Acceptance and Commitment Therapy (ACT)

ACT (Acceptance and Commitment Therapy) is a psychological and psychotherapeutic intervention developed within a coherent theoretical and philosophical framework and based on experimental evidence, which uses acceptance and mindfulness strategies along with strategies of commitment to action and behavior modification, to increase psychological flexibility (Hayes, 2005).

The term psychological flexibility refers to being fully in touch with the present moment as a conscious human being and, based on what the situation allows, changing or persisting in behaviors that pursue the values each person has chosen as important.

The goal of ACT is to help people choose to act effectively (concrete behaviors in line with their values) in the presence of difficult or interfering private events.

ACT was founded by Steven C. Hayes, a professor of psychology at the University of Nevada in the United States. Acceptance Commitment Therapy (ACT) can be defined as one of the third-wave therapies in the cognitive-behavioral psychotherapy landscape.

According to Steven Hayes’ vision, ACT (Acceptance and Commitment Therapy) is part of a larger movement, based and built upon previous behavioral and cognitive-behavioral therapies. However, some concepts present in the ACT body structure are characterized by peculiar instances that constitute a new evolutionary phase, both from a theoretical and applicative point of view.

The so-called “third wave” therapies are characterized by contextually and experientially based change strategies (in addition to the more didactic-directive aspects) and by a strong sensitivity to the context of psychological phenomena and not to their form or content. In short, the focus is on mental processes.

ACT, as a third-wave therapy has some distinctive features compared to other types of cognitive-behavioral psychotherapy:

  • focus on acceptance processes;
  • focus on cognitive decentering;
  • focus on what is important to the individual in life (values).

ACT is a form of cognitive-behavioral therapy that aims to increase personal abilities to pursue meaningful individual goals and values.

The theoretical model: Relational Frame Theory

ACT is based on a theoretical-philosophical model known as Relational Frame Theory. According to this theory, in the human being, language is based on the learned ability to relate events in an arbitrary way (by derivation of relational frames, the core of language and not necessarily by direct experience). The central conception of ACT is that psychological suffering is usually caused by the interface between language, thought, and the control of direct experience over behavior.

The origin of psychological suffering lies in the normal function of some human language processes (e.g., problem solving) when applied to the resolution of private/internal experiences (e.g., thoughts, emotions, memories, bodily sensations, etc.), rather than to the resolution of events/situations in the external world.

Such mental processes lead the individual to make meaning and experience thought in a literal way. Therefore, if I have a thought of inadequacy then “I am inadequate”. The excess of such a process leads to what in ACT is called the conceptualized self (an uncomfortable and dysfunctional mask that we wear, see next paragraph).

The goal of ACT is to promote the psychological flexibility of the individual. According to the model, psychological flexibility can be achieved (or at least promoted) through interventions on what are considered the six pillars of the ACT model.

According to the ACT model, what promotes change and psychological well-being is a set of acceptance and commitment skills. These attitudes, if maintained and experienced over time, lead to psychological flexibility, and therefore better health.

The six pillars of ACT

According to Acceptance Committment Therapy (ACT), psychological flexibility can be promoted through interventions on what are considered the six pillars of the ACT model. The six key processes, subtend two macro-areas. The two macro-areas in question are: 1) the “processes of mindfulness and acceptance”; and 2) the “processes of behavioral modification and committed action according to values”.

Experiential avoidance

The first key process targeted by the ACT intervention is experiential avoidance. Experiential avoidance is the set of strategies that we implement with the purpose of controlling and/or altering our internal experiences (thoughts, emotions, feelings, or memories), even when this causes behavioral harm.

Attempts to control anxiety, thoughts to control other thoughts (e.g., brooding), trying hard not to think or remember a pain through harmful and dysfunctional behaviors. Experiential avoidance also takes the form of attempts to escape or control external experience, such as avoiding anxiogenic situations, avoiding conflict, or expressing anger.

The functional counterpart of experiential avoidance in ACT is called “Acceptance” and can be defined as “allowing space” or “opening to the experience” of painful emotions and painful thoughts and memories. In this sense, ACT therapy aims to promote certain tendencies of acceptance: a) not judging our internal (and external) experiences with a malevolent gaze of the inquisitor of ourselves; b) welcoming emotional states and giving them the “informational” importance they deserve; c) weakening the power of thoughts over our behavior and daily experience.

Cognitive fusion

The second process fundamental to ACT is cognitive fusion. In ACT, “cognitive fusion” is defined as the tendency of human beings to be captured, “harnessed” by the contents of their thoughts. The principle that justifies the dysfunctionality of this “attachment to thoughts” is summarized in the following sentence: It is not so much what we think that creates problems and suffering but the way we relate to what we think.

When we are “fused” with our thoughts, especially our dysfunctional thoughts, we forget that we are interacting with a thought and not an actual event, kind of like our thoughts and assessments of reality are living instead of us.

The virtuous counterpart of cognitive fusion, in ACT is Defusion. Therefore, it is of primary importance to intervene not on the content of the dysfunctional thoughts, but on how the individual relates to their thoughts. In this way, one focuses on the attitude toward one’s thoughts and not the thoughts themselves. For example, having dysfunctional thoughts of the depressive or anxious type makes little difference from the ACT perspective: it is the influence they have on the individual’s life (dictated by the individual’s attitude toward their depressive/anxious thoughts) that defines their impact on individual suffering.

Dominance of the past and future over the present moment

The third key process that Acceptance Committment Therapy focuses on is the “dominance of the past and future over the present moment.” This process can be defined as a set of difficulties in directing and maintaining attention on the present moment and changing the focus of attention among the various dimensions of one’s existence. All the energies of the individual are focused on a “theme” or a difficulty and from that topic can not get out, thus limiting its influence in their lives. Prototypical examples of dominance of the past or future over the present moment are brooding and depressive ruminations. When brooding or ruminating on the past, such processes require a lot of energy and focus all our attention on the process itself.

The proposal of ACT intervention is to promote contact with the present moment, to be psychologically present and available to what happens in the present moment. We human beings, for reasons related to a kind of “mental economy”, we naturally tend to perform many daily activities without paying attention to what we do. As if our actions were often managed by an “autopilot” that allows us to carry out several activities simultaneously. Although, on many occasions, this automaticity is useful and functional, there are several occasions when acting automatically and losing touch with what we are doing is harmful and dysfunctional for our lives. Getting in touch with the present moment also means consciously choosing to bring one’s attention to what is happening inside me and in the external physical world at that precise moment.

The conceptualized self

The fourth key process in Acceptance Commitment Therapy is the “Conceptualized Self.” We might define the conceptualized self as a set of “fusions” of definitions of ourselves that one’s mind tells us. These definitions usually touch on nuclear aspects that are relevant to the definition of self and self-in relation to others. When this process is very present and can be damaging, we identify strongly with the contents of our own mind.

There are various forms that the conceptualized self can take in our daily lives. Some of the most common may be the “labels” we give ourselves. Think, for example, of being “the sick one”, “the unfortunate one”, “the clumsy one”. On other occasions, the conceptualized self takes on the content of rigid fixations on specific problems, a block that leads to failure to grasp the evolution of experience. On still other occasions, the conceptualized self may be characterized by “fusions” with certain rigid and abstract/valuative aspects of self.

The conceptualized self is a mask so glued to the skin of our face that we forget we are wearing it and it becomes our eyes, ears, and mouth. The conceptualized self contains a complex description of ourselves that we have become attached to and soon becomes so crystallized that we mistake it for absolute reality. Thus, an issue such as an anxiety problem (but it really applies to any kind of difficulty) morphs into the conceptualized self “I am an anxious person” and no matter how many experiences I have in which I have not experienced that strong and frightening anxiety, I still verbally describe myself as “I am an anxious person.”

What ACT suggests as the virtuous counterpart to the conceptualized self is The Self as Context. The self as context is a new, sometimes unexperienced point of view in which we learn to observe our internal and external experience from a privileged vantage point, namely that of a “participating, kind, compassionate, and curious observer” of our own experience. What ACT promotes is the observation of experiences as they occur, through a mindful, self-reflective look at one’s own experience as it happens.
This could lead to discover that we ourselves can learn to observe our experience while it happens, to look at it in a curious way and in this way broaden the horizon of possibilities, of choices and recognize in this way which is the mask we wear.

Lack of contact with one’s own values

A fundamental process on which Acceptance and Commitment Therapy works is what is called the “lack of contact with one’s own values”. This expression refers to the set of difficulties related to the identification of what is important to the individual and what would make his or her life meaningful and rich. In some cases, one can observe the confusion and emptiness of personal goals and individual objectives. Basically, people who have difficulties in the process “Lack of contact with their values” have difficulty in answering the question: “what do I want from life?” or “what is important to me?” or “what are my values?”.

The term values in ACT means something other than personal goals, concrete aspirations, and morals. We might define values as “long-term desired qualities of life”; Hayes et al., 2006). Values are what motivate people to change, to face difficult times. The difficult choices in our lives are often made by being guided by our values. Values are often end goals, guiding committed action in life. We can approach our values through sets of goals that are concrete, doable (workable, one of the key words of ACT) and practicable.

Lack of activity and commitment to pursue personal value

The sixth pillar of Acceptance and Commitment Therapy is the process called “lack of activity and commitment to pursue personal value.” This expression refers to the phenomenon that even when we manage to become aware of our harmful mechanisms, our meltdowns, the masks we wear, and the moments of mindlessness, there is still one important step left to take, and that is to commit to taking action and pursuing our values.

The most damaging obstacles to such commitment can be summarized in two categories of behaviors: impulsivity and persistent avoidance. Both of these behaviors lead to living a life characterized by restriction of activities and rigidity of behavioral repertoire. Always doing the same things, always avoiding the same situations is equivalent to not doing.

The proposal of ACT lies in the concept of “committed action”: the term is used to define personal action guided by one’s own values, but it requires the individual to “come to terms” with his or her own difficulties and fragilities. Accepting and coming to terms with one’s own frailties and guiding one’s actions on the basis of one’s personal values makes it possible to pursue a meaningful and rich life, not without suffering, but satisfying and chosen. Particularly important for Acceptance and Commitment Therapy is the concept of workability, of “feasibility”. A committed, purpose-driven action must also be feasible, actionable. In other words, committed action is about continually choosing to commit to actions in the direction of one’s personal values, despite the difficult emotions one may encounter along the way.

References

  1. Hayes, S. C. & Pierson, H. (2005). Acceptance and Commitment Therapy. In A. Freeman, S. H. Felgoise, A. M. Nezu, C. M. Nezu, & M. A. Reinecke (Eds.), Encyclopedia of Cognitive Behavior Therapy. New York: Springer.
  2. Harris R. (2009). ACT Made simple. New Harbinger Publications New York
  3. Harris R. (2011). Fare ACT. Franco Angeli: Milano
  4. Hayes, S.C. &Strosahl, K.D. (2010). A Practical Guide to Acceptance and Commitment Therapy. Springer: New York.
  5. Hayes, S.C., Strosahl, K.D.& Wilson, K.G. (1999). Acceptance and CommitmentTherapy: An ExperientialApproach to BehaviorChange. Guildord Press: New York.

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