Inside Mental Health Podcast: What is ACT (Acceptance and Commitment Therapy)?

Episode Description

What is Acceptance and Commitment Therapy (ACT)? Is it just for select issues or can everyone benefit from ACT? Is there any evidence to support that ACT works at all?

Dr. Steven C. Hayes, one of the pioneers of ACT, answers these questions and shares some of the interesting applications of ACT, ranging from helping professional athletes to Fortune 500 companies.

Guest Bio

Steven C. Hayes is a Nevada Foundation professor of psychology in the behavior analysis program at the University of Nevada. An author of 46 books and nearly 650 scientific articles, he’s especially known for his work on Acceptance and Commitment Therapy or “ACT,” which is one of the most widely-used and researched new methods of psychological intervention in the last 20 years. Hayes has received several national awards, such as the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapy. His popular book “Get Out of Your Mind and Into Your Life” for a time was the best-selling self-help book in the United States, and his new book “A Liberated Mind” has been recently released to wide acclaim. His TEDx talks have been viewed by over 600,000 people, and he’s ranked among the most cited psychologists in the world.

Inside Mental Health Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author.

To learn more about Gabe, please visit his website, gabehoward.com.

Episode Transcript

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Inside Mental Health podcast, formerly The Psych Central Podcast. I’m your host, Gabe Howard, and I want to thank our sponsor, Better Help. You can save 10% and get a week free by visiting BetterHelp.com/PsychCentral. Calling into the show today, we have Stephen C. Hayes, Dr. Hayes is the author of 46 books and nearly 650 scientific articles and is especially known for his work on Acceptance and Commitment Therapy or ACT. Dr. Hayes, welcome to the show.

Dr. Steven C. Hayes: Well, thanks for having me. Looking forward to the conversation.

Gabe Howard: You know, I like to think that I am aware of everything that’s out there when it comes to mental health, mental illness and psychology, so I’m a little embarrassed to say that I was not familiar with ACT before meeting you. Can you tell our listeners what ACT is?

Dr. Steven C. Hayes: Well, it’s an evidence-based therapy, part of the behavioral and cognitive therapies, but we’ve done some things different over the 40 years we’ve developed. We’ve tried to essentially hack the human mind, figure out basic science, you know, why is it hard to be human? Why is what you and I are doing right now make it difficult to live a life that’s whole and free and to put that into a very small set of processes that if you focus on and change, your life lifts up and lifts up not just the mental health, but in behavioral health and social areas and relationships and sports and high performance and all those areas. And sitting on top of about 4,000 studies. I’m prepared to walk you through what we found in that 40-year journey.

Gabe Howard: Well, let’s do that. How does ACT work?

Dr. Steven C. Hayes: It’s kind of a simple formula to say, harder to do, but basically it works through six related processes that make up this concept of psychological flexibility and just like physical flexibility, strength and resilience, the same thing is true with mental skills. And the six are to be more emotionally open, to not get entangled with your thoughts, but be able to learn from them and see them, to be able to consciously from this more spiritual part of you, come into the present moment with attention. That’s flexible, fluid and voluntary. You’re focusing on what’s important and then to use that to focus on what you want to put into your life’s moments. What is your sense of meaning and purpose that you can create behavioral habits around? I just said six things. If you wanted to get it down to three, you can say learning to be more open, aware and actively engaged in life. Or if you just want one, learning how to be psychologically flexible. And that small set of skills predicts more outcomes and more areas than any other set of skills known in science. ACT does it deliberately, but it’s not the only one. A lot of the things that are known to be helpful work through these mechanisms.

Gabe Howard: Dr. Hayes, it sounds so simple, it sounds like if you don’t have enough money, just make more money. If you’re not happy, just cheer up. If you’re overweight, just lose weight. How does ACT address that? Because I don’t disagree at all with what you’re saying, but saying it and doing it, that’s the rub, right?

Dr. Steven C. Hayes: Exactly, and, well, you know, we try to figure out and answer that question, you know, why is it hard to do those things? And the basic reason is what you and I are doing right now, Gabe, is an evolutionarily recent thing. So, you’ve got trying to make your life work. You’re overusing this tool of analytic judgmental language, which is the evolutionary recent kid on the block, and it can be useful for lots of things, doing your taxes and fixing your car, but for peace of mind, for purpose, for being a whole person, for accepting your history and moving on from there, it just doesn’t know how to do that. It gets turned into a problem-solving organ. And next thing you know, your life is a problem to be solved. And if you get into that mode, that life’s a problem to be solved, it’s going to tell you to do things that are either inert or that are harmful. You start trying to get rid of your emotions, eliminate your thoughts, subtract your memories. That’s a train wreck. It’s logical, it’s reasonable and sensible, but it’s pathological. And so you dare not trust your life to that analytic problem solving engine between your ears. And so how to put the mind on a leash is really a lot of what the journey is about.

Gabe Howard: It sounds a little bit like mindfulness or meditation. Is it the same? Does it differ? Are they distant cousins?

Dr. Steven C. Hayes: Yeah, they’re not so distant cousins, you know, mindfulness wasn’t how we were talking about evidence based therapy back in 1981 when ACT started. And we’ve done the work to sort of dig down using Western science methods to what the processes are. And a lot of the mindfulness traditions are based on ideas that come from people who have had spiritual experiences, sometimes thousands of years ago, and sometimes they are pretty wise. But Western science can do some things that the person sitting under the tree a thousand years ago may not have thought of. And so we’ve learned how to distill this thing down into a smaller set. And so let me just give you one example.

Gabe Howard: Yeah, I’d appreciate that. Thank you.

Dr. Steven C. Hayes: Ok, so we have a process we call defusion (sic), which is to take literal thought when it’s dominating your view of the world so thoroughly that you don’t even notice you’re thinking you just notice the products of your thinking. You know, like this sucks. And what you notice is that it sucks. Not that I had the thought that this sucks and that changed how I’m viewing the situation. That gets poured together. We call it fusion. The thing goes together, but you don’t notice what the elements are. Defusion, you teach yourself to back up just a little bit so that you notice the process of thinking, not just the products of thinking. And that will come, if you’re lucky, from a mindfulness tradition. Almost always, in every tradition I know that has elements in there, we have evidence that cognitive defusion is a result of mindfulness training. Yeah, but I can do something that in 30 seconds will help you see how that illusion works. Not a 10 day silent retreat, never mind years of sitting. Not that there’s anything wrong with that, but it’s kind of an indirect way. And so an example might be one that Titchener came up with 100 years ago. We were the first to ever test it clinically. We take a difficult thought that’s really hard for you to manage, distill it down to a single word and then say it out rapidly. And we’ve done the research, so I can tell you exactly how long and how fast. For at least thirty seconds at least once per second. Just say the word out loud. Like if you’re having the thought that you’re unlovable, say unlovable out loud, at least that fast for thirty seconds. Does that seem like mindfulness to you? That probably doesn’t. But I tell you what, the shift.

Gabe Howard: Yeah, it’s not at all. It’s not like mindfulness at all.

Dr. Steven C. Hayes: Not at all, but the shift in believability and distress happens in 30 seconds. No, it’s not permanent. It’ll come back, but it’s one of hundreds of methods we’ve developed. And unlike the 10-day silent retreats, which are great, but let’s face it, they’re for the educated elite or for the young. I mean, Joe Six-Pack on the factory floor is not doing a 10-day silent retreat. Give me a break, gang. Come on. But you can do 30 seconds of word repetition if you’re a, you know, a delivery truck driver and having to face the stress of a stressful life. Take that example I used where you were criticized by a customer or something. You know, maybe a thought came up like you’re a loser. Say loser out loud, fast for 30 seconds. So there’s hundreds of these methods. And because we’ve gone bottom up, we can put them in there. And it adds to things, knowledge of the process and new techniques to do some of what the mindfulness work is trying to do. And then we make sure to add values and committed action, which are in the full mindfulness methods. But when you put them into the health care system, sometimes left behind. Mindfulness based stress reduction doesn’t have a whole values component. You go to a meditation retreat, it does, because they’ll tell you what right action is and so forth. But you’ve given permission because it’s a spiritual tradition. You can’t do that in health care systems. People can’t come in and tell you what your values are. But I can ask the questions that help you find what your values are. And so that’s in the ACT work. And so we’ve added additional things. We build on what’s there. We’ve dug down the process and we’ve turned it into tools you can use fast.

Gabe Howard: Now, ACT stands for Acceptance and Commitment Therapy, the specific word that I’m leaning on is therapy, is this something that you need to go see a therapist or a counselor or a doctor in order to learn? Or is this something that you can learn on your own?

Dr. Steven C. Hayes: You can learn on your own, and when you’re just using it outside of therapy, we call it Acceptance and Commitment Training, and it has the same acronym, it’s still ACT. And so we use it in business and industry. The Olympic gold medal winners have used it. Actively involved in sports and consulting with the mental performance team in Major League Baseball clubs. I was out there in spring training. So in area after area, we have turned it into training methods and you can learn it through self-help books and things of that kind. The first popular book on ACT was in 2006 called Get Out of Your Mind and Into Your Life, was a book I wrote, and it beat Harry Potter for one glorious week

Gabe Howard: [Laughter]

Dr. Steven C. Hayes: Was the best-selling self-help book and we’ve done randomized trials of that humble little book. We get about 60 percent of the change that you get in the course of psychotherapy on anxiety, depression, and stress measures. So there’s a lot you can do. You don’t have to wait. The whole psychotherapy thing. I’m a psychotherapist. I’m a psychotherapy developer. But look, psychotherapy barely touches the problems. We’ve got one out of five folks have these diagnosable conditions, but a fraction of them, last year was down below 10% got psychotherapy only. And don’t we all know it’s not one out of five anymore? It’s five out of five. If COVID didn’t teach you that, you’re not looking. Everybody has mental issues and mental resilience. Mental strength is relevant to everybody. And you don’t wait for the train wreck to do it, just like you wouldn’t wait to get your diet healthy and to exercise until you have a dreaded disease. That’s catawampus. So let’s get working on our mental strength and flexibility now, because who knows when we’re going to need it? You know, you might have a pandemic. You might suddenly not be able to be touched or talk or be with other people. You may, you might get challenged with loneliness and fear and, you know, so let’s be ready for those moments and mental health is for all of us.

Gabe Howard: It’s fascinating that you bring up mental health is for everybody, because I’ve been saying this for years, I mean, everybody has mental health, right? Now, most people most of the time have good mental health, but most people most of the time have good physical health. It doesn’t mean that you’re not going to catch a cold, catch the flu, stub your toe. It’s fascinating that people ignore their brains. It’s our personalities. It’s how we address the world.

Dr. Steven C. Hayes: Sometimes some of the good mental health we have, sometimes what you mean is you don’t have a particular source of distress right now, but, you know, just like in your physical health, you could be eating fast food, sleeping poorly and so forth, you know, for years and years and years. And it’s all fine. It’s all good. And then it isn’t anymore. And your body is keeping the score. And the same thing with your mind if you’re not developing habits of mind that are healthy. The time to start that journey is now. Not because you’re overwhelmed with depression, anxiety, trauma, etc. Now, that’s the metaphor of waiting until you’re ill before you start eating well or exercising. No, even if your mental health is seemingly great now, meaning that you don’t have any particular form of distress. If you look at the research it says, here’s the skills you need, and we’ve now have studies that show, for example, getting through COVID. What is predicted by that? Social support from others, having enough money to be able to manage it, and psychological flexibility. Thirteen thousand people on a meta analysis recently came up with that conclusion. Well, those skills had to be developed before that COVID thing showed up. You can’t wait. And then, well, you can. I mean, the time to start is now.

Gabe Howard: A lot of people, a lot of people do wait and they sort of learn on the fly, right? But your outcomes are a lot less.

Dr. Steven C. Hayes: But also, if you’re thinking, well, this doesn’t apply to me, I’m doing really well, etc., Sure, but how about another meta analysis just came out three weeks ago, showed that relationship success is predicted very strongly by the psychological flexibility of the people in that relationship, whether or not your children are traumatized when things happen, like school shootings or COVID, is predicted by the parental psychological flexibility. So when you get these processes focused on and I’m not necessarily work on it through ACT. As you mentioned, you could do it with mindfulness work or CBT work, good third wave kind of things, methods out there. But develop your flexibility skills because you’re going to need resilience to walk through life. And the time to work on that is now.

Gabe Howard: We’ll be back in a minute after we hear from our sponsors.

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Gabe Howard: And we’re back discussing ACT, which is Acceptance and Commitment Therapy with Dr. Steven C. Hayes. So ACT isn’t something that you just use it after the problem or during a crisis, it’s preventative. It’s really for everybody. Am I understanding that correctly?

Dr. Steven C. Hayes: Well, we have evidence for whom it’s most helpful, the processes are helpful for everybody. If you compare ACT as an intervention method to, say, traditional CBT, it seems to be especially helpful when people have multiple problems, more severe problems, when they’re chronically avoidant, when they’re chronically inflexible, it does have broader spread. It more easily goes from mental health to behavioral health to social health and to issues like prejudice or diet or exercise or running your business. So it has an unusual spread. So psychological inflexibility predicts that you’re going to develop multiple problems if you have a problem it’ll become chronic. And conversely, flexibility predicts being able to succeed in almost every area that you look at relative to being inflexible. So it’s time to learn. I mentioned even in sports, you know, the folks on the, I’ll say the name, the Toronto Blue Jays are the folks who are kind of all ACT all the time.

Dr. Steven C. Hayes: But there’s other teams. ACT was written up recently in Sports Illustrated for work with the 76ers, there’s NFL teams, etc. The point of that being here are some folks who have to do an amazing thing psychologically. They’ve got to throw a fastball. It’s a hundred miles an hour knowing that if they throw it wrong, they might throw out their arm and they’ll never be able to pitch again. Or that guy standing at the plate knowing that he’s had a, you know, a hitting slump. And if it doesn’t correct, he’s going to be benched. Think about that. With thousands and thousands of people cheering them or criticizing them, what helps that person getting centered, getting focused, being open, focused on your values, whole person? You’re not just an athlete. You’re not just a story. You know, your relationships matter, your kids matter, stay in balance and groove that sporting skills that your body knows how to do what your what your mind could never do. It can’t see, think about and make a decision fast enough to hit that fastball. Your body can do it, but your mind can’t.

Gabe Howard: As a sports fan, I’m fascinated by this, can you explain how ACT helps people win championships? What’s that look like?

Dr. Steven C. Hayes: Well, it’s interesting. So in competitive athletics, you’re going to need to respond very often to the other person, that person who’s making that move or throwing that pass or hitting that topspin tennis ball or like that. Well, some of the things that athletes have been told do that are focused on form are actually interfering. You don’t want to be thinking about form and you don’t want to be necessarily even grooving. Like there’s a lot of work on traditional sports psychology of grooving in your mind how you will respond over and over again, imagining. That might be fine if you’re on a luge run. It’s not fine if you’re a tennis match because you don’t know what the other person’s going to do. You may have grooved the wrong thing and they hit a shot that you didn’t expect. And now that 50 to 100 millisecond gap means that you don’t hit that ball back with a kind of angle or spin that you need to play at a world class level. So the advice that you give to beginning athletes, eventually you have to learn how to put aside with high performers. And you see it in the things that we kind of almost laugh about. You know, the Yogi Berra’s, you know, don’t think just hit. OK, how do you not think? Most people, given that instruction, will think I’ll stop thinking by suppressing thought? No, that’s the last thing you want to do. Now, you’ve got another thought about a suppressing of thought, which means you have to attend to see whether or not the thought went away. Have I stopped thinking yet? Have I stopped thinking yet? You turn into like a bad cell phone commercial.

Gabe Howard: It sort of reminds me of the don’t think of a bear.

Dr. Steven C. Hayes: Yes, yeah.

Gabe Howard: Now all you think about is a bear. How does ACT change that?

Dr. Steven C. Hayes: So back to the point here, I’m getting a little bit all excited about sports here, but

Gabe Howard: [Laughter]

Dr. Steven C. Hayes: How do they work with world class athletes? You work with opening up the gates to your attentional processes. You work on getting more sensitive to what’s going on in your body. You work on emotional openness that can pass through you. So when you’re stepping into the batter’s box and you have a little wave of anxiety, this passes through and it turns into something more like focus. You learn how to focus your attention, like on the pitcher and what he’s about to throw. If a thought comes in, you let it go, it moves out, you bring back, you bring your focus to this moment and then the values piece of, you know, living your legacy, of doing the work and you’re in your practice and with your teammates and so forth, that you are ready in that moment to allow your previous training to show up and an athletic performance that reflects many, many thousands of hours of work and being committed to that process so that even when it’s successful or unsuccessful, you can right yourself and be prepared for the next. So you may not have noticed that. I’ve mentioned the six flexibility processes in my answer there. When you measure athletes’ psychological flexibility, there are measures showing things like points per minute on ice for NHL hockey players are predicted by their psychological flexibility. Because what happens, let’s say, if a puck passes the guy shifting sports, if you’re thinking about dang, I missed it. Have you ever seen players do that? Or they eh, you know, they’re grim.

Gabe Howard: Yeah, where they slump, they like slump over and they drop their head and

Dr. Steven C. Hayes: Yeah, and sometimes they clench their fist or they throw their head around. Well, wait a minute, dude, the puck might go past you again in that second. You have to be able to let that thing go in micro milliseconds to be ready for the next thing. So there’s a lot to do with mental skills other than just not being depressed or anxious, there’s having relationships that work, businesses that work, managing the challenges of physical disease, living a life that’s whole, full, your best you.

Gabe Howard: My life’s work is explaining mental health, mental illness and psychology to people, so I have an answer to this question. I’m just interested in what yours is.How can psychology change the world? How can it make a profound difference?

Dr. Steven C. Hayes: Yeah, isn’t it interesting that in so many areas, if you’re psychologically minded, you see psychology relevance and it’s not even mentioned? I mean, you look at COVID, yeah, it’s mentioned when you’re talking about mental health problems, but not when they’re talking about wearing a mask, not when they’re talking about why people might be willing or unwilling to have a vaccine or. For us as a culture to put psychology where it needs to be placed, we need to stop thinking about it only as relevant to a one out of five problem, see it as relevant to human behavior more generally. Don’t fear Western science tools. It’s not going to dominate our culture. It’s not going to eliminate your spiritual tradition or your faith tradition or your particular cultural interest. It can inform it. We need to get out of woo woo. We’ve had too much psychology that’s not based on evidence. And so people learn to be cynical about it. Too much that’s focused on just making money or being popular. Not enough that’s focused on the careful piece by piece building of evidence based methods, but also ones that are accessible. You don’t want evidence based methods that it takes a PhD to understand. So it’s got to be something that hits people where they live and serves them. I think we’ve been on the 50 year journey of trying to put human suffering completely into a biomedical straitjacket with signs and symptoms for syndromes. And so I think we’ve kind of, in a way, made things worse by convincing people that they have this and they have that. And next thing you know, they’re not really looking at what they can do to actually move their life forward. And meanwhile, the application of psychology to your relationships or to your work or to sports or to diet or to exercise or dealing with a cancer diagnosis or what about your kids and so forth has been missed.

Dr. Steven C. Hayes: And so the ACT community really is actively part of an effort to put psychology back at the center of behavioral issues, psychological issues that are everywhere. But before we move from there again, since you asked me that question, I want to know what the answer was to the question you asked me. You said you had a good answer. Why is psychology off on the side and how can we put it more back up to the center?

Gabe Howard: I think that psychology is off on the side because you can’t see or touch it, right? I think a lot of people believe that you’re predicting the future. So you say to somebody, look, if you lose your job, if you lose your spouse, if you are disconnected from your family, your children, you’re going to start making bad decisions. So it’s important that you make sure that you keep your job, that you have a good relationship with your family, your spouse, etc., so that you can protect yourself from that. People look at you and say, no, you’re trying to tell me that in six months from now I’m going to have a bad life based on the and I’m like, yeah, yes, I am telling you that. But people are like, nah, life is long. There’s so many things that can happen. And I truly believe, I truly believe that if people understood how these things are interconnected from and I think we are getting there, you know, as much as we make fun of millennials as a society, they really are the first generation that understands that if you like your job, you have a higher quality of life. And that’s amazing because I grew up in a family where the main breadwinner did not like his job. It was not good for him psychologically. It was not good for him physically. And he was an angry, angry, angry man. And then one day he retired and his personality changed completely. He’s a completely different guy.

Dr. Steven C. Hayes: Wow.

Gabe Howard: I wish more people understood that because I think that they would have a better life. And if people were having better lives, society would be better. It’s desperation that causes a lot of our problems. And to tie this back to the theme of our show, can ACT help people understand that and move in the direction of having those interconnected things?

Dr. Steven C. Hayes: Well, I think that it can, because it orients you towards your own experience and my guess is, is that your dad,

Gabe Howard: Yes,

Dr. Steven C. Hayes: Was it him?

Gabe Howard: Yep.

Dr. Steven C. Hayes: You know, kind of knew it, but he didn’t see a way to use that knowledge. And so he kind of tried not to know it so they could slog through. You know, if we can empower folks to be able to take advantage of the wisdom within to fit it into the what we know about how to prosper psychologically and then create a world that’s a little softer, more compassionate, more values focused. Where people can be lifted up psychologically. I think a lot of folks have not thought they should look to psychology for that. That, you know, psychology is for, quote, crazy people, unquote, or something like that. That was so much in the culture, certainly of those in my father’s time, my mom’s time. And they both suffered psychologically enormously. Their main help was from the priest. They didn’t know about therapists until way late in life, and they benefited greatly when they finally did get in therapy, but it didn’t occur to them. And so I think we’ve gone beyond that. I think the stigma part has fallen away. And we need now to really focus on how to take the best of what science gives us and the best of what your own experience gives you and put that together. I think we’re used to thinking that our physical health is in part up to us. That message has gotten through. Not always in behavior, because people are

Gabe Howard: [Laughter]

Dr. Steven C. Hayes: Feeling guilty about not exercising rather than exercising. And there you really do need the psychology there. There we are at behavior again, there we are. Everything that involves human beings involves psychology and behavior. So you really want those skills that allow you to use our knowledge about how to succeed in other ways, physically or a business or investing or in kinds of cultural changes that we all know that we need to make with the kind of things we see on the television screen. So we’ve got a lot of work to do.

Gabe Howard: Absolutely, absolutely.

Dr. Steven C. Hayes: We need empowered human beings to do that.

Gabe Howard: I could not agree more. Dr. Hayes, where can people find you and ACT on the Internet?

Dr. Steven C. Hayes: Well, if they’re interested in getting my newsletter, whatever, they can go to StevenCHayes.com and click on Yes, please send it to me. I’ll send them a little seven item mini course on ACT. Steven with a “v,” middle initial “C,” Hayes, H A Y E S. And I have a couple of popular trade books. The recent one is called A Liberated Mind, which walks you through that 40 year journey, including my personal journey, my own panic disorder and how it happened and how we develop this underlying knowledge of how the mind works and the basic science of what language is and cognition is. And if there’s something in here that seems of interest to folks, you can easily get out on the Web and find lots of things to look at and sort of explore a little more and there’s many, many, many people out there. The community is there. Very inexpensive ways of seeing whether or not this is for you.

Gabe Howard: Oh, that’s very cool, Dr. Hayes, thank you for being on the show.

Dr. Steven C. Hayes: It was awesome. Thank you for the conversation, for the opportunity.

Gabe Howard: And to all of our listeners, we literally can’t do the show without all of you, wherever you downloaded this podcast, please subscribe. Also share us on social media. Rank and review us. Use your words and tell people why they should listen as well. Hey, if you haven’t talked to your mom or dad in a while, shoot them an email, tell them about the show. Say hi. My name is Gabe Howard and I am the author of Mental Illness Is an Asshole, which is available on Amazon.com. Or you can get signed copies for less money and I’ll throw in some swag over at gabehoward.com. We’ll see everybody next Thursday.

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