- Acceptance and Commitment Therapy (ACT)
- Mindfulness-based Cognitive Therapy (MBCT)
- Integrative Behavioral Couple Therapy (IBCT)
- Dialectical Behavior Therapy (DBT)
These are all examples of effective treatments for anxiety disorders that come under the umbrella term of Acceptance-Based Behavior Therapy (ABBT).
ABBTs are a type of behavior therapy. Like other behavior therapies, ABBTs conceptualize anxiety disorders as developing due to patterns of behavior that may decrease anxiety in the moment, but do not decrease, and may in fact increase, anxiety in the long run.
For example, let’s say that Timmy struggles with generalized anxiety disorder (GAD). A “stuck pattern” of behavior that Timmy may display may be judging himself for feeling anxiety, resulting in him trying to control his anxiety and doing all that he can to try and force it to go away when he is feeling anxious. Because forcing it to go away rarely works, Timmy judges himself more and feels more anxious because he can’t get the anxiety to go away. While this may work to decrease Timmy’s anxiety in the moment, it does not help Timmy deal with his anxiety in the long run. In fact, because Timmy is avoiding his anxiety, it continues to build and increase over time. To stop this cycle, behavior therapies aim to decrease avoidance and to change these problematic “stuck” patterns of behavior in order to decrease or manage anxiety disorders.
What is Unique About ABBTs?
ABBTs are differentiated from other behavior therapies in that they focus on three major goals: increasing awareness, increasing acceptance, and living a meaningful life worth living.
Imagine that you’re sitting on the beach, several feet away from the waves breaking on the shore. Several hours later, you realize that you are soaked and that the waves are breaking over you. Did the waves come out of nowhere and suddenly jump closer to you? Are you now stuck in the waves forever? Are you now helpless and unable to keep yourself out of the waves? Probably not. In fact, you can probably just move. However, to come to this conclusion, you must be aware of several things: that the water moves in with the tide, that high tide was approaching, that it is specifically the waves of the ocean that is getting you wet, that you can move away from the water without it following you around forever, and that you do not need to leave the beach completely in order to stop the waves from crashing onto you.
You can think of anxiety like these waves. Sometimes, when we feel anxious, we may feel as though our anxiety comes out of nowhere, that it will never end, that it consumes us, and that there is nothing we can do about our anxiety. However, when we’re able to take a step back from our anxiety, we’re able to notice that our anxiety is temporary, that it isn’t the case that “everything” is causing anxiety, and that there are things that we can do to manage our anxiety. ABBTs work toward this process of taking a step back by increasing an awareness of internal experiences. Here, awareness refers to more than just noticing your anxiety; it refers to noticing your anxiety building, noticing how your anxiety increases and decreases, noticing what increases or decreases that anxiety, and noticing the ways in which you are not your anxiety. By increasing our awareness, we are able to see that our anxiety is temporary, manageable, and not all-encompassing.
ABBTs also work to build an acceptance of one’s internal experiences, rather than an effort to avoid, change, or control them. Oftentimes, as anxiety grows, we tend to try and change or control our anxiety, willing it to go down or ignoring its occurrence. Going back to the beach example, let’s say that instead of moving, you refuse to accept that the tide is rising. Or maybe you try to change the fact that the tide is rising by mentally willing it to go down. What happens to your things? Have you successfully kept them from getting wet? Probably not. In fact, the longer you refuse to accept that the tide is rising, the more soaked your things get. Again, if we see the tide as our anxiety, we can see that trying to pretend or change something that we cannot change or ignore doesn’t solve the problem. In fact, ignoring the anxiety or trying to change it can make it worse.
Living a Life Worth Living
ABBTs also highlight the importance of living a life that is consistent with what is personally meaningful to individuals by helping individuals identify their values (what is personally meaningful to them) and encouraging them to take valued actions. Many individuals that struggle with anxiety disorders tend to avoid experiences that cause anxiety, leading to a narrowing of their lives. For example, if Sally is struggling with social anxiety disorder (SAD), and consequently avoids social events and gatherings, she may begin to feel more distant from friends and family, leading her to feel even worse. By identifying how individuals want to live their lives and encouraging them to take actions consistent with their values despite their anxiety, ABBTs aim to not get rid of anxiety, but to rather help individuals create and live fulfilling lives despite their anxiety.
What do ABBTs Look Like?
Like other behavioral therapies, ABBTs are often tailored to the needs of clients. However, there are two core techniques that most ABBTs use:
Mindfulness is the process of being aware of the present moment (including thoughts, feelings, and sensations) without judgment, but rather with acceptance and compassion. Mindfulness can take the form of formal mindfulness meditations (ex: observing the breath during breathing exercises, imagining your thoughts as clouds), informal mindfulness practices (ex: noticing the temperature, smell, and texture of soap while washing your hands), or self-monitoring thoughts, feelings, and behaviors (formally or informally), and help to increase the awareness and acceptance of internal and external experiences.
Values clarification is the process of identifying what is personally meaningful to you in several life domains such as friendships, family, work/education, health, and community. Unlike goals, values are not achievable, but rather act as personal compasses to guide us toward the lives that we want to be living. In therapy, values clarification may take the form of talking with your therapist and writing or journaling about what is personally meaningful to you. The following process of taking valued action may consist of identifying and taking actions that are consistent with your values. For example, if I value challenging myself in my work or education, I may choose to take the valued action of learning and implementing a new therapy technique.
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Carol S. Lee is a clinical psychology doctoral student at the University of Massachusetts Boston, with a background in psychology from the University of California San Diego. Her research with Dr. Sarah A. Hayes-Skelton focuses on understanding the effectiveness of anxiety disorder treatments, especially in the context of engaging in behavior despite fear or anxiety. Carol and Dr. Hayes-Skelton co-author articles for Anxiety.org, blending social and clinical psychology in their work.