acceptance and commitment therapy

what is ACT?

• considered a third wave CBT therapy

  • third way inlcudes dialectical behaviour therpay (DBT) and mindfulness based CBT (MCBT)

what does ACT focus on?

• focuses on the function of problematic cognitions rather tan the contnt and differs from the second wave (CBT) in that it does not try to change the or frequency of these private events

what are the three fundamental assumptions of CBT?

• suffering is a normal nd unavoidBLE PART OF HUMAN EXPERIENCE

• peoples attempts t control or avoud their own painful experiences lead to much long term suffering

• action aligned with personla values is key to creating a fulfilling and meaningful life, even when faced with challenges or distressing emotions

who created ACT?

• steven hayes in the 1980s and underpinned by relational frame theory

• draws from different models, including mindfulness, CBT and operant conditioning

what is a main goal of ACT?

• to increase psychological felxibility

• ability to accept experiemces and act in line with values

what is psychological flexibility?

• staying present

• accpeting thoughts an feelings

• acting accoridng to values despite discomfort

what are the six core processes in ACT (hexaflex)

• acceptance

• cognitive defusion

• present moment awareness

• self-as-context

• values

• committed action

what is acceptance?

• allowing thoughts, feelings and sensations to be present

• not trying to avoid, supress, or control yhem

• reduces struggle with internal experiences

what is cognitive diffusion?

• stepping back from thoughts

• seeing them as mental events, not facts

• reduces their influence on behaviour

what is present moment awareness?

• being aware of the here and now

• observing thoughts, feelings and surroundings

• encourages mindful, flexible responding

what is self-as-context?

• seeing yourself as the observed of thoughts and feelings

• recognising you are separate from them

• creates psychological distance from distress

what are values in ACT?

• personal principles about what matters

• provide direction for behaviour

• guide meaningful life choices

what is committed action?

• taking action guides by values

• continuing even when its difficult

• builds a meaningful life despite challenges

what is an example of an excercise in ACT?

• leaves on a stream

what is leaves on a stream?

• a mindfulness exercise where thoughts are placed on leaves floating away

• helps create distance from thoughts (defusion)

• encourages acceptance rather than control

what is the ACT matrix ?

• has four parts

  • the bottom is about inner/mental experineces

  • the top is away sense and experiencing

  • the left is away

  • the right is top

what do each of the four sqaures mean?

• towards

  • things you could do to get closer to the things that are important to you (senses)

  • who and what is important to you (mental)

• away

  • things you do when thoughts and feelinsg show up (non-acceptance)

  • thoughts and feelings that show up when things get tough (fusion)

what are the 6 steps in ACT intervetion?

1. assessmnet and formualtion

   1. build collobartion and value based goals

2. acceptance looks at unworkable bhevaiours - paradoxical control

3. defusion: notcing thoughts and distancing self from thoughts

4. self as context: notcing rather than being experiences

5. values: identifying values

6. commited action: generating helpful belabours

what is the evidence based example of ACT?

• gloster et al (2020) review of 20 meta-analysis including 133 trails with 12,477 patients

what did gloster et al. (2020) find?

• ACT shows positive effects for a broad range of target conditions

• results showed that ACT is efficacious for all conditions examined, including anxiety, depression, substance use, pain and transdiagnostic groups

• results also showed that ACT was generally superior to inactive controls, treatment as usual and most active interventions conditions

what are the key criticisms of ACT?

• conceptual vagueness

  • act includes many constructs but these are not clearly defined, making them difficult to measure reliably

• measurement issues

  • core processes are often measured using questionnaires with questionable validity

  • this weakens claims about how ACT works

• research quality concerns

  • some meta-analyses suggest methodological weaknesses (small samples, lack of control groups)

  • raises doubts about strength of evidence base

• potentail bias in literture

• mechanisms of change unclear

  • it is debated whether ACT works specifically through psychological flexibility or through more general therapy factors

• overly language based

  • heavy use of metaphors and abstract concepts

  • may not be accessible for all clients (cognitive impairments, different cultures)

• complex and wordy

  • formulations can be difficult to understand and apply in practice

  • reduces usability in some clinical settings