Have you heard about the third wave in psychotherapy but don't know if it refers to a journey across the Atlantic Ocean, a set of new mysterious therapies, or the latest evidence-based scientific development in psychological science?

Let's start from the beginning. I won't discuss ALL third-wave therapies because they encompass a range of approaches beyond the scope of this article.

However, I want to share with you, in the most comprehensive and straightforward way possible, the approach I use with my patients, so that you know what Acceptance and Commitment Therapy (ACT) is, and why, together with Mindfulness-Based Cognitive Therapy (MBCT), it results in the best therapeutic approach.

What is Acceptance and Commitment Therapy?

Acceptance and Commitment Therapy (ACT, pronounced as a single word) is one of the new third-generation behavioral therapies. This "third wave" of behavioral therapies emerged in the United States between the 1980s and 1990s and are part of behavioral and cognitive models.

It is "third" because it differs from two previous similar movements, which were more focused on fighting automatic thoughts and replacing them with supposedly more adaptive ones.

In general, third-wave therapies place more emphasis on the dialogue and context of each person, working on acceptance and a non-judgmental attitude as a way to find well-being.

Specifically, ACT seeks a balance between (a) attention and acceptance processes and (b) commitment and behavior change processes in the service of greater psychological flexibility and engagement in valued activities (i.e., values).

As an approach, ACT is part of the CBT framework, focusing on pragmatism, evidence-based practice, and learning principles.

However, it also differs from CBT in many ways.

How does ACT differ from the traditional CBT approach?

Primarily, ACT sets different treatment goals: its aim is not to reduce symptoms as in conventional CBT but to reorient life in a more holistic way.

It is understood that what causes distress are not the situations themselves, but how we relate to them and what emotions we link to them.

And it's not about avoiding what hurts us – since that could have a rebound effect – but about learning to accept our internal experience. As a result, this reduces the intensity of symptoms.

ACT focuses on changing a person's relationship with their internal experiences, rather than focusing on modifying their presence, form, or intensity.

At its core, ACT arises from the idea that psychological pain and distress are inevitable facets of life and cannot be completely avoided or eliminated.

However, both our culture, in general, and the psychological community support active efforts to change, control, minimize, or avoid painful emotions or thoughts.

The message is as follows: "when you learn how to think better, feel better or differently, then your life will get better," so painful emotions or thoughts are seen as barriers to a well-lived life, and this supports direct efforts toward change.

ACT challenges this view by teaching how to live with the painful aspects of our history, with mental chatter, and unpleasant experiences, while at the same time, doing what is important to us.

We use metaphors, experiential exercises, and mindfulness and acceptance strategies to teach skills that allow you to think and feel whatever arises without judging it, acknowledge your history and what the situation allows, persisting in actions that align with your own values.

ACT Processes

ACT is based on a model that links six processes that contribute to psychological inflexibility and many forms of human suffering, with six intervention processes designed to increase psychological flexibility.

For each of these processes, ACT proposes an intervention goal. Let's look at each of these dimensions.

Fusion vs Defusion:

Cognitive fusion occurs when the process of thinking is confused with the actual products of thought. Fusion is neither inherently good nor bad: it allows us to become absorbed in a good book, a movie, or in love, but it can be problematic when it extends to the point of believing in the literalness of thoughts.

In ACT, the goal is to observe thoughts for what they are: words, images, bits of language, etc.

It's like saying, "I am having the thought of..." or "I am noticing such and such thought." This exercise allows us to distance ourselves from thoughts by noticing the difference between ourselves as observers of thinking activity and the activity of thinking itself.

Just as we can observe objects in our external world, defusion creates space to do the same with our inner world, understanding that we are not our thoughts, that the mind is always thinking – because that's what the mind does – and we don't necessarily have to believe or trust everything all our thoughts.

Experiential Avoidance vs Acceptance:

Just as we would try to avoid external sources of threat or danger, we often try to avoid internal experiences that are unpleasant to us. Experiential avoidance describes this tendency, along with the rigid or inflexible efforts we often make to achieve it.

But evidence highlights that these attempts require a lot of effort and often little actually changes the quality or form of internal experience.

Especially, it presents significant costs in terms of living a valuable life because, generally, when we move away from the painful aspects of our history, we also move away from the things that matter to us.

It seems that attempts to suppress or control unwanted thoughts or emotions provoke more – not less – unwanted thoughts and emotions.

"What you resist, persists," said Carl Jung.

Experiential acceptance, on the other hand, means recognizing and allowing our experience without judging it, treating ourselves kindly despite not being perfect, and not struggling against or fleeing from our internal states.

It is a powerful antidote to avoidance because it literally means "taking what is there as it is": staying in contact with painful experiences without trying to change ANYTHING. And yet, acting in accordance with personal values.

It is an active and very brave perspective and should not be confused with passive resignation or giving up.

Disconnection vs Contact with the Present Moment:

Feeling fused with their internal experiences, people often focus on the past or on an imagined future, which leads to more limited behavioral options: it is more likely that past, habitual, and ineffective behaviors dominate, and, moreover, contact with current circumstances that could provide better guidance decreases.

The present moment is the only place where we can act to make a difference in our lives, and that's why ACT teaches to intentionally pay attention to the moment we are in, with an open and non-judgmental mindset.

This way, we learn to counteract the tendency to avoid or withdraw, both from painful experiences and from circumstances or contexts that could be valuable.

Attachment vs Detachment with Conceptualized Self:

The conceptualized self has to do with the stories we tell ourselves about ourselves, and attachment to them is a form of extreme fusion that builds a wall to our Universe of Behavioral Possibilities.

The stories we tell ourselves about ourselves influence what we believe we can do (or not), and often what we do is aimed at somehow sustaining our personal narratives.

For example, whether we identify ourselves as victims, feel broken, incapable, or highly intelligent will have its effects on the decisions we make and what we do (or fail to do).

And letting go of this conceptualized self fundamentally consists of fostering a perspective of the self as an observer. We try to encourage the perception that the stories we tell ourselves are just that – stories – and they don't have to be believed or trusted 100%.

Confusion vs Clarity in Values:

In ACT, values are defined as directions for intentional action and can give new meaning and purpose to what we do. It's not about our beliefs or what is moral, but about domains that involve actions linked to what a good quality of life means for each individual.

In terms of goals, action guided by values is what patients and therapists work to achieve. Each person has their own values, but lack of clarity in them makes it difficult for us to choose how to act.

Many times we feel "stuck," on autopilot – in the service of immediate satisfaction – and not so much of living a life that is valuable to us. As we learn to let go of internal struggle, space opens up to think about what is truly valuable for our lives, with values as a guide to it.

Inaction vs Committed Action:

The tendency to be focused on avoiding painful experiences by feeling fused with unpleasant emotions and thoughts can lead to inaction, losing contact with what is important, committed action, and the present moment.

This domain refers to the commitment to act in relation to our values, which is different from the intention to act. 

In ACT, there are no middle terms: we can choose to do something or not. And in this sense, ACT promotes the use of concrete goals, which, unlike values, can be achieved.

In ACT, we work with metaphors, analogies, and practical exercises to convey certain key messages such as the idea that controlling internal experiences is not viable, thoughts do not control what we do, or that we can choose what is important for our lives.

We try to convey relevant psychological knowledge for each case, but in a different way than psychoeducation is usually done in the cognitive-behavioral tradition.

The main difference is that instead of conveying information purely logically, we use these indirect resources, which allows us to convey these messages in a more experiential and real way for the people on the other side.

What is Mindfulness?

Imagine I ask you what mindfulness is, could you explain it? We hear so much about this word, and in so many different contexts, that it's confusing to define and understand exactly what it refers to.

It comes up in conversations with friends; they tell you that someone close does it and it's going really well for them, there are articles in the media, posts on social networks, but you still don't quite understand what it's for or if it could help you.

Does Mindfulness have something to offer you?

I'll tell you right away: yes, Mindfulness can help you a lot in improving your quality of life.

And since I'm aware of the confusion surrounding this word, I'll explain it from the beginning, so later you can confidently answer what´s its meaning.

In 1979, Jon Kabat-Zinn founded the Center for Mindfulness at the University of Massachusetts and began developing his Mindfulness-Based Stress Reduction (MBSR) program.

Kabat-Zinn adapted certain knowledge and tools from psychology and Buddhist meditation to Western culture, which he coined under the term "Mindfulness," and defined it as follows:

"Mindfulness is a method for polishing and cleaning the impurities in our mentality and the darkness that we have accumulated throughout life."

There are times when your mind just doesn't stop, right? There should be a way, but your attempts just don't seem to work.

Through this cleaning Kabat-Zinn talks about, we can restore to the mind what are its inherent qualities according to Buddhism: clarity, well-being (peace and balance), and compassion.

Perhaps it's easier to understand what Mindfulness is by first examining its opposite: Mindlessness.

You know you're in a state of Mindlessness when:

- You throw away the credit of your card and keep the wrapper of your lunch in your bag.

- You don't remember if you locked the door when you left your house.

- You stumble over objects or break them because you're not really present in the space you're in.

- You're so focused on what's to come that you forget something you need to do right now.

- You don't realize I should have written "credit card" above instead of "the credit of you card."

- You eat or drink something without being hungry or thirsty.

- You feel like an emotion came "out of nowhere."

Mindlessness is the state of lack of awareness in which we operate on autopilot.

We're not really present, and instead, we rely too much on rigid rules that haven't been reflected upon.

That's why it easily leads to getting stuck, and your thoughts keep bombarding you.

On the other end of the spectrum, Mindfulness is what allows you to perceive your emotions and uncomfortable thoughts without getting caught up in them.

When you're fully aware of your anger, you can observe it with greater sensitivity, concentration, and emotional clarity, and you're likely to discover what causes it. You might even realize that behind that anger, there's sadness or fear, and you'll have more and better chances of dealing with it in an appropriate manner: assertively.

About Mindfulness.

1- Mindfulness is not dark or mystical, but quite the opposite: it's familiar to us because we already know it, it's an innate capacity that we gradually lose over the years.

2- It's also not something additional that we do or requires us to change who we are, because it simply recognizes and cultivates the best of what we already are.

3- Mindfulness has the potential to become a transformative social phenomenon because anyone can practice it, it's evidence-based, and it doesn't require large investments or technologies.

What is a formal Mindfulness practice?

It's what we recognize from those photos where we see a person in a stable posture, eyes closed, and appearing to have no thoughts (I assure you they have thousands, but perhaps they've learned to let them pass).

It's a time when you do nothing else but be in the present moment, without getting entangled in what happens; you bring your attention to different focal points, resting on your breath, on environmental sounds, bodily sensations, observing thoughts and moods without judging them.

Why not learn to be present when it's the only place we can truly be?

1- Bring attention to your experience:

You can start with just one minute, and increase the time as you feel comfortable. Sit comfortably, with a straight back, but make sure you're comfortable.

Close your eyes and let your palms face upward resting on your lap, and take two or three slow breaths, inhaling through your nose until your lungs are full, and exhaling gently.

Observe, with curiosity, how your body feels the weight on the surface you're on, the texture of the clothes on your skin, what bodily sensations you experience, the temperature of your breath, sounds, smells, etc.

2- Don't fight your thoughts:

It's not about clearing your mind or eliminating your thoughts, but quite the opposite: simply try to observe your thoughts as they are, without adding any judgment or evaluation. Notice how your thoughts come, and just as they come, let them go.

Don't struggle with them because you might end up getting frustrated, or believing that meditation isn't for you and that you're not good at it. It can be really challenging, but every time you try to control your thoughts, you end up amplifying them.

3- Also, observe your emotions:

It's also important to observe any emotions that may arise. You might feel anxious, sad, irritated, or happy. Become aware of your emotions at every moment without judging them, and without doing anything to change them. Simply observe what happens as if you were witnessing what's going on, as if you were watching a movie.

Four informal mindfulness practices:

Informal mindfulness practices are particular ways of approaching everyday life activities. It's about learning to live more consciously and less on "autopilot."

It's doing what we always do, but paying attention, with full awareness. And the simple act of paying attention brings the self out of the shadows, creates the space between thought and action that we need to be sure that we are acting from our will, rather than automatically.

1 - Start with breathing:

For one minute, focus on your breath. Start by inhaling and exhaling gently, inhaling for 4 counts and exhaling for 4 counts. Naturally, your mind will wander, that's what the mind does. Don't challenge yourself by telling yourself that you're not doing it right, just observe that fact, and let it be. Each time a thought pops into your head, notice it, and kindly refocus on your breath. That's all.

2 - Sharpen your sense of sight:

Choose an object from your surroundings (a cup, a book, your big toe), and concentrate on it for one minute. Look at it with total attention, as if you've just arrived on a new planet and it's the first object you've encountered. Try to identify its different aspects: texture, color, size, dimensions, or any movement it makes.

3 - Rework a routine:

Think of something you do every day and take for granted, like making yourself a coffee or brushing your teeth. The next time you do it, focus on each step of every action, on every element you see or hear related to it, on textures, smells, tastes. Do it fully consciously.

4 - Listen with your 100%:

Choose a song (for example, a classical or jazz piece) and really connect with it. If you can, use headphones, as if you were raised in a cave and this were the first musical piece you've heard upon emerging. Don't judge it, just try to identify different aspects of the rhythm, melody, and structure of the song. If you feel it, you can consciously move your body to the rhythm of the music.

Mindfulness allows you to observe the thinker that contains the thoughts, and this helps you to distance yourself from them, to gain perspective, and thus, to choose better.

What is the purpose of meditating? Benefits.

Regular meditation helps achieve a more serene and balanced mental state, improves concentration, and brings clarity to your perception. It also helps develop your communication skills and creativity; new abilities or talents may emerge, and it can even enhance your immunity and healing capacity against illnesses.

There are many physical benefits, but let's focus on some of the most relevant benefits for psychological well-being and personal development.

1- Mindfulness helps you manage stress and all its cousins: fear, anxiety, nervousness.

This is the most studied and validated benefit throughout the discipline, and I see it in my clinical practice myself: 8 out of 10 people who come to therapy do so for some issue related to anxiety.

2- It improves your cognitive ability and attention.

Mindfulness is primarily a training in your attention, as each time you realize your mind is wandering (which is what the mind does), your only task is to redirect your attention to where you choose. Therefore, mindfulness develops your ability to focus (and maintain) your attention, and it is widely used in education and in businesses.

Practicing mindfulness could prevent burnout, provide tools to overcome blocks, improve your perspective (which aids in making better decisions), increase your creativity (as your mind is more open and relaxed), enhance your concentration, memory, and overall performance.

3- Mindfulness develops psychological flexibility.

Flexibility is one of the most important aspects of intelligence in general, and of emotional intelligence in particular, as it allows you to increase your adaptability and tolerance to frustration. It is the best protection for your mental health: it helps prevent psychological problems from developing, and it prevents relapses and helps overcome emotional conflicts.

Your greatest enemy in mental health is rigidity. Mental rigidity prevents you from having perspective on things to make good decisions. And speaking from my own professional experience, most of the benefits of mindfulness stem precisely from working on psychological flexibility and increasing it.

4- Mindfulness gives you Emotional Management tools.

Practicing mindfulness is very effective for learning to regulate your emotions because you begin to become aware of when an emotion arises, to be able to detect it, see it clearly, and understand how it works, which helps you not get so caught up in them and respond consciously instead of reacting.

Over time, you learn to make better decisions, understand yourself better, and take better care of your relationship with yourself, preventing unnecessary conflicts, focusing your energy on what truly matters to you in life.

In conclusion, practicing mindfulness helps you focus your attention on all the pleasant things around you, allows you to suspend judgment, and approach your experience with warmth and kindness. That's why it connects you with life, with others, and with yourself, and it gives you tools to build Your Better Self.

Why working with ACT and Mindfulness is the best therapeutic approach?

Let's make it clear: I support my patients with all my care and knowledge, and primarily with two psychological tools:

Acceptance and Commitment Therapy (ACT), based on accepting and not judging – nor fighting against – thoughts and emotions that cause distress, and committing to act towards what matters to them.

Mindfulness-Based Cognitive Therapy (MBCT), which teaches techniques to develop Mindfulness, and learn to manage thoughts and emotions that arise automatically.

And every day, I see the effect of implementing these tools in their lives.

I also see the effect it had on my personal life because everything I share, I don't just do it theoretically, rather I practice it in my life every day, and have been doing so for many years. ACT, Mindfulness, and Emotional Management: these are the tools that changed my life.

And I see the same in my patients, in workshop attendees, or in my Meditators Community.

How do these changes present themselves?

By ceasing to add fuel to the fire, that is, by stopping the struggle against thoughts that generate anxiety, changes begin to be felt:

- Less stress, fear, and nervousness.

- Lighter body, as if you took off a backpack.

- Emotional discomfort decreases.

- Increased ability to gain perspective on situations.

- And improved ability to manage your own emotions.

In the end, your decisions start to be more functional, based on your values, because you learn to know yourself and listen to yourself, and thus, you also achieve better results.

Sometimes it can be strange to work with this type of approach because they invite you to see – through experiential exercises, metaphors, paradoxes, etc. – that what is socially or culturally accepted (trying to control your internal experience) is inherently problematic.

This attempt to control is not only NOT THE SOLUTION but also the cause of the problem.

In neurobiological terms, when working with ACT – and especially with Mindfulness-based techniques – the presence of cortisol decreases, which is the stress hormone, and the activity of the amygdala, a brain structure related to fear, also decreases.

- Your psychological flexibility increases.

- You control your impulses better.

- And you learn to be more emotionally intelligent.

Conclusions.

As the world and psychological science evolve, so do the opportunities to improve how we accompany human suffering.

The goal in ACT and Mindfulness is not to control your emotions or thoughts but to facilitate psychologically flexible responses.

Psychological flexibility involves being able to respond sensitively to the context, adjusting your actions as necessary to be consistent with what matters to you.

Self-awareness work is essential to internalize your values and discover what building Your Better Self means to you, understanding at the same time that the struggle against your internal experiences is what holds you back from achieving it.

Here you can learn more about how I work.

And if you would like to schedule a Clarity Session to get to know each other and see how we can work together, you can access my schedule here.

With love,

Katu.