ACT- Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT)

Overview of ACT

  • Definition of ACT:

    • "ACT is a therapeutic approach that uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility."

    • Reference: Hayes, Wilson, Strosahl, 1999

Origins of ACT

  • Historical Context:

    • ACT is considered a "third wave" behavioral therapy.

    • Focuses on changing the individual's relationship with their experiences rather than altering the experiences themselves.

  • Other Therapies in the Same Wave:

    • Dialectical Behavior Therapy (DBT)

    • Mindfulness-Based Cognitive Therapy (MBCT)

    • Functional Analytic Psychotherapy (FAP)

The ACT Question

  • Core Inquiry:

    • Aspirational query posed in ACT:

    • "Given a distinction between you and the stuff you are struggling with and trying to change, are you willing to have that stuff, fully and without defense, as it is, and not as what it says it is, AND do what takes you in the direction of your chosen values at this time, in this situation?"

Relational Frame Theory (RFT)

  • Fundamental Concepts:

    • "Where can you go that your thoughts can't find you?"

    • Highlights the ability to relate anything to anything, similar to the concept of virtual reality.

  • Summary:

    • RFT asserts that "WORDS MAKE MONSTERS REAL."

Implications for Clinicians

  • ACT Theory of Change:

    • Psychological issues stem from thought and language.

    • Goal: Achieve psychological flexibility by engaging with the present moment, leading to persistent movement towards valued outcomes.

    • Verbal regulations impose rigid rules that hinder progress towards these values.

Key Concepts in ACT

  • Cognitive Fusion:

    • The tendency of humans to engage with a heavily structured world defined by literal language.

    • Verbal constructs can replace lived experiences.

    • Individuals often can't differentiate between an evaluated world and direct sensory experiences.

  • Cognitive Fusion: Reason Giving:

    • Individuals view reasons as causes for their behaviors, impacting progress, especially in valued domains.

    • Societal expectations create pressure to justify actions with coherent explanations.

  • Dominance of the Conceptualized Past and Feared Future:

    • Common phrases include "Coulda, shoulda, woulda," "If only," and "What if?"

    • Results in guilt, shame, and fear dominated by past and future thoughts.

  • Weak Self Knowledge and Values Clarity:

    • Feelings of uncertainty about personal desires and identity:

    • Expressions like, "I don't know what I want" or "Nothing matters to me."

    • Aversion to emotions such as fear, shame, and loneliness.

  • Inactivity, Impulsivity, or Avoidant Persistence:

    • Manifestations include:

    • Couch potato behavior reflecting depression.

    • Addiction patterns characterized by self-doubt concerning effort and persistence.

  • Attachment to the Conceptualized Self:

    • Individuals often define themselves through roles:

    • Examples include labels like "I am an attorney" or "I am a loser."

    • Satisfaction is tied to meeting perceived expectations.

  • Experiential Avoidance:

    • Described as efforts to avoid internal experiences like thoughts and emotions.

    • Growing evidence shows that experiential avoidance contributes to most psychological disorders.

Core ACT Processes

  • Acceptance:

    • Defined as an active embrace of the present moment, fully and without defense.

    • Contrasts with experiential avoidance.

    • Acceptance is a willingness to choose action aligned with values, rather than a mere decision based on thoughts or feelings.

  • Cognitive Defusion:

    • Focuses on the functional aspect of thoughts rather than content.

    • Describes how fusion with thoughts can limit presence and responsiveness.

    • Encourages flexible interaction with thoughts, understanding they do not cause behavior.

  • Self as Context:

    • Refers to awareness as a space for experiencing thoughts and emotions without judgment.

    • Distinction made between self-evaluations versus the experiences themselves.

    • It is best understood through direct experiences rather than conceptual narratives.

  • Contact with the Present Moment:

    • Emphasizes that acceptance and defusion facilitate engagement with the current moment.

    • Presence is associated with vitality and creativity, and it is reinforced through the therapeutic relationship.

  • Values:

    • Defines clarified values as a guiding system for behavior.

    • Differentiation between values and goals: Values guide actions, whereas goals are milestones.

    • Emphasizes relinquishing control over experiences to pursue valued outcomes.

Values Clarification Exercise

  • Activity: List values while considering the metaphor of going west, aiming for clarity in decision-making.

Committed Action

  • Primary Goal of ACT:

    • To encourage committed actions towards valued aims, no matter how small.

    • Movement towards values enhances vitality and the growth process.

    • Action is key in overcoming barriers and activates other core interventions.

ACT Therapeutic Relationship Model

  • Components:

    • Involves both client and practitioner psychologies in therapeutic interactions.

ACT Therapeutic Posture

  • Principles:

    • The client’s experience is not adversarial; practitioners should embrace it.

    • Need to avoid rescuing clients but instead support their journey through difficulty.

    • Emphasis on compassionate acceptance without requiring rationalizations from clients.

  • Approach:

    • Practitioners should remain relatable, acknowledging shared experiences with clients.

    • The focus should be on the function of behaviors instead of their forms or frequencies.

    • Always reflect on what serves the client’s best interests.

Empirical Evidence Supporting ACT

  • Substance Abuse:

    • ACT outperformed traditional 12-step programs.

  • Smoking Cessation:

    • ACT better than nicotine patches (n=67):

    • At one-year follow-up, 35% in ACT maintained quit rates versus <10% for nicotine patches.

  • Chronic Pain:

    • ACT led to quicker return to work and fewer sick days; reduced self-reported pain.

  • Stress Management:

    • In a study, ACT was more effective than prior behavioral approaches in mitigating workplace stress and anxiety.

  • Depression:

    • Study (n=18 over 12 weeks) showed ACT had superior outcomes at six-month follow-up compared to Beck’s Cognitive Therapy, reducing believability of depressive thoughts.

  • Epilepsy:

    • In 2004, 27 South African epileptics receiving 9 hours of ACT had fewer seizures than the placebo group.

  • Psychosis:

    • ACT led to:

    • a) 50% reduction in hospitalization rates;

    • b) increased symptom acceptance even with self-reported symptom escalation;

    • c) reduced believability of distressing thoughts.

  • Panic Disorder:

    • ACT methods improved exposure outcomes compared to control strategies in clients with panic disorders.

  • High-Risk Sexual Behaviors:

    • ACT components effectively reduced high-risk sexual behaviors in adolescents.

  • Social Phobia:

    • ACT showed higher success rates than CBT in reducing fears around public speaking.

Learning ACT

  • Recommendations:

    • Join the Association for Contextual Behavioral Science (ACBS) and engage with the ACT and RFT communities.

    • Suggested readings for foundational understanding and practice.

Final Reflections

  • Existential Consideration:

    • Acknowledges that with the only certainty being death and its uncertainty, ACT provides a framework for individuals to confront what matters in their lives now.

    • ACT serves as a pathway to finding clarity amidst uncertainty.