Third wave ACT

What were the key approaches in the first wave of psychological therapy?

Behaviour therapy (classical conditioning, e.g. alcoholism & emetic) and psychodynamic therapy.

What therapies emerged in the second wave of psychological therapy?

Cognitive therapy and cognitive behavioural therapy, focusing on irrational thoughts.

What defines the third wave of psychological therapy?

Mindfulness-based approaches.

Why do we need talking therapies?

Because language and thinking, while vital for problem solving and survival, can also create threat interpretations that fuel anxiety and distress.

What does “Better to miss lunch than be lunch” mean in this context?

It illustrates how our minds evolved to prioritize detecting danger, even when it leads to unnecessary anxiety.

What is thought suppression?

The attempt to avoid or distract from difficult thoughts or feelings.

What did the white bear experiment show?

Trying not to think about something increases its frequency and strength.

What is derived relational responding?

The ability to relate stimuli to one another, meaning any stimuli can become connected in our minds.

Why can avoidance be problematic?

It prevents us from learning to cope with experiences and can increase distress or disability.

What is experiential avoidance?

Avoidance of internal experiences like thoughts, feelings, or sensations.

What did McCracken (1998) find about chronic pain and avoidance?

Psychosocial disability was predicted more by the experiential avoidance of pain than by the degree of pain.

What did Feldner et al. (2006) find about pain tolerance and avoidance?

People with high experiential avoidance had lower pain endurance and tolerance and recovered more slowly.

What is Acceptance and Commitment Therapy (ACT)?

A therapy that promotes openness to difficult experiences and focuses on actions guided by personal values instead of avoidance.

What are the six core processes of ACT?

The Present Moment, Defusion, Acceptance, Values, Committed Action, and Self-as-Context.

What is psychological flexibility in ACT?

The ability to stay in contact with the present moment while behaving in ways consistent with one’s values.

What does “Be Here Now” represent in ACT?

The Present Moment process—focusing awareness on current experiences.

What is defusion in ACT?

Recognizing thoughts as just thoughts, not literal truths or commands.

What is acceptance in ACT?

A willingness to experience thoughts, feelings, and sensations without judgment or avoidance.

What are values in ACT?

Deeply held principles that guide and motivate behavior.

What is committed action in ACT?

Taking concrete steps toward one’s values despite discomfort or obstacles.

What is self-as-context in ACT?

The observing self that maintains awareness and perspective beyond thoughts and feelings.

How does avoidance interfere with important actions?

By escaping or avoiding experiences, people often neglect meaningful life goals.

What is cognitive defusion?

Techniques to separate oneself from thoughts, reducing their power and influence.

Give examples of cognitive defusion exercises.

“I’m having the thought that…”, using a funny voice (e.g. Mickey Mouse), repeating words, naming the mind.

What does research show about cognitive defusion?

Donald et al. (2016) found it predicted more approach coping and less avoidance coping.

What is the main goal of ACT?

To help clients lead a valued, purposeful life.

How are values different from goals in ACT?

Values are ongoing life directions; goals are specific achievable outcomes that serve those values.

Give examples of ACT values exercises.

Eulogy or retirement party speech, values ranking and effectiveness rating.

What is the purpose of committed action?

To define specific targets and progress toward living by values.

What are helpful questions for exploring committed action?

“What are you not doing that would take you in that direction?” and “What barriers are getting in the way?”

What does the “observing self” mean in ACT?

The part of consciousness that notices experiences rather than being defined by them.

What is the purpose of self-as-context exercises?

To develop perspective-taking and loosen attachment to self-stories.

Give examples of self-as-context exercises.

“And who is noticing that…?”, small child exercise, letter from wiser future self, chair exercise.

What is the “torch in the dark” metaphor about?

It represents awareness illuminating experiences without judgment.

What is the evidence base for ACT?

Over 1000+ randomized controlled trials (as of Aug 2025) supporting its effectiveness for various conditions.

Which organizations recognize ACT as evidence-based?

US Substance Abuse and Mental Health Services Administration (2012) and American Psychological Association (2016).

For which conditions does ACT have strong research support?

Chronic pain, and modest support for depression, OCD, psychosis, anxiety, and generalised anxiety disorder.

Case Example 1 – What ACT techniques could help a patient with health anxiety who avoids thoughts of cancer?

Cognitive defusion (“I’m having the thought that…”), acceptance of anxiety, mindfulness of thoughts, and values-based engagement with family.

Case Example 2 – What are the fused thoughts of a patient who says “I have no self-control” and “I can’t stick to diets”?

“I have no self-control,” “I can’t change,” “I always fail,” “I’ll never succeed.”

Case Example 2 – What techniques could help that patient?

Cognitive defusion, self-as-context, and values clarification to promote flexible, values-based behaviour change.

Case Example 3 – How could values and committed action help a housebound patient with severe anxiety?

Identify valued life directions (e.g. family, independence) and set small, actionable steps toward leaving the house in alignment with those values.