Living Well with Cognitive Change: The Role of ACT in Adjustment
Living Well with Cognitive Change: The Role of ACT in Adjustment
Living Well with Cognitive Change: The Role of ACT in Adjustment
Acceptance and Commitment Therapy (ACT) offers a transformative framework for navigating self-adjustment following a brain injury, stroke or neurological diagnosis, helping individuals build meaningful lives whilst acknowledging cognitive change rather than fighting against it.
Why traditional approaches fall short with cognitive adjustment
Conventional rehabilitation often emphasises restoration- working to regain lost abilities through repetitive exercises and compensatory strategies. Whilst these approaches have merit, they can inadvertently foster a mindset of constant striving against deficits, potentially increasing frustration when progress plateaus.
For many experiencing cognitive change, the gap between pre-injury capabilities and current function becomes a source of persistent distress. Traditional cognitive rehabilitation may unintentionally reinforce this gap by focusing primarily on deficit reduction, sometimes overlooking the psychological suffering that accompanies the loss of cognitive abilities.
ACT offers a complementary perspective: rather than solely targeting symptom reduction, it addresses the person’s relationship with their cognitive changes, fostering psychological flexibility that enables meaningful living despite ongoing challenges.
Core ACT principles in cognitive rehabilitation after brain injury
- Cognitive Defusion from Unhelpful Thoughts Following cognitive change, individuals often experience intrusive thoughts about inadequacy, failure, or loss. ACT techniques help create distance from these thoughts without attempting to eliminate them. For someone with memory difficulties, this might mean acknowledging “I’m having the thought that I’m useless” rather than accepting it as truth, thereby reducing its behavioural impact.
- Acceptance Without Resignation ACT distinguishes between passive resignation and active acceptance. Accepting cognitive change doesn’t mean giving up on improvement; it means reducing the exhausting struggle against unchangeable realities whilst channelling energy toward achievable goals. This shift often paradoxically improves engagement with rehabilitation by removing the emotional burden of constant resistance.
- Values-Based Goal Setting Rather than focusing solely on deficit remediation, ACT helps individuals identify core values that transcend cognitive function. A former accountant with dyscalculia might discover that their underlying value wasn’t mathematics but helping others organise their lives — a value that can be honoured through adapted roles. This values clarification provides direction when traditional markers of success feel unreachable.
- Present-Moment Awareness Cognitive change often triggers rumination about lost abilities or anxiety about future decline. ACT’s mindfulness components help individuals engage with current experiences rather than being trapped in temporal comparisons. This presence-focused approach is particularly beneficial for those with memory impairments, reducing distress about forgotten information whilst enhancing engagement with available experiences.
- Committed Action Despite Uncertainty ACT emphasises taking meaningful steps aligned with values, even when outcomes are uncertain. For someone with executive dysfunction, this might mean attempting social activities despite planning difficulties, using the experience to refine strategies rather than viewing challenges as failures.
Practical integration in neurorehabilitation settings
Implementing ACT within cognitive rehabilitation requires thoughtful adaptation. Metaphors may need simplification for those with comprehension difficulties. Mindfulness exercises might be shortened to accommodate attention deficits. Written summaries can support memory consolidation of session content.
Group ACT interventions show particular promise, allowing individuals to witness others navigating similar challenges whilst building communities of acceptance. Family involvement also proves valuable, helping loved ones understand that supporting acceptance doesn’t mean abandoning hope for improvement.
At The London Neurocognitive Clinic, we combine ACT with traditional cognitive rehabilitation, thereby creating a synergy- practical strategies become more effective when psychological barriers to engagement are addressed. Living well with cognitive change isn’t about denying difficulties or abandoning improvement efforts; it’s about building psychological flexibility that allows meaningful life engagement regardless of cognitive status.
