Interview with Triana Sanz: 'ACT is a new way of living'

As advances in psychology occur, new ways of formulating psychotherapeutic intervention tools emerge. This is what has happened with the transition from the cognitive-behavioral model to third-generation therapies.

Enter these new therapies, one of the most interesting is the Acceptance and Commitment Therapy. Let's see what it consists of from the testimony of an expert in the use of this kind of psychological intervention.

• Related article: "What are third generation therapies?"

Interview with Triana Sanz: the keys to Acceptance and Commitment Therapy

the psychologist Triana Sanz Font She is a General Health Psychologist and Director of Lua Psicología, psychotherapy center located in Madrid. Throughout this interview, he explains what Acceptance Therapy is and how it works and Commitment, and the reasons why it is one of the most important resources in your work, attending to patients.

What exactly does Acceptance and Commitment Therapy consist of, and what work philosophy does it start from?

Acceptance and Commitment Therapy or ACT, whose main author is Steven C. Hayes, is included within the so-called Third Generation Therapies, born from Cognitive-Behavioral Therapy.

It starts from a contextual work model, since instead of focusing and wanting to change the content, intensity and frequency of thoughts and emotions, focuses on the way in which each person relates to them, so that they do not control their behaviors.

Suffering increases because the strategies and techniques we use to solve our problems are wrong and make us fall into our own trap. For this reason, ACT proposes a model that helps people to open up and be more aware of their emotions, thoughts, feelings and sensations. allowing them to learn and attend more flexibly to what is inside them and to what can be useful without feeling dominated by they.

This model of psychological flexibility is summarized in three concepts: openness, awareness and commitment. That is, openness to experience without trying to avoid what we find unpleasant, awareness of sensations, thoughts, feelings, emotions, memories, images, etc. in the here and now and commitment to carry out a behavior according to what you really want and commit to those patterns of behavior based on values.

Why did you decide to become an expert in this type of therapy?

Both in my career and in the subsequent training I've done, the base has always been Cognitive-Behavioral Therapy and, although it is true, that it is a current of which we already know its enormous effectiveness in many psychological problems, it remains lame and we need a new approach.

I found this new approach in ACT, since I began to soak up its fundamentals, its theoretical framework and its way of working, I realized the enormous potential that it had, it posed something different but at the same time natural and coherent with the way in which we function and live as people, our life.

Wanting to free ourselves and fight against what makes us suffer is something very common to human beings. We avoid or try to control any thought, emotion, sensation or situation that causes us discomfort and to get rid of them, the strategies we use are nothing more than traps we set for ourselves that increase our discomfort. We get carried away by our thoughts and emotions, taking us away from the life we ​​really want to live.

It is not about avoiding, fighting, thinking positive, changing unpleasant thoughts or emotions for pleasant ones, it is about opening up to the experience (both positive and negative), place it in the context and not in the person (to generate distance) and from there, carry out behaviors or actions (it is the only thing we really have control over) that are important to us. us.

All this, so coherent, natural and that it is so difficult for us to carry out, is why I decided to specialize in this type of therapy, not only as a way of working with my patients but as something that I have been incorporating into my life staff.

Many times it is said that the desire to make the symptoms of a disorder disappear makes patients obsessed with what causes them discomfort. Does Acceptance and Commitment Therapy help to avoid these dynamics?

Without any doubt, as I have mentioned before, to try to get rid of what causes us discomfort, we implement control strategies as an attempt to solve, but the only thing we achieve is to increase the discomfort. That is, the solution becomes the problem, entering a vicious circle.

For example, we have skin eczema with its consequent itching (problem) and to solve it we we scratch (solution), but in this case, the more we scratch, the worse, the itching and irritation increases (problem). The solution has become the problem.

From ACT what is proposed is to break this vicious circle realizing the wrong strategies we use.

In your opinion as a psychologist, is acceptance a value to claim in the face of day-to-day imperfections, beyond the cases in which there are diagnosable psychological disorders?

In life there is a part of pain that is inevitable, we face situations, thoughts, sensations, emotions and attitudes that will cause us discomfort. The problem comes when we offer resistance to that pain. We do not want to feel bad, we fight against that pain and the only thing we achieve is to increase our suffering. So what do we do, how do we handle it?

Acceptance allows us to move forward, move on, and not get stuck in situations that we cannot change. This attitude of focusing on the things we can do makes us adopt an active and committed role in our lives.

Let's give an example, I get fired from a job and my attitude or my coping strategies can go in two lines, one, cursing the bosses and the company for my dismissal, regretting my new situation etc.

However, since I cannot change the situation (the dismissal), the most appropriate thing would be to accept the situation, to be able to move forward and dedicate my time and attention to what I can do and want to do. This does not mean that I avoid or repress thoughts and emotions derived from the dismissal, which is inevitable, but it does mean that I can decide not to get caught up in the vicious circles we were talking about.

It is important to distinguish between acceptance and resignation. By resigning ourselves there is no progress, there is stagnation, there is rumination, there is a fight against that discomfort. We end up thinking that we can't do anything to change the situation, we adopt a passive role and our discomfort increases because we believe that we are not capable of getting out of the situation. We need to accept ourselves, with our thoughts, our emotions, our way of being... and only then can we move forward.

Do you think Acceptance and Commitment Therapy combines well with other forms of psychotherapy?

We have said that ACT is a form of experiential, behavioral and cognitive psychotherapy and that by belonging to the Third Generation Therapies, derived from Cognitive-Behavioral Therapy, can be perfectly combined with she.

In addition, the fact of opening ourselves to the experience, paying attention and being aware of our thoughts, emotions and feelings, is closely linked to full attention and the present moment, derived from the Mindfulness. In general, it combines well with the rest of the Third Generation Therapies, due to the basic principles they share.

Surely many patients must learn to distinguish between what they must accept and what they must fight to change and improve. Is this process also worked on in therapy sessions?

When patients begin to learn about and incorporate acceptance into their daily lives as a way of coping with experiences related to emotional pain and become they commit to carry out actions that are really useful and important, they are already changing and/or improving, they are learning to live with that situation in the best way possible. That is, they try to find the balance between their personal well-being and what they have had to live.

Each one of us works on our acceptance process in order to move forward, change and stop suffering. For there to be a change, there must be prior acceptance.

For example, in a relationship, on many occasions we want the other member of the couple to change instead of accepting them as they are, which can lead to friction, arguments, etc. Another situation is that of accepting that the continuity of the couple is not possible at that moment and, only then, from the acceptance, we will be more capable of seeing reality and things more calmly, to be able to make decisions and carry out the changes that we want.

By this, what I mean is that there may be a moment in our lives when we decide that we do not want to continue living the way we are. But this change refers to oneself, to the course of our life, not to a change on the outside.

What are the early signs that therapeutic intervention is working? How do patients notice it?

What I have been observing in patients is that, by working on the basis of ACT, they discover a new way of relating to emotional pain and suffering different and, as I have already commented, at the same time easy and natural to incorporate it into your life.

The first signs come especially when they begin to be able to defusion of their thoughts (defusion is one of the 6 pillars of ACT), that is, they begin to distance yourself from thoughts, to realize how your mind is working, not to let yourself be carried away by it and to see thoughts for what they are, words in your head.

Our mind is like a television that is on 24 hours a day. We cannot turn it off, we cannot do anything so that our thoughts appear in our minds against our will.

However, if we can decide if we pay attention to it or not, if we have the TV on in the background (our mind) without paying attention to it attention and doing what really matters to us, or if we give it all our attention and let ourselves be carried away by its stories.

The second signal comes from another of the ACT pillars that we have already talked about and that is acceptance.

I would tell you that the first signals come based on these two principles, cognitive defusion and acceptance, but the other 4 pillars of ACT (the observing self, present moment, values ​​and committed action), are also present and influencing each other, since without an openness to experience, thanks to attention to present moment and that observant self that allows us to separate ourselves from our thinking self, we would not be able to undertake committed actions according to our values.

That's why I consider ACT not just an effective therapy, but a new way of living.