The goal of acceptance and commitment therapy (ACT) is to boost psychological flexibility by targeting six processes that underlie a range of mental health challenges: Acceptance, defusion, present-moment awareness, self processes, values-based living and committed action.
Because of its transdiagnostic orientation, the ACT model allows clinicians to effectively address any co-occurring issues that may be present along with the addictive behaviors that bring them to seek help. This approach is especially relevant when it comes to addiction and substance abuse; 18% of those who meet criteria for substance use disorder also meet the criteria for an anxiety disorder, while 20% struggle with mood disorders (Grant et al., 2006).
Here are some of the ways in which the six mechanisms targeted in ACT can play a role in substance abuse, adapted from the edited volume, Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions.
By understanding what to look for in clients, you will be better equipped to target the root cause of their maladaptive behaviors in your treatment plan.
1. Present Moment
Anyone who struggles with rumination or worry knows that how challenging it can be to stay grounded in the present moment. But an inability or refusal to be in the present moment can make it nearly impossible to respond to present experiences appropriately and can, therefore, inhibit one’s ability to respond with potential long-term consequences in mind.
Some people who abuse substances may be incredibly aware of the present moment including physical sensations and urges from one moment to the next. But conversely, these individuals may be almost entirely unaware of other things like the interpersonal consequences, threats of violence or potential for punishment that accompanies their behaviors.
This area is where ACT’s overall focus on increasing psychological flexibility comes in—targeting the process of present moment awareness allows a clinician to focus treatment specifically on boosting a client’s flexibility of attention.
2. Self as Context
ACT defines three ways of relating to the self: Self-as-content, self-as-process and self-as-context (Hayes et al., 2011). Self-as-content may play a role in substance abuse if a client tends to over-identify with her role as an addict, failing to see options to behave in ways that defy her ideas of what an addict should or would do.
This inflexibility around behaviors could be an area of focus.
When struggling with emotions, urges and unwanted thoughts, the ability to behave flexibly can be compromised. Self-as-process, which is the continued awareness of one’s thoughts, feelings, cravings and so on, may be an appropriate treatment target in this case.
An ACT clinician would work toward helping a client practice mindful awareness of internal experiences without allowing such experiences to define him.
People who struggle with substance abuse can tend to have an excess of inward-focused energy, which can interfere with potentially helpful perspective taking skills.
Self-as-context, also known as perspective taking, is the third way of relating to the self and involves dropping into the role of observer or noticer of one’s internal experience.
It also involves the ability to shift perspectives from the past, present, or future, and the ability to see things through the perspectives of others. If a client has too much inward focus, it can interfere with his ability to see things from others’ points-of-view, which may be an issue if he’s a member of a tight-knit family unit, for example.
Further, difficulty recalling what life was like prior to his addiction, and inability to envision what post-addiction life might be like, might limit motivation to seek recovery.