Transcript Acceptance and Commitment Therapy (ACT)

Hayes, Strosahl and Wilson (1999)
Definition
 ‘ACT is a psychological intervention based on modern
behavioural psychology, that applies mindfulness and
acceptance processes, and commitment and behavior
change processes, to the creation of psychological
flexibility’
The importance of language
 Be careful here!
 When I say language I mean;


Spoken language
Private language
 Imagine you are stuck in a room where all the doors
and exits are locked. You only have one chance to get
out.
 What would you do?
 Imagining
 Planning
 Evaluating options
 Predicting consequences
 Choosing the best option
 Reflecting on the plan
 Solutions
 Using a phone
 Kicking down the door
 Calling a spouse
 Breaking a window
 Now consider risks for each of the solutions
 Cell doesn’t have reception
 The door is too strong
 You're spouse cant hear you
 You're on the 8th floor
 Remember this hasn’t actually happened!
 Using only your mind, and the language it has, you
have;
 Created options
 Evaluated them
 Compared them
 Chosen the best option
 Reflected
 Thought of all the possible risks
 This process of languaging/thinking is very important
 Our verbal/cognitive skills enable us to problem solve
in the external world with relative ease and speed
 And it near enough ensures that human beings are the
dominant species on the planet despite being weak,
slow and poorly defended.
 However! Language also has a dark side!
 Our abilities to compare, analyse, evaluate, weigh up
the risks etc. can also lead to psychological issues
 For example, think of someone who compares
themselves to their friends in terms of love, money,
success. Even worse think of someone who compares
their current self to how they envisaged themselves to be
ten years ago
 Such skills bring close a whole host of thoughts and
feelings that are downright unwanted. And how do we
deal with them? In the same way we do in real life;
avoidance.
 Imagine that instead of being trapped inside a room,
that you are instead trapped inside of intense
depression
 What do you do to get out of it?
 Drugs
 Don’t think about it
 Drink
 Bed
 Your problem solving abilities are just as strong in this
context and would provide all sorts of escape options
 The same problem solving skills that are super helpful
in the real world may not be helpful in the realm of
psychological health.
 ACT is based on the principle of Experiential
Avoidance (EA).
 The more you try to get away from or solve psychological issues,
the less you solve and the worse things get.
 The same tools that work well in the external world
may cause real harm when turned toward the internal
world
 Put more simply, ACT is interested in promoting healthy
behaviors
 It understands that many of us listen to our problem solving
mode of mind when it comes to psychological issues i.e. we try to
escape feeling down/angry/anxious etc.
 However the more we try to avoid feeling these ways, the more
our lives generally constrict.
 For example
 In the real world, if we fear a future drought, we buy water. And in
the internal world, if we fear future rejection, then we make sure
no-one will ever hurt us by not connecting with people
 Sometimes the cost of avoidance can be vast
 The point of ACT is to learn to use our minds only
when they are helpful for us. And to catch our mind
each time it stops us from acting in a value consistent
way.
 In a more precise way, ACT aims to enable us to have
the psychological flexibility to experience both good
and bad feelings, and control our behaviour to create
meaningful and rich lives
 The ACT model has been created to help us achieve
psychological flexibility
 ACT is comprised of 6 core processes that are
displayed in a diagram called The Hexaflex
 The aim of this course is to introduce you to each of
these components in detail
 For now, we will just touch on them
Acceptance Commitment Therapy
Contact with the
Present Moment
Acceptance
Values
Essential
Components
of ACT
Defusion
Committed
Action
Self-As-Context
Acceptance
 Can be called acceptance, but is better described by
the word willingness
 Not resignation
 Actively embracing all private events (both painful and
joyful) without attempting to alter the frequency or
form
 The idea is to let clients let go of their struggle
 This is directly opposite to Experiential avoidance
where attempts are made at altering both form and
frequency of unwanted thoughts
 Importantly, acceptance is used in ACT to foster values
based action that may previously had been avoided
Defusion
 The core theoretical posture behind mainstream CBT
is that clients need to rid themselves of negative
unwanted content to facilitate behavior change
 ACT and other third wave therapies are the exact
opposite to this
 ACT suggests that people can live and behave in a
value consistent manner in the face of challenging
thoughts
 To help them do this ‘defusion’ aims to create distance
between the client and their thoughts
Defusion
 People in general tend to be fused with thoughts, and
attach some literal truth and importance to them
 However in some context these thoughts are not
helpful
 Defusion techniques aim to reduce the impact of
thoughts by altering their believability
 Defusion examples include
 I’m having the thought
 Word repetition exercise
 Thanking your mind
 Silly voices
Being present
 Too many of us live our lives ruminating on the past or




worrying about the future
When we do this we lose contact with the present
moment, and all that it offers to us
ACT promotes on-going non judgemental contact with
psychological and environmental events as they occur
When in the present moment, people are flexible,
responsive and aware of the possibilities afforded by
the context
This, in popular psychology is called mindfulness
 The ability to control our attention in a flexible manner
Self as context
 When asked many questions about our history or
experience, the only thing that will be consistent is not the
content of the answer, but the perspective from which the
answer occurs.
 For example, what is common about the answers to these
questions; what did you eat, what do you want, to whom did you
talk?
 Sometimes we tend to create an attachment to the
conceptualized self i.e. over the course of time we
build a story of ‘who we are’. This is made worse by the
fact that the majority of this ‘self’ has truth in it.
Self as context
 However, sometimes this attachment to ‘who we are’
(the conceptualized self) make us inflexible and rigid
in our behavior
 ACT aims to get clients in contact with self as context.
In this place clients let go of their attachment to who
they are in situations where it is not useful
 Self as context is a continuous and secure ‘I’ from
which events are experienced, that is distinct from
those events
 The point is to develop a sense of ourselves as
observers, independent of the particular experience
being had at that moment
Defining Valued directions
 What are the things that are most important to you?
 What are the things you care about most?
 What would you like written on your tombstone?
 In many areas of life we lose touch with the things
important to us






Family
Friends
Career
The environment
Religion
Health
 ACT aims to enable clients to fully contact their values
Committed Action
 Finally, ACT encourages the development of larger and
larger patterns of behavior linked to the clients values
 Clinicians will set achievable goals for their clients
 And then they will look at the possible barriers to
achieving their goals and underlying values
Final points
 Each of the processes in ACT are interrelated and
overlapping. The left hand side of The Hexaflex are the
mindfulness and acceptance processes whilst the right
hand side are the commitment an behavior change
processes
 Importantly, all come together to foster a state of
psychological flexibility - the process of contacting
the present moment fully as a conscious human being
and persisting in behavior change in the service of
chosen values.
Definition
 ‘ACT is a psychological intervention based on modern
behavioural psychology, that applies mindfulness and
acceptance processes, and commitment and behavior
change processes, to the creation of psychological
flexibility’