ACT intends to make symptoms go away!

Although not customary, this post is a rant (good lord!). Too often, and even from ACT practitioners and researchers alike, it is stated that ACT “does not intend to make symptoms go away”. It is wrong.

If this statement were correct, logically then, it would be necessary to remove ACT from its status as a psychotherapy. How could we state that ACT is a psychotherapy if our goal wasn’t to make symptoms go away, or at least decrease them? This would thus be impossible…

However this statement is totally false! ACT absolutely intends to make symptoms go away!

This mistake originates from the definition of psychological disorders proposed by the categorical approach (DSM or ICD). One of the problems is that this approach presents itself as unique and exhaustive. Consequently, disorders would be defined by the symptoms brought together by these classifications and by nothing else. Hence, if a symptom doesn’t make the list, it is as if it is not to be viewed as a problem and does not warrant treatment. On the other hand, all that which is on the list is considered a symptom, seen to be a problem and a reflection of an illness. As a result, all forms of psychotherapy that judge that the real psychological problems aren’t those described by the categorical approach will be considered as if they “do not intend to alleviate symptoms”.

The problem is that these “symptoms” described within the categorical approach appear to be less and less… symptomatic. Indeed, these “symptoms” are often found outside of any need for psychotherapeutic support. It is for example the case for experiences such as depression or anxiety. It is even the case for psychological experiences that might seem more “pathological” such as hearing voices. And yet, even such extreme experiences as these are quite common in the general population. The fact that these experiences don’t concern the entire world does not necessarily indicate that they are indeed symptomatic of an underlying disease. These facts cast serious doubt on the qualifications of symptoms for all the signs listed by the categorical approach.

Let us return to ACT. It is based on the premise that psychological suffering is intrinsic to the human experience, or more precisely put, that suffering emerges from the capacity to speak. From an ACT standpoint, our ability to respond on the basis of arbitrary relations between stimuli -the RFT definition of language- is what produces such suffering. In short, as soon as we speak, we are condemned to feelings of sadness, anger, anxiety, jealousy, and other “lovely” emotions, because we have the capacity to regret, compare, anticipate, judge and create connections between events that before had no relationship… The experience of these emotions is so widespread that ACT does not consider them to be symptomatic. It is suffering, for sure, but does not imply the presence of any illness. And, in anticipation of your questions: yes, regardless of the intensity of said emotions.

What is considered symptomatic in ACT is to consistently react the same way to one’s emotional experiences, thoughts or sensations, what is called loss of psychological flexibility. In fact, when we are practically spending our time exclusively trying to control the psychological experiences that we do not wish to have, we have less and less time and energy to behave in a way which is important for us -what we call values-directed behaviors in ACT. These two combined— loss of psychological flexibility and lack of values-directed behaviors constitute the real symptoms according to ACT. On the other hand, from the ACT viewpoint, the symptoms described by the categorical approach aren’t really symptoms. They are either attempts to avoid/escape emotional experiences (e. g. excessive alcohol consumption, suicide attempts, etc..), or ironic results of focusing on emotions with the goal of controlling them (e. g. panic attacks, depression, etc.), or even widespread psychological experiences that aren’t problematic in-and-of-themselves but become a problem if we place all our energy in getting rid of them (e. g. mood disorders, anxiety, hallucinations, tinnitus, etc.). From an ACT standpoint, these behaviors are problematic because of their repetitive and unworkable nature, and consequently because they steal time and energy for values-oriented behaviors.

ACT therapeutic objectives is to help one recover their psychological flexibility, which means to choose one’s actions when faced with their emotions, their thoughts, their sensations (and no, not choose their emotions, thoughts, and sensations, or their intensity)-, and to no longer be constrained by these psychological events, in order to finally create a fulfilling life that moves in the direction that matters to them. This is the promise and the therapeutic proposition of ACT. It is upon these bases that its effectiveness must be evaluated.

Things are therefore clear: ACT proposes different symptoms to define psychological issues— loss of psychological flexibility and lack of values-oriented behaviors. ACT attempts to make these symptoms go away as much as possible. It does not attempt to make categorically qualified symptoms disappear (whose reality as symptoms of disease still have yet to be demonstrated).

Thank you for spreading the word and for no longer allowing our community or others to say or write that ACT is not interested in trying to make symptoms go away! Furthermore, if someone would like to continue to make these statements, they should complete the phrase such as “ACT isn’t interested in making that which the DSM or ICD call symptoms go away!”

Translated by Chelsea Davis-Laurin

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