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From the course

ACT for Depression and Anxiety Disorders

The Four A’s of Acceptance

Dr. Russ Harris breaks down different stages of acceptance, one of the primary but often misunderstood tenets of Acceptance and Commitment Therapy (ACT).

Contrary to other cognitive behavioural models of therapy, ACT works on the premise that accepting aspects of our experience that are causing us difficulties can bring greater relief than trying to resist or challenge them. This might include negative thoughts, strongly held ideas, pain, and any other sensations that are out of our control.

Clients often fear that acceptance involves a resignation to these types of feelings and experiences dominating their lives forever. But in truth, by finding a way to accept some of the things that cause our suffering, we free ourselves from the laborious struggle of resisting their presence and create more space to focus on what is important.

Acceptance sounds simple, but it is usually not something clients can arrive at straight away, especially when it comes to long held sources of pain. In the video, Russ uses the example of the arrival of an unpleasant, distant relative to illustrate a more detailed trajectory of acceptance using the Four A’s of Acceptance.

The Four A’s of Acceptance include:

Acknowledge

The first step in accepting a problem is acknowledging that it’s there. Staying in denial about unwanted feelings might seem like it helps to deflect discomfort, but it can actually take up a great deal of energy. Imagine that your weird uncle has shown up and is knocking on your door - the stress of pretending he isn’t there would probably be much greater than acknowledging that he is. Once we recognise what’s really going on, we have a much wider range of options for how to handle it. Russ points out that many clients spend a long time in the acknowledgment phase before being able to progress to the next steps of acceptance.

Allow

Allowing uncomfortable feelings is the next step in acceptance, kind of like letting the knocking relative into the house. Sometimes when people have been rejecting or resisting unwanted pain, memories, or experiences for a long time, they might have a fear at this stage that these intruders will take over the whole house. The realisation that making deliberate contact with the experience can actually provide relief, rather than make things worse, can be a profound side effect of acceptance.

Accommodate

The accommodation stage of acceptance involves really making room for what is showing up, and responding to it with curiosity and presence - inviting your unwanted guest into the house, making them comfortable, and accommodating their needs. This step is useful because it gives you the chance to develop a greater understanding of what you’re working with. By accommodating unwanted experiences, rather than resisting them, they have a chance to tell you a little more about why they’ve arrived and what they might need from you. ACT makes room for the reality that feelings - even bad ones - often hold some important message or information that can actually help us in the bigger picture. That annoying relative might actually just have some important news they wanted to share with you before heading off again.

Appreciate

Appreciation involves the real embodiment of a common ACT saying: “Your pain is your ally”. Appreciating difficult or unwanted feelings means turning towards them to discover what they have to show and teach us. Rather than seeing emotions as glitches or inconveniences, acceptance allows us to appreciate them as motivation for us for change, or a path to illuminating some truth we might have previously been unable to see. For example, enduring grief might contain an important connection to a loved one we have lost, or an uneasy feeling about a situation with work might be pointing to some important hidden risk of proceeding that we would have otherwise missed.

These stages aren’t always linear, and clients may move back and forth between them, or work through them differently for different types of experiences. The gift of the stages is the greater nuance they offer in supporting clients with the complex task of accepting negative and unwanted thoughts and feelings.

An important distinction to make about the type of acceptance advocated for in the ACT model is that it is an acceptance of inner experiences: that is, thoughts, emotions, reactions, memories, urges, and physical sensations. ACT doesn’t encourage blanket acceptance of mistreatment from others, dangerous situations, or abuses of boundaries. In fact, it’s just the opposite - through acknowledging, allowing, accommodating and appreciating painful or challenging feelings, clients can become more self aware and ready to take committed action in service of their own protection from unwanted or unhealthy circumstances.

The use of metaphors and stories - like Russ’ annoying relative at the door - is one of the features of ACT that make the model so transferable across clinical presentations and different populations (A-Tjak et al., 2015). For more examples often used by clinicians practicing from an ACT framework, see Monsters on a Boat, the Chessboard Metaphor, and the Struggle Switch.

I find it useful to think of acceptance in terms of the four A's acknowledge, allow, accommodate, and appreciate. These four A's take you deeper into the experience of acceptance. So here's a useful metaphor to get your head around this. One day a distant relative, harmless but unpleasant, you don't particularly like this person for one reason or another. Turns up on you front door step. The-- The first thing is you acknowledge they're there. You look out of the window, you acknowledge there's a relative actually there outside your front door. The next step is you allow them into your house. You open the door, you say, oh, hello. I wasn't expecting you and you allow them in. So you've gone from acknowledging they're there to actually allowing them entry. Now the third step is you accommodate them. You offer them a couch, you make them a cup of tea, you give them a cookie. So you've gone from acknowledging to allowing to accommodating. And then the fourth step is you appreciate them. You spend a bit of time chatting to this person and even though they've got these annoying habits or mannerisms or whatever it was that you didn't like about them, you start to find out there's some qualities about them that you do like. They've got a good sense of humor or they played an important role in your childhood that you'd completely forgotten. That's kind of the final stage. Acknowledge, allow, accommodate, appreciate. And this is what we want to do with our own painful emotions, cognitions, memories, sensations, physiological reactions. So what we'll typically find is throughout therapy in early sessions we're going to be hovering at the shallow end of acceptance. Lots of acknowledging and allowing and then progressively we go more into accommodating all of those classic acceptance exercises, breathing into and making room, physicalizing our emotions, and then going further than that into this, looking at the purpose and the benefits of painful emotions. And I focused on emotions here, but you'll see the same thing going on with cognitions and memories and physical sensations.