Acceptance and Commitment Therapy
Encyclopedia
Acceptance and commitment therapy or ACT (typically pronounced as a word, not as separate initials) is a cognitive–behavioral model of psychotherapy. It is an empirical
ly-based psychological intervention
that uses acceptance
and mindfulness
strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility. The approach was originally called comprehensive distancing. It was developed by Steven C. Hayes
, Kelly Wilson, and Kirk Strosahl.
philosophy
called functional contextualism
. ACT is based on relational frame theory
(RFT), a comprehensive theory of language
and cognition
that is framed as an offshoot of behavior analysis. ACT differs from traditional cognitive behavioral therapy (CBT) in that rather than trying to teach people to better control their thoughts, feelings, sensations, memories and other private events, ACT teaches them to "just notice," accept, and embrace their private events, especially previously unwanted ones. ACT helps the individual get in contact with a transcendent
sense of self known as "self-as-context"—the you that is always there observing and experiencing and yet distinct from one's thoughts, feelings, sensations, and memories. ACT aims to help the individual clarify their personal values and to take action on them, bringing more vitality and meaning to their life in the process, increasing their psychological flexibility.
While Western psychology has typically operated under the "healthy normality" assumption which states that by their nature, humans are psychologically healthy, ACT assumes, rather, that psychological processes of a normal human mind are often destructive. The core conception of ACT is 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 a simple way to summarize the model, ACT views the core of many problems to be due to the concepts represented in the acronym, FEAR:
And the healthy alternative is to ACT:
, with the status of "Modest Research Support" in depression and "Strong Research Support" in chronic pain, with several others specific areas such as psychosis and work site stress currently under review. ACT is also listed as evidence-based by the Substance Abuse and Mental Health Services Administration of the United States federal government which has examined randomized trials for ACT in the areas of psychosis, work site stress, and obsessive compulsive disorder, including depression outcomes
ACT is still relatively new in the development of its research base with the randomized trials beginning in earnest only after the 1999 publication of the original book on ACT. ACT has shown preliminary research evidence of effectiveness in randomized trials for a variety of problems including chronic pain, addictions, smoking cessation
, depression
, anxiety
, psychosis
, workplace stress, diabetes management, weight management, epilepsy control, self-harm, body dissatisfaction, eating disorders, burn out, and several other areas. ACT has more recently been applied to children and adolescents , with good results.
Mediational analyses have provided evidence for the possible causal role of key ACT processes, including acceptance, defusion, and values, in producing beneficial clinical outcomes. Correlational evidence has also found that absence of these processes predicts many forms of psychopathology. A recent meta-analysis
showed that ACT processes, on average, account for 16–29% of the variance in psychopathology (general mental health, depression, anxiety) at baseline, depending on the measure, using correlational methods [see Hayes et al., 2006, pp. 12–13, and Table 1].
, and Mindfulness-based Cognitive Therapy
and other acceptance and mindfulness based approaches as The Third Wave of Behavior Therapy which Steven C. Hayes
defined in his ABCT
President Address as follows:
Similarities are also found with the awareness–management movement in business training programs, where mindfulness and cognitive-shifting
techniques are being employed to generate rapid positive shifts in mood and performance.
ACT has also been adapted to create a non-therapy version of the same processes called Acceptance and Commitment Training. This training process, oriented towards the development of mindfulness, acceptance, and values skills in non-clinical settings such as businesses or schools, has also been investigated in a handful of research studies with good preliminary results.
The emphasis of ACT on present-mindedness, direction and action is similar to other approaches within psychology that, unlike ACT, are not as focused on outcome research or consciously linked to a basic science program, including more humanistic or constructivist approaches such as Narrative Therapy
, Gestalt Therapy
, Morita Therapy
, or Re-evaluation Counseling
among many others.
Wilson, Hayes & Byrd explore at length the compatibilities between ACT and the 12-step treatment of addictions and argue that, unlike most other psychotherapies, both approaches can be implicitly or explicitly integrated due to their broad commonalities. Both approaches endorse acceptance as an alternative to unproductive control. ACT emphasizes the hopelessness of relying on ineffectual strategies to control private experience, similarly the 12-step approach emphasizes the acceptance of powerlessness over addiction. Both approaches encourage a broad life-reorientation, rather than a narrow focus on the elimination of substance use, and both place great value on the long-term project of building of a meaningful life aligned with the clients' values. ACT and 12-step both encourage the pragmatic utility of cultivating a transcendent sense of self (higher power
) within an unconventional, individualized spirituality. Finally they both openly accept the paradox that acceptance is a necessary condition for change and both encourage a playful awareness of the limitations of human thinking.
aspects of some major spiritual and religious traditions such as Buddhism. This approach has at times generated controversy within the field of clinical psychology as to whether or not ACT's proposed mechanisms of change and approach to psychological experiences are radically different than other forms of intervention. This has led leaders in the field to critically examine the evidence supporting ACT.
The Association for Behavior Analysis
International (ABAI) has a special interest group for practitioner issues, behavioral counseling, and clinical behavior analysis ABA:I. ABAI has larger special interest groups for autism
and behavioral medicine
. ABAI serves as the core intellectual home for behavior analysts. ABAI sponsors two conferences/year—one in the U.S. and one international.
The Association for Behavioral and Cognitive Therapies
(ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis. In addition, the ABCT has a special interest group on addictions.
Doctoral-level behavior analysts who are psychologists belong to the American Psychological Association
's division 25—Behavior analysis. APA offers a diplomate in behavioral psychology.
The World Association for Behavior Analysis offers certification in behavior therapy which covers knowledge of ACT .
Empirical
The word empirical denotes information gained by means of observation or experimentation. Empirical data are data produced by an experiment or observation....
ly-based psychological intervention
Intervention (counseling)
An intervention is an orchestrated attempt by one, or often many, people to get someone to seek professional help with an addiction or some kind of traumatic event or crisis, or other serious problem. The term intervention is most often used when the traumatic event involves addiction to drugs...
that uses acceptance
Acceptance
Acceptance is a person's agreement to experience a situation, to follow a process or condition without attempting to change it, protest, or exit....
and mindfulness
Mindfulness (psychology)
Modern clinical psychology and psychiatry since the 1970s have developed a number of therapeutic applications based on the concept of mindfulness in Buddhist meditation.-Definitions:...
strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility. The approach was originally called comprehensive distancing. It was developed by Steven C. Hayes
Steven C. Hayes
Steven C. Hayes is Nevada Foundation Professor at the Department of Psychology at the University of Nevada, Reno. He is known for an analysis of human language and cognition , and its application to various psychological difficulties .Hayes' work is somewhat controversial, and in 2006 was the...
, Kelly Wilson, and Kirk Strosahl.
Basics
ACT is developed within a pragmaticPragmatism
Pragmatism is a philosophical tradition centered on the linking of practice and theory. It describes a process where theory is extracted from practice, and applied back to practice to form what is called intelligent practice...
philosophy
Philosophy
Philosophy is the study of general and fundamental problems, such as those connected with existence, knowledge, values, reason, mind, and language. Philosophy is distinguished from other ways of addressing such problems by its critical, generally systematic approach and its reliance on rational...
called functional contextualism
Functional contextualism
Functional contextualism is a modern philosophy of science rooted in philosophical pragmatism and contextualism. It is most actively developed in behavioral science in general and the field of behavior analysis in particular...
. ACT is based on relational frame theory
Relational frame theory
Relational frame theory, or RFT, is a psychological theory of human language and cognition. It was developed largely through the efforts of Steven C...
(RFT), a comprehensive theory of language
Language
Language may refer either to the specifically human capacity for acquiring and using complex systems of communication, or to a specific instance of such a system of complex communication...
and cognition
Cognition
In science, cognition refers to mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions. Cognition is studied in various disciplines such as psychology, philosophy, linguistics, and computer science...
that is framed as an offshoot of behavior analysis. ACT differs from traditional cognitive behavioral therapy (CBT) in that rather than trying to teach people to better control their thoughts, feelings, sensations, memories and other private events, ACT teaches them to "just notice," accept, and embrace their private events, especially previously unwanted ones. ACT helps the individual get in contact with a transcendent
Transcendence (philosophy)
In philosophy, the adjective transcendental and the noun transcendence convey the basic ground concept from the word's literal meaning , of climbing or going beyond, albeit with varying connotations in its different historical and cultural stages...
sense of self known as "self-as-context"—the you that is always there observing and experiencing and yet distinct from one's thoughts, feelings, sensations, and memories. ACT aims to help the individual clarify their personal values and to take action on them, bringing more vitality and meaning to their life in the process, increasing their psychological flexibility.
While Western psychology has typically operated under the "healthy normality" assumption which states that by their nature, humans are psychologically healthy, ACT assumes, rather, that psychological processes of a normal human mind are often destructive. The core conception of ACT is that psychological suffering is usually caused by experiential avoidance
Experiential avoidance
Experiential avoidance has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences—even when doing so creates harm in the long-run...
, cognitive entanglement, and resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values. As a simple way to summarize the model, ACT views the core of many problems to be due to the concepts represented in the acronym, FEAR:
- Fusion with your thoughts
- Evaluation of experience
- Avoidance of your experience
- Reason-giving for your behavior
And the healthy alternative is to ACT:
- Accept your reactions and be present
- Choose a valued direction
- Take action
Core principles
ACT commonly employs six core principles to help clients develop psychological flexibility:- Cognitive defusion: Learning methods to reduce the tendency to reify thoughts, images, emotions, and memories
- Acceptance: Allowing them to come and go without struggling with them.
- Contact with the present moment: Awareness of the here and now, experienced with openness, interest, and receptiveness.
- Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is unchanging.
- Values: Discovering what is most important to one's true self.
- Committed action: Setting goals according to values and carrying them out responsibly.
Evidence
ACT had, as of October 2006, been evaluated in about 30 controlled time series studies or randomized clinical trials for a variety of client problems. As of 2011 that number has about doubled and new controlled studies are now appearing very regularly. Overall, when compared to other treatments designed to be helpful, the effect size for ACT is a Cohen's d of around 0.6 which is considered a medium effect size. In some studies ACT has exceeded the performance of gold standard treatments , in others it has been equally effective , and in one or two studies with minor problems it has not done as well As compared to treatments that are already known to be effective, the effect size so far is about .3, which is small Across the whole empirical clinical psychology literature the average effect size for such comparisons approaches zero. All of these comparison and their effect sizes need to be viewed with caution, because many of the trials are unfunded and are based on a relatively small number of patients; some might be contaminated by the allegiance effect. In recent years larger trials have begun to appear and the number of areas to which it has been successfully applied is continuing to grow. ACT is considered an empirically validated treatment by the American Psychological AssociationAmerican Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...
, with the status of "Modest Research Support" in depression and "Strong Research Support" in chronic pain, with several others specific areas such as psychosis and work site stress currently under review. ACT is also listed as evidence-based by the Substance Abuse and Mental Health Services Administration of the United States federal government which has examined randomized trials for ACT in the areas of psychosis, work site stress, and obsessive compulsive disorder, including depression outcomes
ACT is still relatively new in the development of its research base with the randomized trials beginning in earnest only after the 1999 publication of the original book on ACT. ACT has shown preliminary research evidence of effectiveness in randomized trials for a variety of problems including chronic pain, addictions, smoking cessation
Smoking cessation
Smoking cessation is the process of discontinuing the practice of inhaling a smoked substance. This article focuses exclusively on cessation of tobacco smoking; however, the methods described may apply to cessation of smoking other substances that can be difficult to stop using due to the...
, depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
, workplace stress, diabetes management, weight management, epilepsy control, self-harm, body dissatisfaction, eating disorders, burn out, and several other areas. ACT has more recently been applied to children and adolescents , with good results.
Mediational analyses have provided evidence for the possible causal role of key ACT processes, including acceptance, defusion, and values, in producing beneficial clinical outcomes. Correlational evidence has also found that absence of these processes predicts many forms of psychopathology. A recent meta-analysis
Meta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...
showed that ACT processes, on average, account for 16–29% of the variance in psychopathology (general mental health, depression, anxiety) at baseline, depending on the measure, using correlational methods [see Hayes et al., 2006, pp. 12–13, and Table 1].
Similarities
ACT is sometimes grouped together with Dialectical Behavior Therapy, Functional Analytic PsychotherapyFunctional Analytic Psychotherapy
Functional analytic psychotherapy is an approach to clinical psychotherapy that uses a radical behaviorist position informed by B.F. Skinner's analysis of verbal behavior....
, and Mindfulness-based Cognitive Therapy
Mindfulness-based Cognitive Therapy
Mindfulness-based cognitive therapy is psychological therapy which blends features of cognitive therapy with mindfulness techniques of Buddhism. MBCT involves accepting thoughts and feelings without judgement rather than trying to push them out of consciousness, with a goal of correcting...
and other acceptance and mindfulness based approaches as The Third Wave of Behavior Therapy which Steven C. Hayes
Steven C. Hayes
Steven C. Hayes is Nevada Foundation Professor at the Department of Psychology at the University of Nevada, Reno. He is known for an analysis of human language and cognition , and its application to various psychological difficulties .Hayes' work is somewhat controversial, and in 2006 was the...
defined in his ABCT
Association for Behavioral and Cognitive Therapies
The Association for Behavioral and Cognitive Therapies was founded in 1966. Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, nurses, and other mental-health practitioners, researchers, and students who...
President Address as follows:
Similarities are also found with the awareness–management movement in business training programs, where mindfulness and cognitive-shifting
Cognitive-shifting
Cognitive shifting is a method used in awareness management describing the mental process of re-directing one's focus of attention away from one fixation and toward a different focus of attention...
techniques are being employed to generate rapid positive shifts in mood and performance.
ACT has also been adapted to create a non-therapy version of the same processes called Acceptance and Commitment Training. This training process, oriented towards the development of mindfulness, acceptance, and values skills in non-clinical settings such as businesses or schools, has also been investigated in a handful of research studies with good preliminary results.
The emphasis of ACT on present-mindedness, direction and action is similar to other approaches within psychology that, unlike ACT, are not as focused on outcome research or consciously linked to a basic science program, including more humanistic or constructivist approaches such as Narrative Therapy
Narrative therapy
Narrative Therapy is a form of psychotherapy using narrative. It was initially developed during the 1970s and 1980s, largely by Australian Michael White and his friend and colleague, David Epston, of New Zealand....
, Gestalt Therapy
Gestalt therapy
Gestalt therapy is an existential/experiential form of psychotherapy that emphasizes personal responsibility, and that focuses upon the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person's life, and the self-regulating...
, Morita Therapy
Morita therapy
Morita Therapy is a purpose-centered, response oriented therapy from Japan, created in the 1930s by Dr. Shoma Morita.-Background:Dr Shoma Morita was a psychiatrist and department chair at Jikei University School of Medicine in Tokyo...
, or Re-evaluation Counseling
Re-evaluation Counseling
Re-evaluation Counseling or RC is an organization founded by Harvey Jackins in the 1950s and led by him until his death in 1999. It introduced a procedure called "co-counseling", which Jackins said was a new and effective method of helping people and bringing about social reform. RC teaches...
among many others.
Wilson, Hayes & Byrd explore at length the compatibilities between ACT and the 12-step treatment of addictions and argue that, unlike most other psychotherapies, both approaches can be implicitly or explicitly integrated due to their broad commonalities. Both approaches endorse acceptance as an alternative to unproductive control. ACT emphasizes the hopelessness of relying on ineffectual strategies to control private experience, similarly the 12-step approach emphasizes the acceptance of powerlessness over addiction. Both approaches encourage a broad life-reorientation, rather than a narrow focus on the elimination of substance use, and both place great value on the long-term project of building of a meaningful life aligned with the clients' values. ACT and 12-step both encourage the pragmatic utility of cultivating a transcendent sense of self (higher power
Higher Power
Higher Power is a term coined in the 1930s in Alcoholics Anonymous and is used in other twelve-step programs. It is also sometimes referred to as a power greater than ourselves and is frequently abbreviated to HP.-History:...
) within an unconventional, individualized spirituality. Finally they both openly accept the paradox that acceptance is a necessary condition for change and both encourage a playful awareness of the limitations of human thinking.
Criticisms
The mindfulness strategies in ACT have similarities to mysticalMysticism
Mysticism is the knowledge of, and especially the personal experience of, states of consciousness, i.e. levels of being, beyond normal human perception, including experience and even communion with a supreme being.-Classical origins:...
aspects of some major spiritual and religious traditions such as Buddhism. This approach has at times generated controversy within the field of clinical psychology as to whether or not ACT's proposed mechanisms of change and approach to psychological experiences are radically different than other forms of intervention. This has led leaders in the field to critically examine the evidence supporting ACT.
Professional organizations
The Association for Contextual Behavioral Science is committed to research and development in the area of ACT, RFT, and contextual behavioral science more generally. As of late 2011 it had about 4,000 members world wide, about half outside of the United States. It holds annual "world conference" meetings: The tenth will be in Bethesda in July 2012; the 11th in Sydney in 2013.The Association for Behavior Analysis
Association for Behavior Analysis
The Association for Behavior Analysis International is a nonprofit professional membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and...
International (ABAI) has a special interest group for practitioner issues, behavioral counseling, and clinical behavior analysis ABA:I. ABAI has larger special interest groups for autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...
and behavioral medicine
Behavioral medicine
Behavioral medicine is an interdisciplinary field of medicine concerned with the development and integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness...
. ABAI serves as the core intellectual home for behavior analysts. ABAI sponsors two conferences/year—one in the U.S. and one international.
The Association for Behavioral and Cognitive Therapies
Association for Behavioral and Cognitive Therapies
The Association for Behavioral and Cognitive Therapies was founded in 1966. Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, nurses, and other mental-health practitioners, researchers, and students who...
(ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis. In addition, the ABCT has a special interest group on addictions.
Doctoral-level behavior analysts who are psychologists belong to the American Psychological Association
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...
's division 25—Behavior analysis. APA offers a diplomate in behavioral psychology.
The World Association for Behavior Analysis offers certification in behavior therapy which covers knowledge of ACT .
See also
- ContextualismContextualismContextualism describes a collection of views in philosophy which emphasize the context in which an action, utterance, or expression occurs, and argues that, in some important respect, the action, utterance, or expression can only be understood relative to that context...
- Behavioral psychotherapyBehavioral psychotherapyBehavioral psychotherapy is one of two streams of thought that have come together to produce cognitive behavioral therapy....
- Behavior therapy
- Clinical behavior analysisClinical behavior analysisClinical behavior analysis has its origins in applied behavior analysis and behavior therapy. It is sometimes referred to as third-generation behavior therapy.-Current models in clinical behavior analysis:...
- Experiential avoidanceExperiential avoidanceExperiential avoidance has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences—even when doing so creates harm in the long-run...
External links
- Free Mindfulness Videos – Helpful Introduction to Mindfulness from Jon Kabat-Zinn and other key figures
- Contextualpsychology.org – Home for the Association for Contextual Behavioral Science, a professional organization dedicated to ACT, RFT, and functional contextualism. Also helpful for training opportunities for professionals interested in ACT and RFT. Most ACT workshops world wide are listed here.
- Steven C Hayes – One of ACT's main theorists, Dr. Hayes' is at the University of NevadaUniversity of Nevada, RenoThe University of Nevada, Reno , is a teaching and research university established in 1874 and located in Reno, Nevada, USA...
. Information can also be found at his website - Jason Luoma, PhD – Resources for ACT therapists
- ACT Workshops in the UK
- An Introduction to Relational Frame Theory Online Tutorial