ACT and Third Wave therapies

What was the primary focus of the 1st wave of Behavioural Therapies (BT)?

The application of theories of learning to clinical issues with an emphasis on first-order behavior change.

Who are prominent theorists in first wave behavioural therapies?

• Pavlov (Classical conditioning ) - pairing stimuli and response

• Skinner (Operant conditioning)

• Bandura (Social Learning Theory)

According to the 1st wave perspective, where does suffering arise from and what was the solution to tackling it?

• Suffering: Maladaptive learned behaviours and responses to environmental stimuli.

• Solution: to modification of these learned behaviours (change your behaviour or the environment), incl. behavioural activation, exposure, etc

What was the shift in focus for the 2nd wave (CT/CBT)?

The application of learning from the "cognitive revolution," identifying cognitive biases and irrational beliefs.

Who are prominent theorists in the 2nd wave of behavioural therapy?

• Beck (Cognitive Behavioural Theory)

• Ellis (Rational Emotive therapy - ABC model)

According to the second wave, where did suffering arise from and what was the solution to tackling it?

• Suffering is caused by cognitive biases & irrational beliefs.

• Solution: cognitive restructuring & identification of such biases (change your behaviour & your thinking).

What is the core difference in how 3rd wave therapies relate to thinking?

Instead of just changing content and behaviour, they focus on changing the individual's relationship to their thinking.

Why does ACT focus on context and function in behavior?

Because behaviour cannot be understood without its context and consequences; the same behavior can have different meanings in different situations.

What is the primary goal of Acceptance & Commitment Therapy (ACT)?

To promote psychological flexibility—the capacity to embrace necessary pain to allow for committed, life-affirming action.

Upon what two theoretical foundations does ACT rely?

Functional contextualism and Relational Frame Theory (RFT).

What does "successful working" mean in functional contextualism?

A focus on what is "true" based on what works to help a person achieve their clear goals and values.

How does Relational Frame Theory (RFT) explain cognitive fusion?

It view cognition as an elaborate entanglement of relational networks that are difficult to remove from language.

What professional body recommends ACT for chronic primary pain in adults?

NICE (National Institute for Health and Care Excellence).

In the Livheim et al. (2015) Swedish study, what were the primary outcomes for the ACT group?

Significantly lower stress, a significant decrease in anxiety, and a marginal increase in mindfulness skills compared to TAU.

How does ACT's view of "negative thoughts" differ from CBT's cognitive restructuring?

CBT addresses faulty thinking to change emotions, while ACT uses cognitive defusion to view thoughts merely as thoughts without literal meaning.

What did Larsson et al. (2015) find regarding the "comfort" of thoughts in defusion vs. restructuring?

The defusion group showed significant improvement in thought believability and reduced comfort, whereas restructuring did not reduce comfort.

What is a "Towards move" in the Russ Harris choice point model?

Behaviour that takes an individual toward their values and allows them to engage in a meaningful manner.

What defines an "Away move" in ACT?

Behaviour that takes a person away from their values, often driven by being "hooked" by difficult thoughts or escaping discomfort.

What is experiential avoidance (EA)?

A pattern of escaping unwanted internal experiences, such as distressing thoughts.

What is the difference between "clean" and "dirty" pain?

Clean pain is natural and unavoidable (like grief); dirty pain results from self-judgement and unhelpful attempts to avoid or control experience.

What is the "Paradox of Control" in ACT?

Attempts to avoid or control inner experiences typically increase problems, narrow behavior, and disconnect people from their values.

According to Akbari et al. (2022), what disorders have moderate-to-large associations with EA?

GAD, depressive symptoms, anxiety symptoms, and PTSD.

Why do individuals often engage in escape and avoidance behaviors despite long-term costs?

Because they often "work" in the short-term through positive or negative reinforcement.

What are the six points of the ACT "hexaflex"?

Acceptance, Defusion, Present moment awareness, Self-as-context, Values clarity, and Committed action.

How does Jon Kabat-Zinn define mindfulness?

"Paying attention on purpose, in the present moment, nonjudgmentally".

What has research shown about Mindfulness Based Interventions?

• Review paper evaluating Mindfulness based interventions (MBI) found that they were significantly more effective than passive control interventions (standard care, waitlist) for reducing pain severity but not more effective than active controls (education, CBT)

What is values clarity?

• Knowing which way to go - qualities of being and action

• Values provide meaning, motivation, inspiration, direction for action in good times; motor to keep us going in challenging times.

How are values defined by Russ Harris?

Your heart's deepest desires for the person you want to be and what you want to stand for in life.

What did Branstetter-Rost et al. (2009) find regarding pain tolerance?

The "Acceptance + Values" group had the greatest pain tolerance in an ice water task compared to acceptance-only or control groups.

What is the opposite of values clarity?

Lack of direction or unclear values

What is present moment awareness ?

• conscious awareness of experience and having the flexibility to move attention in service of ones values

• Enables accurate perception of what is going on, & full engagement - BUT, not about always being present; instead, flexibility to shift between past, present, future as needed.

What is the "opposite" of committed action?

Inaction or action controlled by factors other than one’s own values, such as fear or compliance.

What is the goal of cognitive defusion?

To notice thoughts without getting "hooked" by them and to reduce the control they have over behavior.

• Recognising that we are simply having a thought versus ruminating on the meaning of the thought

What is the opposite of cognitive defusion?

getting mindlessly hooked / controlled by thoughts (fusion); believing them unquestionably.

What is acceptance?

• not being pulled off track and opening oneself up to pain

• Actively contacting experience fully, directly & without needless defence.

What is the opposite of acceptance?

Experiential avoidance

What is "Self-as-context"?

• acknowledgement that the self is not welded to one track

A "transcendent" sense of self that observes and accepts experience without being rigidly fused to any specific role or story.

What is the opposite of self as context?

identification with the temporary contents of experience.

How may self as context be practiced?

The chessboard metaphor, or the self-as-sky metaphor.

• Imagine an event from several months ago, and then focus on the self presently to examine various domains from an observer perspective of those events. "The things you have been struggling with and trying to change are not you anyway"

In the ACT case study of the 18-year-old student, what was the focus of "Values clarification"?

Exploring how his social withdrawal was undermining his values of social connection and learning.

What "Defusion" exercise was suggested for the student's thought "I'm going mad"?

The "leaves on a stream" exercise to observe how thoughts come and go without hooking him.

What is the "Quicksand metaphor" used to illustrate?

The concept of acceptance—that struggling against pain (like quicksand) only makes you sink further.