Enhancing Coaching with Acceptance and Commitment Therapy

Introduction

In this blog we will explore how Acceptance and Commitment Therapy (ACT) can enhance coaching services for their clients. To do so, we will first start to uncover where ACT comes from, outline it’s main aims, and explore in which context ACT is applied. Next, we will move on to why it makes sense to weave ACT into coaching services. Lastly, we discuss the latest developments in ACT and shed light on the future direction of behavioural therapy and coaching.

This blog will delve into the ways in which Acceptance and Commitment Therapy (ACT) can improve coaching services for clients. To begin, we will uncover the origins of ACT, outline its primary goals, and examine the contexts in which it is applied. Following this, we will explore the rationale behind incorporating ACT into coaching services. Finally, we will discuss recent advancements in ACT and shed light on the future direction of behavioral therapy.

Origins of Acceptance and Commitment Therapy

ACT, a mindfulness-based form of cognitive behaviour therapy (CBT), was developed by Steven Hayes, Kirk Strosahl, and Kelly Wilson in the late 90s. While the first publications emerged in the late 80s, the official textbook on ACT was completed in 1999. ACT belongs to the 3rd wave of behavioral therapies, alongside other approaches like Dialectical Behaviour Therapy (DBT), Compassion Focused Therapy (CFT), and Behavioural Activation.

What all these behavioural therapies have in common is that they share an emphasis on acceptance and mindfulness. ACT adds commitment and behaviour-change strategies on top of that. ACT rests on assumptions from much older theories, functional contextualism, evolutionary science, relational frame theory and attachment theory to name a few. Psychological interventions progress over time and are built upon each other. You couldn’t have had ACT without it’s previous 1st and 2nd wave iterations. The field of behavioural science continues to advance beyond ACT, but we will talk about that later. Lets first learn more about ACT.

ACT stance

As we grow older, the chances of stumbling across something that is going to be unpleasant or painful is going to increase. We may face the loss of loved ones or endure relationship breakdowns. Perhaps we have endured traumatic events in our past or recently faced setbacks in our careers. Whatever it is, it is likely that you can recall something of similar sorts. Most likely, you can recall something similar that has happened to you. And that’s life. Being human means facing painful events. Caring about something also means feeling hurt when something happens to that. However, certain aspects of our nature, like our problem-solving mindset, can contribute to additional suffering on top of that initial painful event. It can compound the pain, adding additional layers. What this looks like, as the image below hopefully depicts, varies from person to person.

For instance, we can get overly attached to our past, or too preoccupied with the future. But that doesn’t mean you have a ‘disorder‘, ‘defective‘, ‘abnormal’ or ‘broken‘. This is more the stance of the medical model. ACT takes the stance that labels have to be held lightly and that these symptoms can be perfectly normal and natural, given the context you are facing that your mind is racing or you get all sweaty palms. For instance, when you face a board of directors and you’re trying to give them a keynote speech, stress and worry will likely come to the surface. Or you have been let down by people close to you in the past. That might make it difficult to create safe and secure relationships going forward because you see reasons everywhere not to trust people.

ACT views things like this ‘human suffering’ as normal. Not a disorder driven by pathological processes. Adopting this stance, symptom reduction (like reducing anxiety) is not a goal within ACT (even though they tend to go down). Symptom reduction doesn’t equal improved quality of life. The model actually assumes that attempts to ‘get rid’ of symptoms can actually magnify and compound problems (in other words: increase it).

Aim of ACT

So instead of focusing on lowering stress and anxiety, what is ACT about?

ACT is all about expanding your repertoire of behaviour (what you are able to do with your body and focus) in the presence of difficult stimuli. Or in plain English, when you find yourself in tricky and challenging situations, finding a way to make room for these experiences so you can still put your attention on doing what matters?

Broad application of ACT

ACT has been shown to have numerous benefits. This is also recognised by health institutions in the UK, such as the National Institute of Health and Care Excellence (NICE). In 2020, they recommended the use of ACT for chronic pain. ACT is also getting more and more used in the NHS. In part, you can see how much momentum it’s gaining in the diagram below. There are over 1100 RCT at this moment of writing (February 2024).

ACT is about following up on a life that is meaningful to you, also in difficult situations. But responding to these tricky situations in a way that is more open, aware , and engaged. Learning these skills can be effective in various settings. One key strength of using ACT in the is its adaptability to various sectors and a wide range of challenges as is depicted in the illustration below.

• ACT for athletes: ACT has been applied for skill coaching, in sport for instance.
• ACT for neurodivergent people: People who are neurodivergent often face challenges with executive functioning. According to McGabe, executive functioning is impaired and develops at a slower pace in individuals with ADHD. This essentially means that there is underdevelopment in the areas of the brain responsible for emotions, attention, motivation, and cognition. The solution to this underdevelopment is to focus on development and learn the necessary skills. For example, ACT (Acceptance and Commitment Therapy) targets attentional flexibility skills to improve attention regulation. McGabe, the creator of the How to ADHD Youtube channel, has highlighted in her videos and in her recent book that ACT has proven to be highly effective for ADHD.
• ACT to improve the mental health of cancer patients: ACT can effectively improve the mental health of cancer patients. There are support programmes run in hospitals that use ACT for their patients. There are even books written about it.
• ACT in the workplace: ACT is extensively used to create staff wellbeing programs. In the UK, there are organisations that offer specialised training to train such specialists. Such an intervention is typically aimed to improve psychological wellbeing, reduce staff burnout and decreases worry and rumination outside working hours leading to better work-life balances.

Why weave ACT into coaching?

So far you’ve read that ACT is applied in various settings. But why should ACT be integrated into coaching? Two reasons stand out.

ACT is a robust model for coaches

As you have seen in the graph, ACT has got a very strong research base with (as of Feb 2024) over 1100 randomised controlled trials and 454 meta analyses. It’s an empirical psychological intervention with a strong scientific foundation. Coaching on the other hand, has not got that same level of rigorous and evidence-based standard that ACT has developed since the 90s. That’s also because coaching is more of an approach or style, a series of structured conversations, rather then a psychological intervention. Coaches use (or perhaps borrow) behavioural modalities such a positive psychology or ACT to promote personal growth in these series of structured conversations. But not every model should be treated equally.

Take coaches who heavily lean on NLP as an example. NLP is a pseudoscience. This means there is limited scientific evidence supporting the claims made by NLP advocates. Scientific reviews have shown that NLP is based on outdated metaphors of the brain’s inner workings that are inconsistent with current neurological science, and that NLP contains numerous factual errors. Behavioural science has moved on. That doesn’t imply NLP is not a useful model to use. I did a NLP practitioners course back in 2017. And as mentioned before, psychological interventions progress over time and are built upon each other. But you have to be careful on coaches who perhaps are over-relying on this model and are not as open to looking elsewhere, on more evidence-based and empirically supported theories.

Develops a set of psychological skills

ACT can be quite skill-focused and experiential, meaning you will learn to do the practical techniques in session to help you build the sort of life you want to live. In ACT, this is often referred to as psychological flexibility skills and has 6 different components or processes grouped together under 3 main response styles we briefly mentioned before: open, aware and engaged.

The 6 psychological processes ACT is aiming to develop are:

The first four processes (open and aware) are considered to be “mindfulness” processes

But how can you commit to a future if you experience difficulty in holding yourself together in the present moment? Or what if you fail miserably, how do you bounce back from that experience and make sure your history doesn’t get in the way? This is where ACT comes in. It’s quite a nice addition to a coach’s skillset. It complementary and enhances the likelihood that clients commit to a future they care about. ACT shows them a way forward in the face of life’s many hardships.

By integrating ACT into the coaching domain, coaches provide a more practical, contextual and evidence-based approach that acknowledges the importance and role psychological skills play in shaping personal growth. As we mentioned in our blog life coach vs therapist, coaches are typically strong in providing support and accountability to help their clients commit to their future. Breaking thought processes down, setting goals, and nudging their clients outside their comfort zone.

Criticism around Acceptance and Commitment Therapy

Lack of set standards

The ACT model, similar to the traditional coaching model, possesses a shared characteristic in terms of being highly flexible and open-source. While anyone can identify as a coach, the same applies to individuals who label themselves as ACT practitioners. Consequently, a parallel issue can arise in this scenario.

Due to the absence of standardised training methods, there is a lack of uniformity among ACT practitioners in their approach. Yes, there are recognised training platforms for ACT practitioners. Platforms such as Praxis, Contextual Consulting, and Psychwire that offer short training courses exist, but following their training doesn’t produce a set standard of ACT practitioners. As a result, and in practise, ACT is a very free-style and free form manualised approach to behaviour change. No two ACT practitioners are alike. Some may argue that labelling it as evidence-based approach is a bit of a bold claim.

‘Fuzzy’ measures

A lot of ideas of ACT are not exactly measurable, just like you can measure a litre of water the amount of red blood cells in your blood. This is a drawback common to psychological science. They also call this reliance on ‘middle level terms’. Terms that sit between scientific language and common sense language. Terms that can’t put it under a microscope, and therefore lack preciseness. Terms such as self-esteem, core beliefs, ego, psychical flexibility, acceptance, for instance. These terms make the model you’re trying to convey more user friendly way, but these terms are difficult to measure. For instance, the 6 processes within ACT are not empirically derived. Yes, they do make a lot of sense and a lot of research has gone into it and academics have brought forward suggestions for measurements, but it still remains difficult to measure someone’s level of attentional flexibility.

Future of behaviour change interventions

Fourth wave of behavioural therapies?

Third-wave behavioural therapies (such as ACT, DBT, and CFT) are experiencing a surge in popularity, while traditional forms of CBT are declining. Notably, the effectiveness of CBT in addressing anxiety and depression is decreasing. However, what lies ahead? Are we on the verge of a fourth wave?

Some are advocating for something they call process-based therapies (PBT). PBT argues that we have to be more mentally open and look beyond the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM. The DSM is at the heart of the medical model.

PBT not a new type of therapy, althought some are calling it ACT 2.0 as at the moment it’s still very ACTy. PBT adds a few things:

1. PBT defines the domains of processes of change more widely, 
2. It links them more strongly to evolutionary science. 
3. It goes beyond the purely psychological level to explicitly add the biophysiological and sociocultural level, having a more meta-model approach to add more context.

If you want to read more about PBT there are books that go more into detail.

Incorporating digital solutions

Healthcare and psychological interventions are likely to to weave more digital solutions into their offer. You see this with bigger organisations such as the NHS, but also at the Habit Coach we embrace digital solutions to drive behavioural change for our clients. Since October 2023, we have integrated PsychFlex into our coaching services.

PsychFlex integration allows us to extend support clients beyond regular coaching sessions by securely delivering personalised techniques and resources through the app (also accessible via web browser). These resources, including videos, links, audio files, text, and images, are fully customisable or drawn form 3rd wave behavioural therapies. This approach enhances the likelihood that clients will retain and actively practise psychological skills between scheduled sessions. Here is Steven Hayes, one of the 5 founders of PsychFlex (and co-founder of ACT!) take on it.

Conclusion

In conclusion, Acceptance and Commitment Therapy emerges as a powerful and flexible approach carrying forward the positive momentum of third wave of behavioural therapies. Unlike traditional CBT models, ACT views human suffering as a normal part of life and emphasises building psychological flexibility rather than merely reducing symptoms. It’s more of a contextual model, rather than a medical one.

Its broad application across various domains, from increasing performance for athletes to support mental health for cancer patients, highlights its versatility and effectiveness. Furthermore, ACT’s evidence-based nature, supported by over 1100 randomised controlled trials, positions it as a reliable intervention. While ACT has received praise for its effectiveness, it is not without criticism. Its fluid and open-source nature raises concerns about standardisation, and some find the measure of psychological flexibility to be vague.

When successfully incorporating ACT, coaches provide a more robust and skill-based approach to support clients in navigating life’s challenges. Looking ahead, discussions about the future of behaviour change interventions suggest the emergence of a potential fourth wave, labeled process-based therapies (PBT). PBT aims to expand the domains of change processes, link them to evolutionary science, and more consciously incorporate biophysiological and sociocultural dimensions.

As we have seen, the evolving landscape of behavioural interventions also includes a growing integration of digital solutions, with the PsychFlex app serving as an example. As healthcare and psychological interventions incorporate more digital tools, the field is likely to witness continued innovation in providing personalised resources and coaches should embrace this to offer more value for their clients as it promotes skills practise and retention.

Or as we would say it at Habit Coach, co-creating lasting change 🙂