Emily Sandoz, a psychologist in Louisiana, has witnessed clients’ grueling struggles during the pandemic. Many said they felt trapped and deprived of their usual ways of coping. Others began therapy for the first time after the pause in their busy lives forced some existential questions: “Do any of these things that I used to put all this energy into even matter? Does my job even matter? Do my relationships matter?”
Then, she said, her clients felt guilty.
“I know that this has been stressful for everyone, but . . .”
“I just feel like I should be able to handle this.”
“I know what I need to do, but I’m just not doing it.”
It’s natural to feel distress during such a harrowing time, Sandoz tells them, but even in the midst of inevitable pain and hardship, people can still live meaningful lives aligned with their highest values.
Sandoz provides a form of behavioral therapy called acceptance and commitment therapy, or ACT. Psychologists consider it a third-wave therapy after traditional behavior therapy and cognitive behavioral therapy. Infused with mindfulness concepts, ACT acknowledges that suffering is part of the human condition and guides people in becoming “psychologically flexible” to navigate life’s ups and downs and keep moving forward.
“Traditionally, most people think about psychological wellness in terms of the absence of something — the absence of a painful feeling, the absence of a painful memory,” said Sandoz, who is also a psychology professor at the University of Louisiana at Lafayette. When people struggle, they believe it’s abnormal, she said.
What is ACT?
ACT, pronounced like the word “act,” defines emotional health differently. “Psychological flexibility is really how we in ACT conceptualize psychological wellness,” Sandoz said. “What we mean by that is people being able to live their lives meaningfully and effectively, regardless of what they’re thinking or feeling, regardless of what memories are coming up, regardless of how they’re thinking of themselves, regardless of how much anxiety they may be experiencing or sadness or hopelessness.”
Steven C. Hayes, a psychology professor at the University of Nevada, originated ACT during the 1980s, but it still hasn’t fully entered the public consciousness. Research has shown that it can work to treat anxiety, depression, substance abuse, pain and other conditions. In one review of 36 randomized, controlled trials, ACT proved as effective as cognitive behavioral therapy in treating anxiety and depression, specifically by increasing psychological flexibility.
ACT diverges significantly from the rest of Western psychotherapy, which tends to label negative emotions as symptoms or problems to overcome. ACT teaches acceptance of negative feelings instead of trying to resist or wrestle with them.
While life has moments of joy, it’s unrealistic to expect happiness all the time, ACT experts say. Indeed, Americans’ love affair with the happiness myth — that we should constantly strive for positivity, productivity, success and a pleasurable life — started to feel hollow for many during the pandemic.
But people who feel unhappy or pressured can still take purposeful action, said Judy Ho, an associate professor of psychology at Pepperdine University in Southern California. “Even if that stress is intense, you don’t have to wait until things get better to do the things that are meaningful to you.”
Those with long-standing anxiety, depression, thoughts of self-harm or suicide, or other serious issues should consider working with a mental health professional who can lead them through ACT or provide other treatment, Ho said.
Tips on using ACT techniques
Many people can try using ACT approaches on their own, however. Three experts offered these tips:
Learn to accept all of your emotions.
Trying to control or suppress difficult emotions often doesn’t work and might even worsen distress in the long run, ACT experts say. ACT aims to help people accept (but not necessarily approve of) all of their emotions instead of avoiding or grappling with them.
That’s in contrast with cognitive behavioral therapy (CBT), which seeks to help people identify and change negative or inaccurate thinking. While CBT can be quite effective, it didn’t suit Jennifer Gregg, a psychology professor at San José State University who said that she uses ACT in her own life. “That’s how I manage my own tough moments,” she said.
“A lot of what traditional psychotherapy approaches do is try to help you see the distortions in your thought processes or the ways that you might be thinking yourself into a corner,” she said. “All of the logic I could bring to the way I was thinking really didn’t change what I was feeling that much, and it didn’t really help me think about what I wanted to do differently next.”
By defining what gives her life meaning, she can “move toward those things rather than spending all of my time trying to control my thoughts and feelings,” she said.
Avoiding one’s emotions also can be counterproductive and lead to misuse of alcohol or drugs, Ho said.
ACT doesn’t aim expressly to eliminate bad feelings, but to help people open up to all of their emotional experiences to live more effectively, Sandoz said.
“Most people who come to therapy want me to help them get rid of something: painful memories, hard thoughts, difficult feelings. But that is not what I do,” she said. Instead, she tells them: “We are going to intentionally look at and welcome in those difficult experiences. We’re going to talk about things that bring up painful memories. We’re going to talk about things that bring up those hard, existential questions. And when we do that, we’ll then be practicing being with that experience in a different way.”
Sandoz said she hopes that clients will move from a rigid, debilitating thought, for example, “I want to go to college, but I’m too anxious about it,” to a more expansive and psychologically flexible one: “I want to go to college, and I’m anxious about it.” With the latter, a person can more readily accept her anxiety and start taking concrete steps toward attending college.
Change your relationship with your negative thoughts.
Most people look at the world from their thoughts and believe that everything they think must be true, Ho said. ACT teaches people to look at their thoughts as a mental event. Thoughts don’t always reflect reality. Instead of telling oneself, “I’m worthless,” a person can say, “I’m having a thought that I’m worthless.”
What’s known as ‘mental reframing’ can help us with all kinds of physical and psychological challenges
That small linguistic cue can create some healthy distance.
“Those thoughts and feelings are not you,” Gregg said. “I can just notice that these are feelings and that they are separate from me. From that stance, I might be able to let them come in, let them be there without needing to solve or reduce them or make them go away.”
When people step back to observe a thought, the notion might simply pass on its own, leaving them less likely to be consumed by it, Ho said.
In contrast, when a person gets entangled in a negative thought, “it tends to dominate everything,” Sandoz said. “It’ll feel like I have to do something here. I have to make this anxiety go away, or I have to prove to this person how right I am.”
ACT therapists also speak of an “observing self,” which can sound abstract, but refers to an abiding, detached awareness that notices and watches events unfolding in one’s own life. Ho, who counsels clients using ACT, said, “The observing self is much like an audience watching a play, where they care about the story, but they’re not so attached to it. Yet they’re still engaged in that conversation.”
By taking time to observe what’s going on externally and internally (how one is thinking and feeling), people can decide how to proceed more thoughtfully, the experts say.
Clarify your values and take committed action toward a meaningful life.
ACT doesn’t aim to only increase psychological flexibility. It also emphasizes the pursuit of a meaningful life in accordance with one’s most cherished values, Ho said.
Choosing one’s values creates a north star to guide the journey. “Values clarification is about really connecting to who I want to be today,” Gregg said. “What matters to me? What difference do I want to make?”
People select values that give their lives inherent meaning. Those values might include creativity, compassion, faith, rewarding relationships, knowledge, mentoring and professional accomplishment, among many others.
Values must be connected to concrete goals that flow from them. “If you just think about your values, it can be a little stressful unless you tie it to really specific actions and things that you know how to do,” said Gregg, who has done research on ACT.
For starters, someone who prizes community can text a relative who isn’t doing well, Gregg said. A person who seeks knowledge can start reading a periodical that offers fresh perspectives.
The ultimate goal is to move toward “bigger or more extended patterns of action that we might call valued action or committed actions — these larger goals that are connected to very clear purposes,” Sandoz said.
Sandoz knows that it can be tough to pursue goals fully during the pandemic.
“Sometimes, the only action that we see is the biggest perfect behavior that we can engage in and that feels so far away and so overwhelming and it can be hard to get moving at all,” she said. “So I encourage people to start with the most simple needs,” including taking care of one’s physical needs.
“The world is different today,” Sandoz said. Sometimes, “the only thing that we can do is add to our learning. That’s what healing is.”
If people are struggling, Sandoz said, they can ask themselves: “‘Okay, the learning I’ve had so far didn’t prepare me for this. What new learning can I offer myself? What new experiences can I give myself?”
When people take steps despite their distress, they might start feeling better as a byproduct, Ho said.
During the pandemic, ACT therapists have seen clients move in novel directions. Some have questioned their former values, including career success. New values are trending, including spirituality, community, social justice and adventure.
There’s a greater sense of urgency, too, Sandoz said.
“Some people are recognizing values that maybe they’ve always had on the back burner,” she said. “It always felt like they’d get around to it at some point, and suddenly, it feels like, ‘Oh, this is right now. People are dying. If I want this to happen, I really need to acknowledge and admit this value now.’”
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