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mental health

ACT Is a Little-Known, Fast Treatment for Depression

Some psychologists believe that accepting your negative thoughts can help them pass faster.

Meryl Davids Landau

Nabi Tang / Stocksy

Scott Stambach felt consumed by anxiety, sometimes to the point of gasping for breath, whenever he had to speak in public—an especially big problem for a guy who was training to be a teacher. Fighting his fears, which would emerge even days before he had to give a lecture, only made things worse. Then he stumbled on a book advocating a more chill approach: watching and accepting his demons rather than trying to destroy them.

"The notion that I could stop the war I was having with myself gave me a tremendous sense of relief," Stambach, now a 37-year-old high school and community college teacher in San Diego, tells me. "You can make space for that fear, even love it. This has changed my life."

The method Stambach discovered is called acceptance and commitment therapy, or ACT. Although ACT was developed in the 1980s, only in recent years have enough studies been completed to give it broader street cred. Research has now shown ACT to be effective for treating anxiety, depression, chronic pain, and addiction, among other conditions, although many of the studies are small.

ACT is a form of cognitive behavioral therapy (CBT). But while in classic CBT, a therapist will encourage you to challenge and try to change your negative or irrational thoughts, ACT wants you to be more mindful and accepting of them. One review article published in Psychotherapy and Psychomatics in 2015 compared the two methods, concluding that ACT seems to be more effective for treating several mental health conditions, although the authors also say that larger studies are needed.

"When you meditate, you let your thoughts pass by like a cloud in the sky, noticing them rather than pushing them away. ACT is based on this idea," explains Steven C. Hayes, a professor of psychology at the University of Nevada, and a founder of the method. What's key here, he says, isn't cleaning up your thoughts, "it's changing your relationship to the world within yourself." Determining what's important to you (i.e., your values) is another part of the therapy. "Once you stop fighting your thoughts, it's important for you to ask yourself what kind of life you want to live," says Hayes, who wrote the seminal book on ACT, Get Out of Your Mind and Into Your Life, in 2005.

The ways you get to that detached, or in ACT-speak, "defused" state, where you see those thoughts simply as flickers in your brain waves, can seem weird at first: You can sing the thought, a technique Stambach favored ("I'm gonna panic in front of everyone," he would croon, which made it seem less serious); distill it down to a single word and repeat it rapid-fire for 30 seconds ("faint, faint, faint, faint"); describe it as a color and shape ("my craving is red and circular, with jagged edges"); or use conscious language to separate yourself from the emotion. One woman who discovered ACT in a recovery program for her eating disorder found it helpful to say, "I'm noticing that I'm having the thought that I'm feeling anxious," which made it less overwhelming than her prior lament, "I'm anxious."

Separating the issue from the emotion can change your entire experience of it, says Megan Call, a clinical psychologist who uses ACT with clients at the University of Utah health center. An elite runner might experience the same pain after a long run as someone with a physical disability, she observes, but the runner doesn't believe the pain will limit him, and the person with the disability doesn't have to, either. "There's a difference between thinking, 'I can't handle this situation,' and 'I'm having the thought that I can't handle this,'" Call observes. The latter might lead you to realize that, indeed, you can.

In a YouTube from a 2014 TedX talk viewed more than 2 million times, addiction and cancer researcher Jonathan Bricker, affiliate associate professor of psychology at the University of Washington, describes how he's come to see that ACT is more effective for controlling cravings like junk food or cigarettes than the typical approach of trying to gin up willpower. You can't win a tug-of-war with a craving monster, he says in the talk, because eventually the monster will win and you will give in. ACT encourages you to drop the rope. "If you just allow the monster to occupy a space in your body, you discover [he] is not as threatening as he appears. And sometimes he even goes away," Bricker observes.

Of course, the method does have its critics. Some researchers believe the evidence isn't yet strong enough to abandon long-used treatments, especially for complex conditions like obsessive compulsive disorder. Others note that you have to remember to use the tools in your daily life, which can be challenging since the techniques are hardly intuitive. One depressed man admits that, over time, he forgot to "defuse" his thoughts, leading to a return of his depression.

The good thing about ACT is that, like CBT, it is thought to be effective after just a handful of sessions, not the years of visits that some psychology methods require. If your insurance includes mental health, ACT sessions should be covered. You can find a therapist in your area on the websites of Psychology Today or the Association for Contextual Behavioral Science. Research has shown you can also benefit from working with a therapist online or using workbooks, like Stambach did.

In the years since he discovered that book, Stambach admits he still sometimes feels nervous when standing before a group. But now he knows he doesn't have to take those fears so seriously. "Before, my mind treated anxious thoughts as the gospel. Now I have a much more playful relationship with them," he says.

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