Acceptance and Commitment Therapy


Childhood Obesity News talked about the exciting discovery that certain kinds of therapeutic interventions can help with depression and anxiety, even if they are delivered largely or even solely via smartphone applications. The researchers mentioned one example, called ACT, which is a sub-species of cognitive behavioral therapy. The unabbreviated name is Acceptance and Commitment Therapy. It has been mentioned here before, as a successful treatment for Body Focused Repetitive Behaviors.

For a popular magazine, psychologist/psychoanalyst Deborah Serani provided a no-nonsense, nuts-and-bolts shorthand:

Accept your reactions and be present
Choose a valued direction
Take action.

Acceptance is just what it sounds like. Even when a person would rather tell herself, “This isn’t happening,” unfortunately, it usually is. The connection to mindfulness-based therapy is obvious. “Be here now” is a nudge to stop spiraling out, and turn back toward the good path. The good path is the one that takes you where you want to go, which is where the “C” comes in. That’s the valued direction, and it’s yours to choose. And then, you act.

Rather than attempt a makeover from the ground up, which could take years, ACT plays to a person’s strengths which are already present and developed. Commitment is key, and ACT helps with how to cope when commitment falters.

For some folks the idea of entertaining a feeling or a thought, without immediately acting on it, is a brand-new concept. For others, the notion that they do not have to do everything perfectly all the time is a revelation. For many, the thought of managing an experience rather than avoiding it is quite novel.

To defuse a bomb is to disarm it, and render it harmless. A person can learn to do the same thing with an unwanted emotional response. Again, this is not avoidance, but the technique of turning a provocative negative stimulus into an ineffectual nuisance.

There are all kinds of tricks: Turn the troublesome thought into a song, or distill it to a single word and then repeat that word until it seems ridiculous; perceive the negative thought as an object with a color and shape. Meryl Davids Landau describes a typical coping mechanism:

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.”

It’s actually easier to face your demons than to fight them. As the old saying goes, “Resistance causes persistence.”

The role of the human therapist is to help identify the purpose that depression, for instance, serves in a person’s life, and what brings it on; and to aid in devising a treatment plan congruent with the patient’s needs. The therapist inquires about what has been tried so far, and how it worked.

This is why the identification of values is an important component, because the mere impetus to escape the present situation is not enough. There needs to be a vision of the desired state. To paraphrase Randy Pausch’s famous quote, you don’t get to choose the cards you’ve been dealt — you only get to choose how you play them.

Your responses and feedback are welcome!

Source: “An Introduction to Acceptance and Commitment Therapy,”, 02/22/11
Source: “ACT Is a Little-Known, Fast Treatment for Depression,”, 09/18/17
Source: “ACT With Depression & Chronic Suicidality,”
Photo credit: sagesolar on Visualhunt/CC BY

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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