The Use of Acceptance and Commitment Therapy in Treating SAD

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Acceptance and commitment therapy (ACT) is a type of psychotherapy that can be used in the treatment of social anxiety disorder (SAD). ACT was developed in 1980s by psychology professor Steven Hayes. It is part of the third wave of behavioral therapies, following on the heels of second-wave therapies such as cognitive-behavioral therapy (CBT).

ACT was developed along with a research program known as relational frame theory. Acceptance and commitment therapy also shares many of the values of Buddhist philosophy. The goal of ACT is the acceptance of negative thoughts instead of the elimination or reduction of them. 

Although CBT is an effective form of therapy for social anxiety disorder (SAD), not everyone responds to CBT. Acceptance and commitment therapy shows promise for use with SAD and can be used in brief or long-term individual, couples or group therapy.

If you are going to be receiving ACT for SAD, it is important to understand how this type of therapy is different from more traditional behavioral treatments. Knowing what to expect will make it easier for you to get the most out of acceptance and commitment therapy.

What Is Acceptance and Commitment Therapy?

Acceptance and commitment therapy is different from traditional western therapy treatments in that there is no focus on symptom reduction. In fact, attempts to get rid of "symptoms" can actually create problems.

Instead, ACT theorists argue that your normal everyday thoughts and beliefs can become destructive.

In addition, according to acceptance and commitment therapy, language is at the root of human suffering. This is because it is the basis for negative thoughts and emotions such as deception, prejudice, obsession, fear, and self-criticism.

The Goal

The goal of acceptance and commitment therapy is not to totally get rid of your social anxiety symptoms. In fact, according to ACT, trying to directly control or lessen your symptoms will actually make them worse.

While receiving acceptance and commitment therapy, you will be encouraged to enjoy a meaningful life, accept that there will always be pain and suffering and that you should detach from it and take action based on your values. It is expected that your symptoms will become less as a by-product of ACT therapy.

Tools Used in Therapy

Your ACT therapist will use metaphors to convey messages to you during therapy. Therapy usually involves experiential exercises (in which you will take an active part), values-guided behavioral interventions (learning about what you value in life), and mindfulness skills training (becoming aware of the present moment).

Principles of Acceptance and Commitment Therapy

There are six core principles of acceptance and commitment therapy. Below is an explanation of these principles and how they apply to the treatment of social anxiety disorder.

Cognitive Defusion

Cognitive defusion involves separating yourself from unpleasant "private experiences" such as thoughts, feelings, images, memories, urges, and sensations.

You will always have these experiences, but the goal of ACT is to reduce the influence that they have on you.

While your natural reaction will be to struggle against unpleasant experiences, doing so only makes them worse.

Your therapist may point out how struggling against negative thoughts is like trying to climb out of quicksand. The harder you try, the worse you make your situation. Using metaphors to explain experiences is one of the tools that your acceptance and commitment therapist will use.

In the case of SAD, your therapist may point out the emotional control strategies that you have used in the past that have actually increased your anxiety, such as avoidance, drinking alcohol or attempts at relaxation.

Your therapist wants you to understand that trying to control your anxiety is part of the problem instead of the solution.

There are many potential strategies that your therapist may introduce to help you achieve cognitive defusion. Below are some possibilities:

  • If you typically have thoughts such as "I have nothing to say," or "Everyone thinks I am boring," your therapist will ask you to add the words "I am having the thought that..." to the beginning of these sentences.
  • The new sentences "I am having the thought that I have nothing to say" and "I am having the thought that everyone thinks I am boring" give you some distance and reduces the impact of your thoughts so that you can see them as just words.
  • Your therapist may ask you to imagine that your thoughts, feelings, and images as soldiers in a parade, passing by, but having little impact on you.
  • Your therapist might ask you to imagine that your thoughts are words on a karaoke screen with a ball bouncing beneath them. The thought, "I am a loser" has less impact when accompanied by a bouncing ball.


Acceptance means allowing your unpleasant internal experiences to come and go without trying to control them. Doing so will make them seem less threatening and will reduce their impact on your life.

Your therapist will ask you to accept unwanted experiences that are out of your control rather than struggle against them. When talking about acceptance, your therapist may use the terms "clean discomfort" and "dirty discomfort."

In the case of social anxiety disorder, clean discomfort refers to normal feelings of anxiety in social and performance situations. Dirty discomfort refers to secondary emotions such as your anxious reaction to your own anxiety.

To help you with acceptance, your therapist may ask you to imagine that there is a switch in the back of your brain. When that switch is turned "ON," you will struggle against unpleasant private experiences, making them worse.

For example, at the first sign of social anxiety, you may become angry, sad and anxious about your anxiety. These secondary emotions set up a vicious cycle of social anxiety. Your therapist will ask you to turn the switch "OFF" and notice how the secondary emotions disappear.

Contact With the Present Moment

Mindfulness refers to living in the here and now. Your therapist will ask you to practice engaging in the present moment instead of becoming lost in your own thoughts.

In the case of social anxiety, mindfulness can help you to be present in social situations and experience them to the fullest extent.

The Observing Self

Your therapist will ask you to notice that you can observe yourself thinking. You are in control of your thoughts; they are not dangerous or threatening.


Your therapist will help you to identify what you stand for, what is important to you and what has meaning in your life.

If you suffer from SAD, these might include values such as building relationships or being genuine with others.

Committed Action

Your therapist will ask you to commit yourself to action that is in line with your values, even if it causes you some distress.

For example, someone with social anxiety disorder may set a goal to get together with a friend once a week and share something personal about themselves.

Committed action involves settings goals based on your values and taking steps to achieve them.

Many of the strategies introduced by your therapist will have the secondary effect of reducing your symptoms of social anxiety. Being fully present in social situations is a form of exposure therapy and over time will reduce your anxiety. Taking action despite anxiety is another form of exposure therapy.

How ACT Differs From CBT

The strategies used by an ACT therapist differ from those used by a CBT therapist. In addition, there may be some differences in emphasis in your relationship with the therapist.

A CBT therapist may be more likely to take on a teacher-like role, whereas an ACT therapist may see themselves more in the role of a guide. Your therapist might explain it to you using this metaphor:

"I do not have it all figured out. It is like you are on a mountain, and so am I, and I just happen to have a vantage point that I can see obstacles in your path that you can't see. All I want to do is to help make the path easier for you."

Both ACT and CBT involve awareness of your thoughts. However, the goal of acceptance and commitment therapy is the acceptance of negative thoughts while the goal of CBT is the reduction or elimination of negative thoughts.

For example, while a CBT therapist will argue that negative thoughts cause your social anxiety, an ACT therapist will argue that it is your struggle against negative thoughts which creates your social anxiety.

Research Support for the Use of ACT in Treating SAD

Although there is a large amount of empirical data to support acceptance and commitment therapy for various disorders, research into the use of ACT for SAD is in its infancy.

In a 2002 study of public speaking anxiety in college students, participants displayed improvement in social anxiety symptoms and a reduction in avoidance after receiving ACT. In a 2005 pilot study of ACT treatment with individuals diagnosed with generalized SAD, study participants showed improvement in social anxiety symptoms, social skills, and quality of life, and decreased avoidance.

In a 2013 study of mindfulness and acceptance-based group therapy compared with traditional cognitive-behavioral group therapy, it was shown that mindfulness may be the most important aspect of ACT therapy in terms of changing your social anxiety disorder symptoms, whereas with CBT, changing your thought processes may be most important.

Finally, another 2013 study confirmed that having a commitment to a purpose in life helped to relieve social anxiety. As this is one of the basic tenants of ACT, this lends support for this type of therapy.

Overall, if you are the type of person who prefers meditative practice to examine and changing your thought processes, acceptance and commitment therapy may be suited to you.

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By Arlin Cuncic, MA
Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." She has a Master's degree in psychology.