Application of Acceptance and Commitment Therapy in the Treatment of SAD

Acceptance and Commitment Therapy (ACT) is a psychotherapy that can be used to treat social anxiety disorder (SAD). ACT was developed by psychology professor Steven Hayes in the 1980s. It is part of the third wave of behavioral therapy following the second wave of cognitive behavioral therapy (CBT).

ACT was developed in conjunction with a research project called Relational Framework Theory. Acceptance and commitment therapy also has many Buddhist philosophical values. The goal of ACT is to accept negative thoughts, not to eliminate or reduce them.

Although CBT is an effective form of treatment for social anxiety disorder (SAD), not everyone responds to CBT. Acceptance and commitment therapy shows promise for SAD, which can be used for short-term or long-term individual, couple, or group treatment.

If you will receive ACT for SAD, it is important to understand how this treatment differs from more traditional behavioral treatments. Knowing what will happen will make it easier for you to get the most benefit from receiving and promising therapies.

What is acceptance and commitment therapy?

Acceptance and commitment therapy is different from traditional Western therapy because it does not focus on alleviating symptoms. In fact, trying to get rid of “symptoms” can actually cause problems.

On the contrary, ACT theorists believe that your daily normal thoughts and beliefs can be destructive.

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


The goal of receiving and committing therapy is not to completely get rid of your social anxiety symptoms. In fact, according to the ACT, trying to directly control or reduce your symptoms can actually make them worse.

While accepting acceptance and commitment therapy, you will be encouraged to enjoy a meaningful life, accept that pain and suffering will always exist, and you should get rid of it and act according to your values. As a by-product of ACT treatment, your symptoms are expected to decrease.

Tools used in treatment

Your ACT therapist will use metaphors to convey information to you during treatment. Treatment usually includes experiential exercises (you will actively participate in it), value-oriented behavioral interventions (understand your value in life), and mindfulness skills training (be aware of the present).

READ ALSO:  Treatment of Social Anxiety Disorder

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 can be applied to the treatment of social anxiety disorder.

Cognitive dissolution

Cognitive alienation involves separating oneself from unpleasant “private experiences” such as thoughts, feelings, images, memories, impulses, and feelings.

You will always have these experiences, but the goal of ACT is to reduce their impact on you.

Although your natural reaction is to fight unpleasant experiences, doing so will only make them worse.

Your therapist may point out that fighting negative thoughts is like trying to crawl out of quicksand. The harder you work, the worse your situation becomes. Using metaphors to explain the experience is one of the tools you accept and promise that the therapist will use.

With SAD, your therapist may point out that emotion control strategies you used in the past have actually increased your anxiety, such as avoidance, drinking, or trying to relax.

Your therapist wants you to understand that trying to control your anxiety is part of the problem, not the solution.

Your therapist may introduce many potential strategies to help you achieve cognitive dissociation. Here are some possibilities:

  • If you usually have thoughts such as “I have nothing to say” or “Everyone thinks I am boring”, your therapist will ask you to add “I have this idea…” at the beginning of these sentences .
  • The new sentences “I think I have nothing to say” and “I think everyone thinks I am bored” will give you some distance and reduce the influence of your thoughts so that you can treat them as words.
  • Your therapist may ask you to imagine that your thoughts, feelings, and images are soldiers in the parade passing by, but they have little effect on you.
  • Your therapist may ask you to imagine that your idea is text on a karaoke screen with a ball bouncing below it. With the bouncing ball, the idea of ​​”I am a loser” has less impact.


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

Your therapist will ask you to accept unwanted experiences that you cannot control, rather than fight against them. When talking about acceptance, your therapist may use the terms “clean discomfort” and “dirty discomfort”.

READ ALSO:  Coping with the anxiety of office gatherings

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

To help you accept, your therapist may ask you to imagine a switch in the back of your brain. When the switch is turned on, you will fight unpleasant personal experiences to make them worse.

For example, at the first sign of social anxiety, you may feel angry, sad, and anxious about your anxiety. These secondary emotions form a vicious circle of social anxiety. Your therapist will ask you to turn the switch “off” and pay attention to how the secondary emotions disappear.

Contact the present

Mindfulness means living in the here and now. Your therapist will ask you to practice blending into the moment instead of getting lost in your own thoughts.

In situations of social anxiety, mindfulness can help you show up in social situations and experience them to the fullest.

Observe yourself

Your therapist will ask you to pay attention to your thoughts that you can observe yourself. You can control your thoughts; they are not dangerous or threatening.


Your therapist will help you determine where you stand, what is important to you, and what is meaningful to your life.

If you have SAD, these may include values ​​such as building relationships with others or treating them sincerely.

Promised action

Your therapist will ask you to commit to actions that are consistent with your values, even if it makes you feel painful.

For example, a person with social anxiety disorder may set a goal to meet with friends once a week to share some personal information about themselves.

Commitment actions include setting goals based on your values ​​and taking steps to achieve those goals.

Many of the strategies introduced by your therapist will have the secondary effect of reducing the symptoms of social anxiety. Being completely in social situations is an exposure therapy that will reduce your anxiety over time. Acting in spite of anxiety is another form of exposure therapy.

What is the difference between ACT and CBT

The strategies used by ACT therapists are different from those used by CBT therapists. In addition, your relationship with the therapist may have some differences in focus.

READ ALSO:  Aggressive communication and social anxiety disorder

CBT therapists may be more likely to play a teacher-like role, while ACT therapists may see themselves more as guides. Your therapist might use this metaphor to explain to you:

“I haven’t figured it out yet. Just like you are on the mountain, so do I. I happen to have a vantage point where I can see obstacles that you can’t see. All I want to do is to help make your path easier.”

Both ACT and CBT involve understanding your ideas. However, the goal of acceptance and commitment therapy is to accept negative thoughts, while the goal of CBT is to reduce or eliminate negative thoughts.

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

Research support for the use of ACT to treat SAD

Although there is a large amount of empirical data to support the acceptance and commitment of treatments for various diseases, research on the use of ACT to treat SAD is still in its infancy.

In a 2002 study on public speaking anxiety among college students, participants showed improvement in social anxiety symptoms and a decrease in avoidance after receiving ACT. In a 2005 pilot study of ACT treatment for individuals diagnosed with widespread SAD, study participants showed improvements in social anxiety symptoms, social skills, and quality of life, and reduced avoidance.

A 2013 study on the comparison of mindfulness and acceptance-based group therapy with traditional cognitive behavioral group therapy showed that in terms of changing the symptoms of social anxiety disorder, mindfulness may be the most important aspect of ACT therapy, and the use of CBT changes Your thought process may be the most important.

Finally, another 2013 study confirmed that making a commitment to life goals can help alleviate social anxiety. Since this is one of the basic tenants of ACT, this provides support for this type of treatment.

In general, if you are the kind of person who likes to examine and change your thought process through meditation practice, acceptance and commitment therapy may be for you.