shouldn't feel anxious.

3. Radical Acceptance: Radical acceptance involves fully and completely accepting the reality of a situation, even if it's not what you want or if it's causing you distress. It means recognizing that certain aspects of life are beyond your control and that struggling against them only adds to your suffering.

4. Letting Go of Control: Acceptance involves letting go of the need to control or change every thought, emotion, or external circumstance. Recognize that there are certain things you cannot control, and trying to do so will only create frustration and resistance. Focus instead on how you respond to those experiences.

5. Cultivate Self-Compassion: Acceptance is not about resignation or giving up; it's about responding to your experiences with kindness and compassion. Treat yourself with gentleness and understanding, acknowledging that it's okay to have difficult thoughts and emotions. Practice self-care and self-compassion to support yourself through challenging times.

6. Practice Acceptance Daily: Make acceptance a daily practice. Regularly check in with yourself and notice any resistance or judgment that arises. Allow yourself to experience your thoughts and emotions fully, without trying to change or suppress them. Over time, acceptance becomes more natural and integrated into your way of being.

Remember that acceptance does not mean approving or condoning everything that happens. It is about acknowledging and making peace with the reality of the present moment, so you can respond to it in a more flexible and value-driven way. It takes time and practice, but embracing acceptance can lead to greater emotional well-being and the ability to navigate life's challenges with resilience.

Cognitive defusion, within the framework of Acceptance and Commitment Therapy (ACT), refers to the process of creating psychological distance from our thoughts and learning to see them as what they are—mental events or passing patterns of language—rather than absolute truths or accurate reflections of reality. It involves recognizing that thoughts are not necessarily facts and can be observed without getting entangled in them or taking them too seriously.

To practice cognitive defusion, here are some strategies and techniques you can use:

1. Noticing Thoughts: Begin by developing awareness of your thoughts. Observe them as they arise in your mind. Notice the content, the words, and the stories they tell. Pay attention to the way they come and go.

2. Labelling Thoughts: When a thought arises, practice labelling it as just a thought. For example, if the thought is "I am a failure," mentally note it as "I am having the thought that I am a failure." This helps create some distance and reminds you that thoughts are not necessarily reality.

3. Externalizing Thoughts: Treat your thoughts as external events rather than something you are fused with. Imagine your thoughts floating by like clouds or leaves on a stream. This imagery helps you detach from your thoughts and see them as separate from your core self.

4. Silly Voices or Tones: Playfully experiment with changing the tone or voice of your thoughts. For example, if a negative thought arises, repeat it in a silly voice or sing it out loud. This technique helps to break the seriousness and emotional impact of thoughts.

5. Repeat Thoughts Out Loud: When a thought feels particularly sticky or overpowering, say it out loud repeatedly for a minute or two. By doing so, the thought loses its power and begins to sound more like a repetitive sound or noise rather than a profound truth.

6. Mindful Observing: Practice observing your thoughts without getting caught up in them. Imagine yourself sitting by a river, and each thought that arises is a leaf flowing by on the water. Observe the thoughts come and go without judgment or attachment.

7. Metaphors and Parables: ACT often uses metaphors and parables to help defuse from thoughts. For example, viewing thoughts as cars passing by on a busy road, or seeing thoughts as unhelpful radio chatter in the background. These metaphors help to create distance and reduce the impact of thoughts.

Remember that cognitive defusion is not about trying to eliminate or suppress thoughts. It is about creating space between you and your thoughts, so you can relate to them in a more flexible and objective manner. With practice, cognitive defusion can help you free yourself from unhelpful thought patterns and reduce their influence on your emotions and behaviours.

Being present, often referred to as mindfulness, means fully engaging with and experiencing the present moment without judgment or attachment to the past or future. It involves directing your attention and awareness to what is happening right now, both internally (your thoughts, emotions, bodily sensations) and externally (your surroundings).

To practice being present in the moment, you can incorporate the following techniques into your daily life:

1. Mindful Breathing: Focus your attention on your breath. Notice the sensation of the breath entering and leaving your body. Whenever your mind wanders, gently bring your attention back to the breath. This anchors you in the present moment and helps cultivate awareness.

2. Body Scan: Take a few moments to scan your body from head to toe, noticing any sensations or areas of tension. Be curious about what you feel without trying to change or judge it. This practice helps you connect with your physical experience in the present moment.

3. Engage Your Senses: Tune in to your senses and fully engage with your surroundings. Notice the colours, shapes, and textures around you. Listen attentively to sounds. Savour the flavours and textures of the food you eat. Engaging your senses helps anchor you in the present moment and enhances your experience.

4. Non-judgmental Awareness: Practice observing your thoughts, emotions, and bodily sensations without labelling them as good or bad, right or wrong. Be an impartial observer, accepting the full range of experiences without getting caught up in judgments or evaluations.

5. Letting Go of Multitasking: When engaging in activities, give them your full attention. Avoid multitasking or constantly shifting your focus between different tasks. Whether it's washing dishes, talking to someone, or reading a book, commit to being fully present and engaged in that activity.

6. Mindful Movement: Engage in activities like walking, yoga, or Tai Chi with full awareness. Pay attention to the sensations of your body moving, the rhythm of your breath, and the sensations in your muscles. This helps cultivate a sense of presence and embodiment.

7. Mini Mindfulness Breaks: Throughout the day, take short breaks to check in with yourself. Pause for a few moments, close your eyes if possible, and take a few deep breaths. Notice how you're feeling physically, emotionally, and mentally. This mini reset allows you to reconnect with the present moment.

Remember, being present is not about achieving a particular state of mind but rather a way of engaging with your experiences. It takes practice and patience, as our minds tend to wander and get caught up in past regrets or future worries. However, by consistently bringing your attention back to the present moment, you can cultivate a greater sense of clarity, peace, and fulfilment in your daily life.

Self-as-context, also known as the observing self or pure awareness, is a concept within Acceptance and Commitment Therapy (ACT) that refers to the part of you that can observe and be aware of your thoughts, emotions, sensations, and experiences without being defined or fused with them. It is the aspect of consciousness that remains constant and unchanged amidst the ever-changing content of your mind and the world around you.

Working on self-as-context involves developing a greater sense of connection with this observing self and recognizing that your thoughts, emotions, and experiences are not the totality of who you are. Here are some ways to cultivate self-as-context:

1. Mindfulness Meditation: Regular mindfulness meditation practices, such as focused attention on the breath or body scan, can help you develop a greater sense of self-as-context. By observing your thoughts and experiences during meditation, you begin to recognize the presence of an observing self that remains constant amidst the passing thoughts and sensations.

2. Detaching from Thoughts and Emotions: Practice recognizing that thoughts and emotions come and go, while the observing self remains present. When thoughts or emotions arise, remind yourself that they are temporary mental events and not a reflection of your true self. Cultivate a sense of detachment and observe them without getting caught up or fused with them.

3. Perspective-Taking: Imagine stepping back and seeing yourself from a larger perspective. Visualize yourself as an observer watching a movie of your life. This exercise helps you shift from being immersed in the content of your experiences to observing them from a broader vantage point.

4. Labelling Thoughts and Emotions: When thoughts and emotions arise, practice labelling them by saying, "I am having the thought that..." or "I am experiencing the emotion of..." This simple act of labelling helps create a separation between your observing self and the thoughts or emotions you are experiencing.

5. Noticing Changes: Pay attention to the changes and fluctuations in your thoughts, emotions, and sensations. Notice that these experiences are not constant or permanent, whereas the observing self remains consistent. This recognition helps reinforce the understanding of self-as-context.

6. Cultivating Acceptance: Acceptance of your thoughts, emotions, and experiences without judgment or resistance supports the development of self-as-context. As you accept all aspects of your internal and external experiences, you strengthen the connection with the observing self that can hold and observe them all.

Remember, working on self-as-context is an ongoing process that requires patience and practice. As you continue to cultivate awareness and strengthen your connection with the observing self, you'll develop a greater sense of psychological flexibility and resilience in navigating life's challenges

Values are deeply held beliefs and principles that guide your actions, behaviours, and decisions. They reflect what is truly important and meaningful to you in life, serving as a compass for your choices and providing a sense of purpose and fulfilment. Values can encompass various domains of life, including relationships, work, personal growth, health, community, and more.

To decide what your values are, consider the following steps:

1. Reflection: Take time for self-reflection and introspection. Consider the aspects of life that are most meaningful to you. What brings you joy, fulfilment, and a sense of purpose? Reflect on your past experiences and identify the moments when you felt most alive and aligned with your values.

2. Core Aspects of Life: Consider the different domains of life, such as relationships, career, health, personal growth, spirituality, and community involvement. Think about what matters to you within each domain and the qualities or principles you want to embody in those areas.

3. Prioritization: Once you have a list of potential values, prioritize them by considering which ones are most essential and non-negotiable to you. Identify the values that resonate the strongest and align with your sense of identity and purpose.

4. Personal Exploration: Engage in activities and experiences that align with your potential values. Explore different areas of interest and observe how engaging with them makes you feel. Pay attention to activities that bring you a sense of meaning, fulfilment, and authenticity.

5. Clarifying Statements: Write down clear and concise statements that describe your values. For example, if you value compassion, your statement could be "I value treating others with kindness and empathy." These statements serve as reminders of your values and can guide your decisions and actions.

6. Revisit and Revise: Your values can evolve and change over time as you grow and gain new insights. Regularly revisit and reassess your values to ensure they still resonate with who you are and what you aspire to be. Be open to revising and refining your values as needed.

7. Integration: Integrate your values into your daily life by aligning your actions and behaviours with them. Make conscious choices that reflect your values and evaluate whether your actions are in harmony with what you deem important. This alignment between your values and actions fosters a sense of authenticity and fulfilment.

Remember that values are personal and individual. Your values may be different from others, and that's perfectly okay. The key is to identify and embrace the values that are true to you, as they will serve as a guide to living a more meaningful and purposeful life.

In Acceptance and Commitment Therapy (ACT), setting values is of great importance as it serves as a fundamental component of psychological flexibility and overall well-being. Here are the key reasons why values are emphasized in ACT:

1. Providing Direction and Purpose: Values help you clarify what is truly important and meaningful to you in life. They act as a compass, guiding your choices, actions, and behaviours. When you have a clear sense of your values, you can make decisions that align with what matters most to you, providing a sense of direction and purpose.

2. Enhancing Commitment and Motivation: When your actions are aligned with your values, you are more likely to experience a sense of motivation and commitment. Values serve as a source of intrinsic motivation, driving you to engage in actions that are in line with what you hold dear. This intrinsic motivation is often more sustainable and fulfilling compared to relying solely on external rewards or pressures.

3. Promoting Psychological Flexibility: Values are a core component of psychological flexibility, which is a central aim of ACT. Psychological flexibility involves being present, open, and engaged with the present moment while persisting in actions that align with your values, even in the presence of difficult thoughts and emotions. By actively living your values, you develop the capacity to respond flexibly to life's challenges and move toward a rich and meaningful life.

4. Providing a Framework for Decision-Making: Values can serve as a framework for decision-making. When faced with choices or dilemmas, you can evaluate which option aligns more closely with your values. This helps you make decisions that are in harmony with what truly matters to you, rather than being swayed by external pressures or fleeting desires.

5. Fostering a Sense of Authenticity and Well-Being: Living in alignment with your values promotes a sense of authenticity and congruence. When your actions and behaviours reflect your deeply held beliefs, you experience a greater sense of integrity and well-being. Living a life that is true to your values cultivates a sense of fulfilment and satisfaction.

Remember that values in ACT are not about achieving specific outcomes or goals. They are not about being "better" or "worse" than others. Instead, values are about the qualities and principles you want to embody and the way you want to engage with the world. By setting and living according to your values, you can foster psychological flexibility, navigate challenges with resilience, and create a meaningful and purposeful life.

Committed action refers to taking purposeful and values-driven action in line with your identified values. It involves actively engaging in behaviours that align with what you deeply care about, even in the presence of challenging thoughts, emotions, or external obstacles. Committed action is an essential component of psychological flexibility and living a meaningful life.

Here are some key aspects and characteristics of committed action in ACT:

1. Values-Driven: Committed action is rooted in your identified values. It involves aligning your actions and behaviours with what you truly care about and consider meaningful in life. Your values act as a guide, helping you make choices and take actions that are in line with what matters most to you.

2. Contextually Relevant: Committed action takes into account the specific context and circumstances in which you find yourself. It involves considering the current situation, available resources, and potential obstacles. Committed action is flexible and adaptive, adjusting based on the context while maintaining alignment with your values.

3. Persistence and Effort: Committed action requires persistence and effort. It involves staying committed to your values and taking steps toward them even when faced with challenges, discomfort, or setbacks. It recognizes that meaningful action often requires sustained effort and a willingness to persevere.

4. Mindfulness and Awareness: Committed action is grounded in mindfulness and awareness of the present moment. It involves being fully present and engaged in your actions, without being overly consumed by past regrets or future worries. Mindfulness helps you connect with the task at hand and make conscious choices in line with your values.

5. Flexibility and Adaptability: Committed action is flexible and adaptable. It recognizes that different strategies or approaches may be necessary to pursue your values in different situations. It involves being open to learning, trying new approaches, and adjusting your actions as needed to move closer to what you value.

6. Small, Incremental Steps: Committed action often involves taking small, manageable steps toward your values rather than waiting for grand, monumental changes. It recognizes that consistent, incremental progress can lead to significant transformations over time. Breaking down larger goals into smaller, achievable actions helps build momentum and confidence.

7. Evaluation and Reflection: Committed action involves regularly evaluating and reflecting on the outcomes and consequences of your actions. This reflection allows you to assess whether your actions are moving you closer to your values and make adjustments if necessary. It emphasizes learning from experience and adapting your approach as you gain new insights.

Committed action in ACT is not about achieving specific outcomes or external validation. It is about actively engaging in behaviours that align with your values, even in the face of challenges or discomfort, and experiencing a sense of purpose, fulfilment, and growth as a result

Psychological flexibility is a core concept in Acceptance and Commitment Therapy (ACT) that refers to the ability to adapt and respond effectively to the ever-changing circumstances of life. It involves being open, present, and engaged with the present moment while persisting in actions that align with your values. Psychological flexibility is important for several reasons:

1. Enhanced Well-Being: Psychological flexibility is associated with greater psychological well-being and overall life satisfaction. When you are psychologically flexible, you are better able to navigate life's challenges and bounce back from setbacks. You can experience a greater sense of fulfilment, meaning, and vitality in your life.

2. Reduced Psychological Distress: Developing psychological flexibility can help reduce psychological distress, such as anxiety and depression. By cultivating acceptance, mindfulness, and values-driven action, you can effectively respond to difficult thoughts and emotions and prevent them from controlling your behaviour and well-being.

3. Improved Relationship Satisfaction: Psychological flexibility can positively impact your relationships. It enables you to be more present, attentive, and responsive in your interactions with others. You can better manage conflicts, engage in effective communication, and show empathy and understanding towards others' experiences.

4. Greater Resilience: Psychological flexibility fosters resilience, the ability to adapt and bounce back from adversity. When faced with challenges or setbacks, you can approach them with openness and flexibility, learning from experiences and adjusting your actions as needed. This adaptability helps you navigate difficult times and bounce back stronger.

5. Values-Driven Action: Psychological flexibility emphasizes taking actions that align with your identified values, which leads to a greater sense of purpose and fulfilment. By actively engaging in behaviours that reflect what truly matters to you, you can create a meaningful and valued life.

6. Improved Cognitive Functioning: Psychological flexibility is associated with improved cognitive functioning. By defusing from unhelpful thoughts, practicing mindfulness, and being present in the moment, you can enhance your cognitive flexibility, attention, and problem-solving skills.

7. Increased Personal Growth: Developing psychological flexibility allows for personal growth and self-development. It involves challenging unhelpful patterns of behaviour, embracing discomfort, and stepping outside your comfort zone. By being open to new experiences and learning, you can continuously grow and evolve as an individual.

Overall, psychological flexibility is essential for navigating life's challenges, living in alignment with your values, and experiencing greater well-being and satisfaction. It enables you to respond effectively to difficult thoughts and emotions, adapt to changing circumstances, and create a meaningful and valued life.

While I hope this piece has interested you in the components of ACT, if you are seeking some kind of psychological support you should contact a professional, accredited psychologist who is adequately trained to help you encompass the different aspects of the ACT Hexaflex. This blog simply aims to shed light on the kind of work I do with my clients, and potentially illustrate the benefits and utility of ACT. You should not consider this information alone as sufficient, for ACT to be most effective you would still require a trained psychologist to help you navigate the framework and apply it to your own unique circumstances.

If ACT is something that appeals to you, please do not hesitate in reaching out and getting in touch. And if you have any questions you’re more than welcome to reach out!.

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