ACT – The Absolute Basics; Acceptance & Commitment Therapy
In this post I begin a series of writing dealing with ACT, Acceptance and Commitment Therapy. The details below are basic, but perhaps just enough to develop more interest in learning about ACT. Here we go!
1) Act, developed mainly by Steven Hayes Ph.D.and based on a foundation of Relational Frame Theory, uses both language and cognition as key components of therapy. However, ACT goes much further than RFT.
2) Act utilizes the Hexaflex Model to ground the therapy process. Within this model ACT focuses on flexible contact with the present moment, no matter what that contact is. It suggests that acceptance of difficulties works better than avoidance of them, in fact showing how avoidance of personal problems often makes condition worse emotionally. Self-as-context is emphasized. The focus is on cognition, emotion, and behavior of the person seeking help. Values are used in congruence with motivation, and cognitive diffusion is taught to free the person from deep “stuckness” in unhelpful thoughts. Finally, once a behavioral action plan is agreed upon, ACT works to obtain clear commitment to action by the person who is suffering. In summary, ACT does its best to reduce/eliminate cognitive and behavioral inflexibility. Ultimately, ACT strives to enhance and expand psychological flexibility on the part of the person seeking help.
3) ACT emphasizes the utter importance of a strong clinical relationship, alliance and trust in therapy. Without such a therapeutic relationship, it is unlikely there will be constructive, positive change.
4) Act utilizes helpful metaphors and reinforcing clinical interventions to support positive change. Act intends to reduce the power on unhelpful verbal rules used by the person hoping to change. For example, ACT notes the hopeless futility of avoiding personal problems and works to get the person unstuck from unhelpful thoughts, emotions, and behaviors. With both personal acceptance of your own cognition, emotion, and behavior (they are important but they are NOT you) – and commitment to valued actions – ACT hopes to improve what needs to be changed in a collaborative relationship.
5) ACT skill building occurs in interactive experiential actions and experiments; ACT pays close attention to positive changes that may occur. In the process ACT is both interpersonal and intrapersonal in nature. With costs-benefits analysis and various forms of behavioral functional analysis, ACT supports personal goals and improved stimulus control via contingencies of reinforcement (very behavioral here).
6) ACT has shown effectiveness in dealing with depression, anxiety, and addictions. More recently, ACT has modified its approach to improve outcomes in trauma treatment. In this process ACT recognizes self-medication contingencies, the role of avoidance in making things worse, as well as intrusive cognitions, emotions, and behaviors. Act hopes to use skillful means (mindfulness in acceptance and defusion) to reduce rigid reactions and fears. Act is flexible enough to complement other forms of evidence-based therapies.
For more information refer to Harris, R. (2019). ACT Made Simple. Oakland, CA: New Harbinger Publications or the various articles and book written by Steven Hayes on this topic.
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha
Author of Mindful Happiness
“experience near empathy” (Kohut), “unconditional positive regard” (Rogers), “hovering attention” (Freud), “the holding environment” in “intersubjective space” (Winnicott), and compassionate awareness to emotional distancing, separation, and dispassion is no easy task. In more in-depth clinical interactions, the process of projective identification between therapist and client may drain your emotional resources; sometimes being “as if” you were the experiencer of your client’s pain and suffering can take a serious toll on your own emotional resources. At time the therapist’s own emotional life lacks the quality of connection experienced in the therapy session. Success in setting emotional boundaries is a very important self-care skill. It may determine your success, failure, joy, or misery in the clinical work you do. It will definitely prevent most case of “burn out.”
helping skills. We suffer just like other people do. Hopefully, our training and experience have given us a bit of a positive edge here. Here are some things you may wish to consider to improve your own level of self-compassion.
may be sexual, physical, or emotional. This form of abuse is so destructive because the child has no cognitive/executive/verbal ways to understand and respond to the experience. The long-term bio-psycho-social-spiritual effects of PVT are quite difficult to treat effectively. One reason for this is that some therapist are determined to utilize their favorite approaches (mainly forms of pure talk-therapy and psychodynamic holding) despite the limited effectiveness that these forms of therapy results in. Still worse for the client is generic talk therapy, often a mixture of various talk-therapy components but no actual evidence-based method of helping. Remember it is our obligation to Do No Harm and to use therapeutic interventions beyond alliance that are effective. There may be moral if not ethical implications here.
outcomes. In the interest of research, of course other therapies have been found to be effective with trauma. To mention a few, these are EMDR, DBT, PET, and, Briere’s self-trauma therapy with slow, complete exposure work. MBSR and ACT may be helpful regarding emotional dysregulation in traumatic re-experiencing and self-empowerment. Of course effective attachment therapy with very specific object relations correctives is also helpful.
positive thoughts and emotions. When we get stuck in negative cycles of thinking, feeling and doing our right brain and limbic area dominate. A very old mindfulness belief is that you are not your thoughts, your emotions, or your behaviors; these parts of you are simply associated with your life experiences. When a client learns to defuse a though it means they have changed its linguistic structure and removed it from being cemented into their CABs, or cognition-affect-behavior cycles. In all good therapies, especially Cognitive-Behavioral Therapy and various mindfulness therapies (MBCR, DBT, MBCT, MBRP, ACT), helpers often work on truth-analysis of unhelpful, repetitive, negative thoughts patterns – especially those embedded into CABs cycles of ineffective experiences. Self-medication, isolation, and avoidance are commonly associated with these realities. Sometimes this work includes meta-cognitive analysis regarding your thoughts about your thoughts or the patterns of your thoughts. The clear logic is that the words we often tell ourselves in times of stress or fear are NOT often true. Of course, if indeed you are seriously endangered best to allow your limbic brain area to save your life. The list below will note various approaches used to defuse thoughts from our experience of being, our CABs cycles.
example: “I am so worthless” helps solidify your brain plasticity about personal meanings and images. Try this: “Sometimes I feel worthless” or “When really bad things happen, I can feel worthless” or “My unpleasant feeling can relate to feeling less worthwhile.”