Acceptance and Commitment Therapy (ACT)

1. Acceptance and Commitment Therapy (ACT) Hayes, Strosahl and Wilson (1999)

2. 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’

3. 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?

4. Imagining • Planning • Evaluating options • Predicting consequences • Choosing the best option • Reflecting on the plan

5. 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

6. 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

7. 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.

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

14. Contact with the Present Moment Acceptance Values Acceptance Commitment Therapy Defusion Committed Action Self-As-Context

15. 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

16. 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

17. 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

18. 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

19. 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.

20. 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

21. 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

22. 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

23. 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.

24. 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’