ACT With Compassion

It's great to see some readers of this blog/website start to respond! One of our readers (who chose to remain anonymous but agreed to let me post this) asked a great question about ACT and compassion interventions. I wanted to share my response publicly so that others might benefit (assuming there's something useful in there). If you are not already pretty well versed in ACT, this post might be too heavy in theory and you might want to skip it. However, if you already know something about ACT, you might find it interesting. Here's an excerpt from the email she sent:

I have found that I really take to approaches such as ACT and CFT (compassion-focused therapy), and I was hoping I could ask you a question regarding the way compassion fits within the ACT framework.

....

As ACT and CBT begin to incorporate mindfulness components and overlap in certain ways, I am feeling a bit confused about the way ACT might understand compassionate self-talk.

My question is: Is it possible to implement compassionate self-talk within the ACT framework? From my understanding, ACT emphasizes acceptance of reality and its sensations over avoidance. For instance, acknowledging self-criticism as transient thoughts rather than challenging them as in CBT. If I understand this correctly, ACT suggests that effort spent "fighting" symptoms actually contributes to the "problem" itself- As my yoga teacher would say, whatever we resist, persists. Given that compassionate self-talk seems to be a form of cognitive restructuring, would the ACT model consider this self-talk to be a form of resistance? If an individual acknowledges self-critical thoughts and then engages in compassionate self-talk, would that be more "ACT-consistent" or still contradictory to the acceptance-based nature of ACT?

Thank you so much for your inspiring stories shared on your website and your efforts to open psychotherapy up to mindfulness and compassion!

I'll respond directly to this part:

My question is:  Is it possible to implement compassionate self-talk within the ACT framework?
From my understanding, ACT emphasizes acceptance of reality and its sensations over avoidance.  For instance, acknowledging self-criticism as transient thoughts rather than challenging them as in CBT.  If I understand this correctly, ACT suggests that effort spent "fighting" symptoms actually contributes to the "problem" itself- As my yoga teacher would say, whatever we resist, persists. Given that compassionate self-talk seems to be a form of cognitive restructuring, would the ACT model consider this self-talk to be a form of resistance?  If an individual acknowledges self-critical thoughts and then engages in compassionate self-talk, would that be more "ACT-consistent" or still contradictory to the acceptance-based nature of ACT?

Please forgive me if my response seems to nitpicky. That you can ask such a detailed question shows you have a really good understanding of the model! However, comments which get into such details of the model and can sometimes come across in a way that sounds critical. Hopefully I won't do that. However I've found that sometimes focusing on little details can help to clarify important theoretical issues that have a larger scope.

I wouldn't see compassionate self talk as necessarily a form of cognitive restructuring. It all depends upon the function of this "self talk." We are coaching clients in self-talk all the time in ACT. If we help a client to learn an acceptance exercise for use when experiencing distressing emotion, her or she is "talking" (privately) to him or herself when doing the exercise. If we suggest a client to check in on his/her values by thinking "What would I want to be about in this situation?" , again, we are asking clients to engage in a form of self-talk. From this vantage point, ACT therapists are persistently adding new "self talk" to our clients repertoires.

The central issue is not whether we are adding new self-talk, but rather what the function of the self-talk is.

In trying to think through function as it relates to self-compassion, I have often observed that self-critical thinking can have two primary functions (if we are speaking at a hexaflex level of ACT theory). One of these is avoidance and the other is fusion. The avoidance function is probably most relevant to your question. Self-criticism often serves as a way to identify potential and actual mistakes so as to repair or avoid them before encountering negative outcomes, such as shame. If we think of self-criticism as part of an avoidance repertoire, then learning to notice the self-criticism and allow it to be there with some distance would be consistent with an ACT perspective. Further feeding self-criticism would be further feeding avoidance. If a person is able to notice this habitual self-criticism and defuse from it, at that point a typical next step in ACT is to identify what is important for that person to do in that situation. In this case, a person might choose a value of self-care, self kindness, or self compassion (i.e., a self-relevant value). They might then engage in some sort of self-compassionate activity, which could take the form of compassionate "self-talk," or it might involve just compassionate action, such as giving oneself a rest when overworked. 

In addition, to functioning as valued action, compassionate self-talk can also facilitate acceptance. Self-criticism often involves attempting to eliminate, fix, or otherwise escape/avoid some sort of emotion or experience that the person has evaluated negatively. Self-compassionate self-talk could facilitate opening up to, allowing, and even learning from aspects of their experience that are typically judged/avoided/rejected. For example, a person might say to themselves during a time when they are feeling defeated, "Yes my dear...this is really painful [while pausing and noticing the painful experience]. We all experience pain. We all have failures. This is part of being human. You are not alone in this. Gentle. Gentle. Gentle.”

I'm not well trained in cognitive restructuring, but from my understanding, cognitive restructuring often focuses on the veracity (i.e., truth) of thinking, such as self-evaluations. As you can see in the example of self-talk I gave above, the focus is not on whether the content of the evaluation is true or not, but instead on responding to oneself in a kind, gentle way. The idea is to act on and build a pattern of responding to oneself with empathy and compassion, the same way you might respond to a loved one or a good friend. A kind and loving response to a friend/loved one in distress usually does NOT involve arguing the person out of their view of themselves or the situation, but instead starts with listening and finding ways to empathize, validate, and perhaps soothe them.

In the way I think about things, self-compassion exercises like lovingkindness meditation, compassion-focused meditations, the "self-compassion break" (from Neff), or other forms of self-compassion self-talk would ideally occur as part of the values portion of the ACT model and reflect a chosen value towards oneself of love, kindness,compassion or the like. You could imagine scenarios where a person does a lovingkindness meditation as a form of avoidance and in that circumstance, self-talk would not be psychologically flexible.

Hope some of you find that helpful. Please ask questions or comments. Let's interact!