Acceptance and commitment therapy

Overview

Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.

A therapist and a client during an Acceptance and Commitment Therapy session.

History

The history of Acceptance and Commitment Therapy (ACT) is rooted in the philosophy of functional contextualism and the theory of Relational Frame Theory (RFT). ACT was developed within a coherent theoretical and philosophical framework known as Functional Contextualism. ACT is based on Relational Frame Theory, a comprehensive theory of language and cognition that is an offshoot of behavior analysis.

Theory and Philosophy

ACT is based on the idea that psychological suffering is usually caused by experiential avoidance, cognitive entanglement, and resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values. As its name suggests, ACT is focused on helping clients to commit to action that is consistent with their own values. This is done by helping clients to experience difficult thoughts, feelings, memories, and sensations fully and without defense, as they are, not as what they say they are, and with all their needless layers of history stripped away.

Techniques

ACT uses six core processes (Acceptance, Cognitive Defusion, Being Present, Self as Context, Values, and Committed Action) to help clients develop psychological flexibility.

Acceptance

Acceptance in ACT is not about resignation or giving up, but about facing reality as it is. Acceptance involves the active and aware embrace of those private events occasioned by one's history without unnecessary attempts to change their frequency or form.

Cognitive Defusion

Cognitive defusion techniques attempt to alter the undesirable functions of thoughts and other private events, rather than trying to alter their form, frequency or situational sensitivity.

Being Present

Being present involves ongoing non-judgmental contact with psychological and environmental events as they occur. The goal of these mindfulness exercises is to help clients become more aware of their experiences in the moment and to develop a kind of transcendent sense of self.

Self as Context

Self as Context is fostered through exercises that help the client to cognitively de-fuse from the conceptualized self and to contact a more transcendent sense of self, a continuity of consciousness that is unchanging.

Values

Values are chosen qualities of purposive action that can never be obtained as an object but can be instantiated moment by moment. ACT uses a variety of exercises to help a client choose life directions in various domains (e.g. family, career, spirituality) while undermining verbal processes that might lead to a literal and destructive mode of managing those domains.

Committed Action

Committed action involves the client setting goals according to their values and carrying them out responsibly. ACT promotes the development of larger and larger patterns of effective action linked to chosen values.

Applications

ACT has been used effectively for a variety of mental health disorders, including depression, OCD, workplace stress, chronic pain, the stress of terminal cancer, anxiety, PTSD, anorexia, heroin abuse, marijuana abuse, and even schizophrenia.

Research

Research seems to suggest that ACT works through different processes than traditional CBT, and that it might be useful for a different range of problems.

Criticism

Like any approach, ACT is not without its critics. Some argue that the empirical evidence for ACT is thin, others argue that it is conceptually overcomplicated.