The ACE Model: Accept, Connect, Embody

The ACE model presents the six psychological flexibility processes of acceptance and commitment therapy, renamed and rearranged in an acceptance triad (defusion, present moment focus, willingness) and a connection triad (self as context, values, committed action).

This regrouping and renaming was based upon qualitative research on clients’ experiences in psilocybin-assisted psychotherapy that identified themes of acceptance and connection (Watts & Luoma, 2020). Clients are encouraged to:

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Accept and move toward challenging or negative content while staying open to a message or ‘pearl’ that may be found by moving toward the pain (Watts & Luoma, 2020).

Connect with positive sensations and with an expanding awareness of what one values (Watts & Luoma, 2020).

Embody or feel everything as deeply as possible by attending to somatic cues (Watts & Luoma, 2020).

The ACE model is intended to be used flexibly in practice and is paired with a metaphor describing the process.

Select self, act, value, defuse, sense, and feel to learn more about each phase.

Figure 3.2 Adapted from Watts & Luoma, 2020.

Self

  • What does the small Self say?

  • What would the big Self choose?

Act

  • What are you doing differently?

  • Keep to your new path.

Value

  • What’s important here for you and others?

Defuse

  • How old is that thought, and where does it take you?

Sense

  • What do you sense in your body, moment to moment?

Feel

  • What are you trying not to feel?

  • Allow it, is there a message in your pain?

The ACE Body Scan

ACE body scan process with the let go, then sense, then feel stages below the water. At the surface of the water, there is self, then meaning, then intention.

Figure 3.3: Adapted from Watts & Luoma, 2020.

The ACE Body Scan is employed to remind and encourage clients to accept what is challenging, connect with their somatic resources, and stay embodied in the process. The point with the ACE metaphor and guidance into embodied and felt experience is to encourage clients to move out of their “head”—their thinking mind—and into a different state of awareness, one that is present-moment-oriented, broader, more expansive, and perhaps quite new to them.

In the ACE metaphor health professionals guides clients to dive down under the surface of ordinary ’thinking mind’ consciousness into the ocean (or into the depths of one’s ’feeling’ self in the body), and to accept through the steps of letting go (defusion), sensing (present moment awareness, body scan), and feeling (willingness to feel, open up to emotion) by looking for oysters which are often rough on the outside, representing painful or challenging felt experiences or emotions and look for the pearl inside. The pearl represents the healing, insight, and learning that comes from approaching rather than avoiding. The clinician will offer support in approaching aspects of experience that may feel scary by encouraging and offering suggestions like “ask this feeling/image what it is here to teach you and see what happens.”

Connect guides clients in breathing deeply and connecting with warmth and expansive sense of self (self-as-context) with the image of a calm, sunlit sky, then harvesting the fruits of the process by creating meaning around what the pearl represents and why it matters (values), then making a commitment to oneself about how to honour this pearl and what it means through actions (committed action).

In the ACE metaphor health professionals guide clients to dive down under the surface of ordinary ’thinking mind’ consciousness into the ocean (or into the depths of one’s ’feeling’ self in the body), and to accept through the steps of letting go (defusion), sensing (present moment awareness, body scan), and feeling (willingness to feel, open up to emotion) by looking for oysters which are often rough on the outside, representing painful or challenging felt experiences or emotions and look for the pearl inside. The pearl represents the healing, insight, and learning that comes from approaching rather than avoiding. The clinician will offer support in approaching aspects of experience that may feel scary by encouraging and offering suggestions like “ask this feeling/image what it is here to teach you and see what happens.”

Connect guides clients in breathing deeply and connecting with warmth and expansive sense of self (self-as-context) with the image of a calm, sunlit sky, then harvesting the fruits of the process by creating meaning around what the pearl represents and why it matters (values), then making a commitment to oneself about how to honour this pearl and what it means through actions (committed action).

Learn More

To read the full script, please visit Appendix A and B in Watts & Luoma (2020).

Part of the benefit of the ACE model analogy is that it can be easily recalled and referenced by clients—or for clients by health professionals—should they need help with exploring and approaching the content of their present-moment experience, even when clients are in the midst of the psychedelic experience.

Video: The ACE Body Scan (Visualization Exercise) Guided by Dr. Rosalind Watts

8:01

In this video, the founder of the ACE Body Scan walks us through a visualization exercise using the ACE Body Scan. Note: this is an excerpt from the full podcast.

Trauma-Informed Care

If clients have a history of traumatic associations with water or do not know how to swim, the ACE analogy of diving down and swimming into their experience while looking for oysters may be countertherapeutic. Thus, in keeping with trauma-informed care, we suggest that health professionals offer options, and ask clients which metaphor they would prefer to use.

Reflection

If the diving and water visualization was deemed to be inappropriate for a client, which visualization could you leverage instead?

For example, you could change the diving and water visualization to walking into a dense forest, or a dark cavern with hidden treasures.

References

Agin-Liebes, G., Zeifman, R., Luoma, J. B., Garland, E. L., Campbell, W. K., & Weiss, B. (2022). Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca. Journal of Psychopharmacology, 36(3), 295–308. https://doi.org/10.1177/02698811221080165

Bond, F., Hayes, S., Baer, R., Carpenter, K., Guenole, N., Orcutt, H., . . . Zettle, R. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire - II: A revised measure of psychological flexibility and acceptance. Behavior Therapy, 42.

Coyne, L. W., Mchugh, L., Martinez, E. R. (2011). Acceptance and Commitment Therapy (ACT): Advances and Applications with Children, Adolescents, and Families. Child and adolescent psychiatric clinics of North America, 20(2), 379-99. http://dx.doi.org/10.1016/j.chc.2011.01.010

Davis A. K., Barrett, F. S., and Griffiths R. R. (2020). Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of Contextual Behavioural Sciences, 15, 39-45. doi: 10.1016/j.jcbs.2019.11.004. PMID: 32864325; PMCID: PMC7451132.

Hayes, S. T., Law, S., Malady, M., Zhuohong, Z., Bai, X. (2019). The centrality of sense of self in psychological flexibility processes: What the neurobiological and psychological correlates of psychedelics suggest. Journal of Contextual Behavioural Science, 15(2), http://dx.doi.org/10.1016/j.jcbs.2019.11.005

Kashdan, T., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical psychology review, 30 7, 865-878.

Kočárová, R., Horáček, J., and Carhart-Harris, R. (2021). Does psychedelic therapy have a transdiagnostic action and prophylactic potential? Insights in Pharmacology. https://doi.org/10.3389/fpsyt.2021.661233

Nikolic, N. (N.d.). The Hexaflex. https://neshnikolic.com/hexaflex

Watts, R., & Luoma, J. B. (2020). The use of the psychological flexibility model to support psychedelic assisted therapy. Journal of Contextual Behavioral Science, 15, 92-102.