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How can acceptance and commitment therapy help carers in challenging times such as the COVID-19 pandemic?

Updated Wednesday, 9th September 2020

Acceptance and Commitment Therapy (also known as ‘ACT’) is a type of psychological therapy used for people who feel ‘stuck’ due to complex life circumstances. This article explains more and offers some top tips.

The COVID-19 pandemic has been a time of great stress for carers. They have endured decreased access to support services and social support, decreased time to look after themselves and difficulties maintaining the physical and emotional health of themselves and their loved one, in the face of national and local restrictions.

For many carers, routine and planning are central to managing the ongoing stressors of a caregiving role and meeting everyone’s needs. The changes to lifestyle caused by COVID have prevented this way of coping, and forced people to live with changes in routine, uncertainty and worry. For more research about Covid-19 pandemic and carers see our current research study. Many people routinely manage stress by problem-solving in a very active way, but this has not been possible, with many factors being outside the average person’s control.

Acceptance and Commitment Therapy (also known as ‘ACT’) is a type of psychological therapy that is often used for people who feel ‘stuck’ due to complex life circumstances. Unlike traditional therapies which focussed on so-called ‘errors in thinking’ (such as the more commonly known CBT approach), the focus of ACT is on how to create a meaningful life despite the difficulties that we all encounter in life. It is therefore a very useful therapy where peoples’ worries and low mood are a valid response to a difficult situation.

Whilst ACT is a type of therapy that can be completed with the support of a trained therapist, its key principles are valuable far beyond this formal practice and can be applied in our daily lives with or without a therapist:

1: Being in the moment

Very often we spend large amounts of time in the past (ruminating over things, replaying past events, wishing we had done things differently) or in the future (worrying about what is to come, fast-forwarding to worst case scenarios). It is rare that we allow ourselves to just ‘be’ in the moment. But if we think of the times we have made the most of life, we were often doing just that, e.g. walking on a beach and noticing all the sensations, really paying attention to the food we eat during a meal. Whilst lockdown has prevented some of these experiences, it is always possible to be more in the moment, and to then increase our awareness of this in all our daily activities. This also prevents the distress we feel when we are constantly stuck in the past or the future. A simple technique to be more in the moment is described here.

2: Knowing what matters

Often we experience distress because we are acting in a way that is not in line with our values. Examples of this may be when we value our compassion but get frustrated with someone we love; or value our sense of adventure but feel ‘stuck’ in a boring daily lifestyle. The key to living a life in line with our values is firstly to spend some time identifying what they are and knowing what matters.

3: Doing what it takes

Once we have identified what matters the next step is to work out what helps us live in line with these values, and what ‘hooks’ us, or pulls us back from living this way. It is common to think that the hooks must be practical things such as time or money, but there is always a way to live in line with values, no matter how small the first steps. Hooks can also be emotional, such as not feeling deserving, worry about what other people will think and not feeling confident in making changes. Once these are known we are then in a position to take ‘committed action’ to making these changes for the better.

4: Opening up (acceptance)

Many people dislike the word acceptance, as they have often been told to ‘accept’ things in a way that implies they should ‘just deal with it’, maybe stop complaining or ‘take it on the chin’. This can often feel invalidating and unfair. This is not what is meant by acceptance in this type of therapy. Instead, it refers to the ability to open up and make room for painful feelings, sensations, urges and emotions. This does not mean that we like them or want them to be there, but means that instead of investing energy into fighting them, resisting them, running from them or getting overwhelmed, we invest our energy into the things and people that really matter to us. This allows a much better quality of life, even when the external stressors haven’t gone away (such as living with a chronic health condition, or where external events cause us anxiety). 

5: Noticing our thinking

A key part of developing skills in acceptance, mindfulness (being in the moment) and living in line with values, is starting to notice the thoughts we have and how at times we automatically respond to them. Since our days as caveman our minds have evolved to notice danger and keep us safe.

This has had a big advantage for our survival but the downside is that now we live in physically safer environments, our brains still constantly focus on danger whether to our physical health, our loved ones, our self-esteem or practical things such as our homes or finances. This means that at times we need to slow down our thinking and decide whether we agree with this line of thinking, or whether it doesn’t help us in the current moment. If it is not helpful, then it can help to imagine the thought as a leaf on a stream...

... or on the top of a bus driving away, to create a sense of distance. This then leaves us free to decide how we want to respond next. This is also true of the ‘stories’ we tell about ourselves, such as the ‘I’m a bad mum/dad/partner/child’ story where we may feel we have not done enough and criticise ourselves. Telling this story often, and believing it, can have a big impact on mood and confidence. The trick is to notice when we are telling ourselves this story and take a step back, moving from ‘I am…’, to ‘I am having the thought that I am…’ to ‘I am noticing myself having the thought that I am…’. This creates distance from these painful thoughts and lets us take a different perspective on them.

For more information on these ideas try ‘The Happiness Trap’ by Russ Harris. If you feel you need some support with your thoughts and feelings at the moment then contact your local Improving Access to Psychological Therapies service.

Related resources

The Happiness Trap: Stop Struggling, Start Living. Book by Russ Harris

  • Vseteckova J & King J (2020) COVID-19 Interview podcast for The Retirement Café: ‘Ageing Well Under Lockdown’  https://theretirementcafe.co.uk/077-dr-jitka/
  • Jones K, Methley A, Boyle G, Garcia R, Vseteckova J (2020) A systematic review of the effectiveness of Acceptance and Commitment Therapy (ACT) compared with other psychological therapies in managing grief experienced by bereaved spouses or partners of adults who had received palliative care in the UK. Prospero - International Prospective Register of Systematic reviews  CRD42020191393 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=191393
  • Vseteckova J, Jones K, Methley A, Boyle G, Garcia R (2020) A systematic review of the effectiveness of Acceptance and Commitment Therapy (ACT) compared with other psychological therapies in managing grief experienced by bereaved spouses or partners of adults who had received palliative care worldwide. Prospero - International Prospective Register of Systematic reviews CRD42020191394 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=191394 
 

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