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Acceptance and Commitment Therapy (ACT)

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Jeremy Hall

on 5 December 2013

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Transcript of Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT)

6 Core Processes
The History
Steven C. Hayes is credited as the founder of ACT in 1986 along with Kelly Wilson and Kirk Strosahl
Fully systematized in 1999
The ACT approach was originally called comprehensive distancing
Empirically validated by over 60 studies conducted on components of ACT
From the behavioral school of therapy
What is ACT?
Being able to direct attention flexibly and voluntarily to present external and internal events rather than automatically focusing on the past or future
Realize that thoughts and feelings do not always lead to actions
Reduce the motivation to avoid certain situations
Accept that painful feelings and sensations are just feelings then turn the struggle switch off
Does not mean accept every situation (abusive relationships)
Acceptance of Private Experiences
Willingness to experience odd or uncomfortable thoughts, feelings, or physical sensations in the service of response flexibility
Engaging fully with your here-and-now experience
Avoiding or ignoring our feelings or experiences will not make them go away - you can't erase the past or the pain associated with it.
•Cognitive Defusion or Emotional Separation/Distancing
Observing one's own uncomfortable thoughts without automatically taking them literally or attaching any particular value to them
Distancing from, and letting go of, unhelpful thoughts, beliefs and memories
Thinking and experiencing are an ongoing behavioral process, not an outcome
Values
Identify what ultimately matters to you in the big picture.
Understand the distinction between a value and a goal
Figure out what kind of person you want to be then move toward those goals
•A Perspective-Taking Sense of Self
Being in touch with a sense of ongoing awareness
While we focus on becoming more aware of inner experiences, they are not who we are
Consciously connect with what is happening here and now
Thoughts come and go; acknowledge them and choose to move forward
Commitment to Action
Taking action guided by your values - doing what matters - even if it's difficult or uncomfortable
Set behavioral tasks linked to values
The goals can start out as big or small as the individual is ready for as long as they are rooted in the values set by the individual
Acceptance
Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.
ACT is an orientation to psychotherapy that is based on functional contextualism as a philosophy and (RFT) as a theory.
How Does it Work?
Functional Contextualism
ACT is rooted in functional contextualism. Its goal is the prediction and influence of
events
, with precision, scope and depth. Contextualism views psychological events as ongoing actions of the whole organism interacting in and with
historically and situationally defined contexts
. These actions are whole events that can only be broken up for pragmatic purposes, not ontologically.
Relational Frame Theory
ACT is based on Relational Frame Theory (RFT), which is a comprehensive basic experimental research program into human language and cognition. RFT has become one of the most actively researched basic behavior analytic theories of human behavior, with over 70 empirical studies focused on it tenets. In ACT, virtually every component of the technology is connected conceptually to RFT, and several of these connections have been studied empirically.
RFT
According to RFT, the core of human language and cognition is the learned and contextually controlled ability to arbitrarily relate events mutually and in combination, and to change the functions of specific events based on their relations to others.
For example, very young children will know that a nickel is larger than a dime by physical size, but not until later will the child understand that a nickel is smaller than a dime by social attribution. In addition to being arbitrarily applicable (a nickel is “smaller” than a dime merely by social convention), this more psychologically complex relation is mutual (e.g., if a nickel is smaller than a dime, a dime is bigger than a nickel), combinatorial (e.g., if a penny is smaller than a nickel and a nickel is smaller than a dime then a penny is smaller than a dime), and alters the function of related events (if a nickel has been used to buy candy a dime will now be preferred even if it has never actually been used before).
RFT
Therapeutic Steps
Compassionately confront the unworkable agenda, appealing always to the client's experience as the ultimate arbiter
Support the client in feeling and thinking what they directly feel and think already—as it is not as what it says it is—and to find a place from which that is possible.
In the service of that goal, teach acceptance and defusion skills.
Help the client make a richer and less defended contact with the present moment, and with their own on-going thoughts, feelings, and sensations.
Help the client contact a transcendent sense of self.
Help the client become more consistently mindful.
Help the client move in a value direction, with all of their history and automatic reactions.
Help the client detect traps, fusions, and strange loops.
Repeat, expand the scope of the work, and repeat again, until the client generalizes.
ACT Analysis of Psychological Problems
Most psychological difficulties have to do with the avoidance and manipulation of private events.
Conscious control belongs primarily in the area of overt, purposive behavior.
All verbal persons have the “self” needed as an ally, but some have run from that too.
Clients are not broken, and in the areas of acceptance and defusion they have the psychological resources they need if they can be harnessed.
To take a new direction, we must let go of an old one. If a problem is chronic, the client's solutions are probably part of them.
When you see strange loops, inappropriate verbal rules are involved.
The value of any action is its workability measured against the client's true values (those he/she would have if it were a free choice). The bottom line issue is living well, not having small sets of “good” feelings.
Two things are needed to transform the situation: accept and move.
ACT Therapeutic Posture
Whatever a client is experiencing is not the enemy. It is the fight against experiencing experiences that is harmful and traumatic.
You can't rescue clients from the difficulty and challenge of growth.
Compassionately accept no reasons—the issue is workability not reasonableness.
If the client is trapped, frustrated, confused, afraid, angry or anxious be glad—this is exactly what needs to be worked on and it is here now. Turn the barrier into the opportunity.
If you yourself feel trapped, frustrated, confused, afraid, angry or anxious be glad: you are now in the same boat as the client and your work will be humanized by that.
In the area of acceptance, defusion, self, and values it is more important as a therapist to do as you say than to say what to do.
Don't argue. Don't persuade. The issue is the client's life and the client's experience, not your opinions and beliefs. Belief is not your friend.
The issue is always function, not form or frequency. When in doubt ask yourself or the client “what is this in the service of.”
Can Therapy Help the Brain

We actively change our brains through our experiences in the environment.

Therapy is essentially a laboratory for reshaping and strengthening the neurons in the brain. The brain is a muscle and when therapy gets tough, the stress is being applied to the brain which in turn enhances the psychological growth.
Louis Cozolino, Ph.D., in his second edition of
The Neuroscience of Psychotherapy, suggests four areas in which psychotherapy enhances neural growth and integration:

1. The establishment of a safe and trusting relationship.
2. Mild to moderate levels of stress.
3. Activating both emotion and cognition.
4. The co-construction of new personal narratives.
In ACT, clients develop mindfulness skills , (both traditional techniques, and many modern, innovative ones) which enable them to fundamentally change their relationship with painful thoughts and feelings. When clients practice these skills in everyday life, painful feelings and unhelpful thoughts have much less impact and influence over them. Therefore, instead of wasting their time and energy in a fruitless battle with their inner experiences, they can invest their energy in taking action to change their life for the better - guided by their deepest values.
Acceptance of Private Experiences
Cognitive Defusion/Emotional Separation/Distancing
Acceptance
A Perspective-Taking Sense of Self
Values
Commitment to Action
Considered to be part of the third-wave/generation of behaviorism
Traditional behaviorism began in 1920s - well known in 50s and 60s (operant/classical conditioning) - only looked at observable behavior
Cognitive-behavioral therapy (CBT) - 1970s - included both behavior and cognition
The third wave - contextual approaches to behavior - focus on mindfulness as a valid focus of behavior change
Relational Frame Theory
ACT & RFT: Conquering your stress
Huh?
Thoughts and feelings do not cause other actions except as regulated by
context
.
It is possible to go beyond attempting to change thoughts or feelings so as to change overt behavior, to
changing the context that causally links
these psychological domains.

Katie E., Jeremy H., & Brandy P.
Sources
http://contextualscience.org/
http://www.socialworktoday.com/archive/090208p36.shtml
http://www.goodtherapy.org/acceptance_commitment_therapy.html
http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=191
http://actskills.com/
http://youtube.com/
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