Utilizing Acceptance Commitment Therapy as a framework for dialogue.

Patients sit in my office every day telling me about their frustrations about their lives and their seeming inability to change things. There is a lot of hopelessness because there is a sense of being trapped with no way out because they “have tried everything.”


Joseph Troncale, M.D. FASAM, has been working in addiction medicine for 20 years. He is the Medical Director of the Retreat.

Editor:  Saad Shaheed


One of the things that seems to help people who are “stuck” in this way comes from Russ Harris and Steven Hayes and their writings on Acceptance Commitment Therapy (ACT). I have found that ACT gives me a framework for the beginnings of a dialogue of hope. With few exceptions, people generally know what they value in life. Their goal of realizing their values is frustrated by many factors, but chief among them is an inability to, as Russ Harris says, maintain “psychological flexibility.” It is difficult for people to stay in the present, be in touch with their feelings and accept them, and to move toward their values rather than suffer in silence.

One of the exercises that I learned from ACT literature that is so helpful for me to talk with patients about is having them determine the things that are important to them in their life and list them. Then we look at how close their real life actually correlates with what they profess to value. Generally, there are many areas of their life that are not moving toward their values.

If the patient agrees that this is the case, and most of the time it is self-evident, then we begin to look at a few very concrete behaviors that, if changed in their life, would change the course of what they are currently doing to steer them toward what they truly what they say they want from life but are not doing.

With patients with addiction, it is a given that part of their behaviors includes doing what they need to do to remain sober, but in addition, we discuss specific “little” things that move them toward the values they profess. Examples of this include things which some people might take for granted, such as following a schedule for meals, having daily conversations with a significant other or children, staying connected to friends or relatives on a regular basis, engaging and committing to leisure activities, or some self-care event such as a manicure.

Underlying all of this is generally a lack of self-compassion. Regarding oneself as important is a cornerstone for any of the behaviors mentioned above to happen. In the next installment of this blog, I plan to devote the space to self-compassion and techniques for helping people develop a stronger, more positive self-image.

Courtesy: PsychologyToday