Interview with Triana Sanz: ’ACT is a new way of living’.

The psychologist Triana Sanz explains what Acceptance and Commitment Therapy (ACT) consists of.

As advances in psychology occur, new ways of formulating psychotherapeutic intervention tools emerge. This is what has happened with the shift from the cognitive-behavioral model to third generation therapies.

Among these new therapies, one of the most interesting is Acceptance and Commitment Therapy (ACT).. Let's see what it consists of from the testimony of an expert in the use of this kind of psychological intervention.

Interview with Triana Sanz: the keys to Acceptance and Commitment Therapy.

The psychologist Triana Sanz Font is General Health Psychologist and Director of Lua Psicología, a psychotherapy center located in Madrid.. Throughout this interview he explains what Acceptance and Commitment Therapy is and how it works, and the reasons why it is one of the most important resources in his work with patients.

What exactly does Acceptance and Commitment Therapy consist of, and what is its working philosophy?

Acceptance and Commitment Therapy or ACT, whose main author is Steven C. Hayes, is included within the so-called Third Generation Therapies, born from Cognitive-Behavioral Therapy.

It is based on a contextual work model, since instead of focusing on and wanting to change the content, intensity and frequency of thoughts and emotions, it focuses on the way in which each person relates to them, so that they do not control their behavior.

Suffering increases because the strategies and techniques we use to solve our problems are wrong and make us fall into our own trap. For this reason, ACT proposes a model that helps people to open up and become more aware of their emotions, thoughts, feelings and bodily sensations, allowing them to learn and attend with greater flexibility to what is inside them and what can be useful without feeling dominated by them.

This model of psychological flexibility is summarized in three concepts: openness, awareness and commitment. That is, openness to experience without trying to avoid what we find unpleasant, awareness of sensations, thoughts, feelings, emotions, memories, images, etc. in the here and now and commitment to carry out a behavior according to what you really want and commit to those patterns of behavior based on values.

Why did you decide to become an expert in this type of therapy?

Both in my career and in the subsequent training I have done, the basis has always been the Cognitive-Behavioral Therapy and, although it is true that it is a current of which we already know its enormous effectiveness in many psychological problems, it is lame and we need a new approach.

That new approach I found in ACT, since I began to soak up its foundations, its theoretical framework and its way of working, I realized the enormous potential it had, it raised something different but at the same time natural and consistent with the way we function and live our lives.

Wanting to free ourselves and fight against what makes us suffer is something very common to human beings. We avoid or try to control any thought, emotion, sensation or situation that generates discomfort and to get rid of them, the strategies we use are nothing more than traps that we set for ourselves and that increase our discomfort. We let ourselves be carried away by our thoughts and emotions, distancing ourselves from the life we really want to live.

It is not about avoiding, fighting, thinking positive, changing unpleasant thoughts or emotions for pleasant ones, it is about opening ourselves to the experience (both positive and negative), placing it in the context and not in the person (to generate distance) and from there, carrying out behaviors or actions (it is the only thing over which we really have control) that are important to us.

All this, so coherent, natural and so difficult to carry out, is why I decided to specialize in this type of therapy, not only as a way of working with my patients but as something that I have been incorporating into my personal life.

It is often said that the desire to make the symptoms of a disorder disappear makes patients become obsessed with that which causes them discomfort. Does Acceptance and Commitment Therapy help to avoid these dynamics?

Without any doubt, as I mentioned before, in order to try to get rid of what is causing us discomfort, we implement control strategies as an attempt at a solution, but the only thing we achieve is to increase the discomfort. That is to say, the solution becomes the problem, entering a vicious circle.

For example, we have skin eczema with its consequent itching (problem) and to solve it we scratch (solution), but in this case, the more we scratch, the worse, the itching and irritation increases (problem). The solution has become the problem.

ACT proposes to break this vicious circle by making us aware of the wrong strategies we use.

In your opinion as a psychologist, is acceptance a value to be claimed in the face of the imperfections of everyday life, beyond the cases in which there are diagnosable psychological disorders?

In life there is a part of Pain that is inevitable, we face situations, thoughts, sensations, emotions and attitudes that will generate discomfort. The problem comes when we offer resistance to that pain. We do not want to feel bad, we fight against that pain and the only thing we achieve is to increase our suffering. So what do we do, how do we deal with it?

Acceptance allows us to move forward, to move on and not get stuck in situations we cannot change. This attitude of focusing on the things we can do, makes us take an active and committed role in our life.

Let's take an example, I get fired from a job and my attitude or my coping strategies can go in two lines, one, cursing bosses and company for my dismissal, regretting my new situation and so on.

However, as I cannot change the situation (the layoff), the most appropriate thing to do would be to accept the situation, in order to move forward and dedicate my time and attention to what I can do and what I want to do. This does not mean that I avoid or repress thoughts and emotions derived from the dismissal, which is inevitable, but I can decide not to get trapped in the vicious circles we were talking about.

It is important to distinguish between acceptance and resignation. When we resign ourselves there is no progress, there is stagnation, there is rumination, there is a struggle against this discomfort. We end up thinking that we cannot do anything to change the situation, we adopt a passive role and our discomfort increases because we believe that we are not capable of getting out of the situation. We need to accept ourselves, with our thoughts, our emotions, our way of being... and, only then, we will be able to move forward.

Do you think Acceptance and Commitment Therapy combines well with other forms of psychotherapy?

We have said that ACT is a form of experiential, behavioral and cognitive psychotherapy and that as it belongs to the Third Generation Therapies, derived from Cognitive-Behavioral Therapy, it can be perfectly combined with it.

In addition, the fact of opening ourselves to experience, paying attention and being aware of our thoughts, emotions and feelings, is closely linked to mindfulness and the present moment, derived from Mindfulness. In general it combines well with the rest of Third Generation Therapies, because of the basic principles they share.

Surely many patients must learn to distinguish between what they must accept and what they must strive to change and improve. Is this process also worked on in therapy sessions?

When patients begin to learn about and incorporate acceptance as a way of coping with experiences related to emotional pain in their daily lives and commit themselves to carry out actions that are really useful and important, they are already changing and/or improving, they are learning to live with that situation in the best possible way. In other words, they try to find a balance between their personal wellbeing and what they have lived through.

Each one of us works on our acceptance process in order to move forward, change and stop suffering. For there to be a change, there must be prior acceptance.

For example, in a couple relationship, in many occasions we pretend that the other member of the couple changes instead of accepting him/her as he/she is, which can lead to friction, arguments, etc. Another situation is to accept that the continuity of the couple is not possible at that moment and, only then, from the acceptance, we will be more able to see reality and things with more tranquility, to be able to make decisions and carry out the changes we want.

By this, what I mean is that there may be a moment in our life when we decide that we do not want to continue living the way we are living. But this change refers to oneself, to the direction of one's life, not to a change on the outside.

What are the first signs that the therapeutic intervention is working? How do patients notice it?

What I have been observing in the patients is that, as they work on the basis of ACT, they discover a new way of relating to emotional pain and suffering that is different and, as I have already mentioned, at the same time easy and natural to incorporate into their lives.

The first signs come especially when they start to be able to defuse their thoughts (defusion is one of the 6 pillars of ACT), that is, they start to take distance from thoughts, to realize how their mind is working, not to be dragged by it and to see thoughts as what they are, words in their head.

Our mind is like a TV that is on 24 hours a day. We cannot turn it off, we cannot do anything to make our thoughts appear in our mind against our will.

However, we can decide whether we pay attention to it or not, whether we have the TV on in the background (our mind) not paying attention to it and doing what really matters to us, or whether we give it our full attention and let ourselves be swept away by its stories.

The second sign comes in another of the pillars of ACT that we have already talked about and that is acceptance.

I would tell you that the first signs come based on these two principles, cognitive defusion and acceptance, but the other 4 pillars of ACT (the observing self, present moment, values and committed action), are also present and influencing each other, because without an openness to experience, thanks to the attention to the present moment and to that observing self that allows us to separate ourselves from our thinking self, we would not be able to undertake committed actions according to our values.

This is why I consider ACT not only an effective therapy, but also a new way of living.