Acceptance and Commitment Therapy (ACT)

website: www.actmindfully.com.au
Acceptance and Commitment Therapy (ACT) is a mindfulness-based, values-
directed behavioural therapy. There are six core processes in ACT:
The ssence of ACT : ! ma"or #oals
1 Acceptance of unwanted private experiences which are out of personal control
2 Commited action towards living a valued life
In other words Emrace !our demons" and follow !our heart#$
%ut simpl!:
1 &'he aim of AC' is to create a rich" full and meaningful life" while accepting the
pain that inevital! goes with it(
%ut more technicall!:
1 &'he goal of AC' is to increase ps!chological flexiilit!( %s!chological flexiilit!
has two components: 1) the ailit! to e ps!chologicall! present & i(e( aware" attentive"
open to" and engaged in !our experience* 2) the ailit! to control !our ehaviour to serve
valued ends
2 +fficial AC' definition: 'he goal of AC' is to increase ps!chological flexiilit!:
the ailit! to contact the present moment and the ps!chological reactions it produces" as a
full! conscious human eing" and ased on the situation" to persist with or change
ehaviour for valued ends
$.%. &n ACT, there is no #oal of symptom reduction. 'ymptom reduction fre(uently
happens, but it is simply a fortuitous byproduct, not a #oal.
There are six core processes in ACT:
1. Contact with the Present Moment
Conscious awareness of !our experience in the present moment enales !ou to perceive
accuratel! what is happening
,ives !ou important information aout whether to change or persist in ehaviour
Enales !ou to -catch. cognitive fusion -in flight.
Allows !ou to engage full! in what !ou are doing
2. Acceptance
Activel! contacting ps!chological experiences directl!" full!" and without needless defense
/efinition: defused" open" undefended contact with the present moment" as a full! conscious
human eing(
Collo0uial: -+pening !ourself full! to experience" as it is" not as !our mind sa!s it is.
3. Defusion
1oo2ing at thoughts" rather than from thoughts
3oticing thoughts" rather than eing caught up in thoughts
4eeing thoughts as what the! are" not as what the! seem to e
Aim of /efusion is NOT to feel etter" nor to get rid of unwanted thoughts
Aim of /efusion IS to reduce influence of unhelpful cognitive processes upon ehaviour* to
facilitate eing ps!chologicall! present 5 engaged in experience* to facilitate awareness of
language processes" in order to enhance ps!chological flexiilit!
4. Sef!as!conte"t
A transcendent sense of self: a consistent perspective from which to oserve and accept all
changing experiences( 6+ften called 'he +serving 4elf)
It is a process" not a thing: an awareness of awareness itself: -pure awareness.
#. $aues
Chosen life directions
Your hearts deepest desires for the sort of person you want to be and the things you want to do
in your time on this planet; in other words, what you want to stand for in life
%rovide motivation 5 inspiration
%rovide guidance for !our actions
,ive life meaning
,ive a sense of aundance
Are different to goals
%.Committe& Action
+vert ehavior in the service of values
6ma! re0uire s2ills training)
Committed action is: values7guided" effective 5 mindful
)indfulness
'he official AC' definition of mindfulness is:
'he defused" accepting" open contact with the present moment and the private events it
contains" as a conscious human eing" experientiall! distinct from the content eing noticed($
8! own definition" for clients:
Consciousl! ringing awareness to !our here7and7now experience" with openness" interest and
receptiveness($
In AC'" mindfulness 9 acceptance 9 willingness
The Assumption of *ealthy $ormality
1 :! their nature humans are ps!chologicall! health!
2 Anormalit! is a disease or s!ndrome driven ! unusual pathological processes
; <e need to understand these processes and change them
The +bi(uity of *uman ,sycholo#ical 'ufferin#
=igh lifetime incidence of ma>or /48 disorders
1 =igh treatment demand
2 =igh rates of divorce" sexual concerns" ause" violence" ull!ing" pre>udice"
loneliness
; 4ome extremel! destructive ehaviours are oth common and non7s!ndromal" e(g(
suicide
The xample of 'uicide
?n2nown in nonhumans ut universal in human societ!
1 Aout 1@A incidence of attempts
2 Aout 2@A serious struggles including a plan
; Aout 2@A serious struggles without a plan
B Aout C@A not associated with /48 disorder
Alternative Assumption: -estructive $ormality
3ormal ps!chological processes often are destructive
1 <e need to understand these processes and wor2 within them to promote health
2 'he source of the prolem is human language and cognition
&n ACT, the word .)ind/ is a metaphor for human lan#ua#e
&n other words: 1anguage 9 Cognition 9 8ind
'he mind is not a -thing.( It is a complex set of cognitive processes" such as anal!sing"
comparing" evaluating" planning" rememering" visualising etc
1 'hese cognitions all rel! on human language(
2 'he human language: a complex s!stem of s!mols which includes words"
images" sounds" and ph!sical gestures(
; Cognitions 9 language used privatel! 9 mind$
0an#ua#e is a double-ed#ed sword: the positive side:
8a2e maps 5 models of the world
1 %redict and plan for the future
2 4hare 2nowledge
; 1earn from the past
B Imagine things that have never existed" and then go on to create them
C 'o develop rules that guide our ehaviour effectivel!" and help us to thrive as a
communit!
D 'o communicate with people who are far awa!
E 1earn from people that are no longer alive(
F
G 0an#ua#e is a double-ed#ed sword: the negative side:
?se it to spread liel and slander and ignorance
1 'o incite hatred and pre>udice and violence*
2 'o criticise and condemn ourselves*
; 'o ma2e weapons of mass destruction*
B 'o dwell on and -relive. painful events from the past*
C 'o create rules for ourselves that can often e ineffective or destructive
+nli1e all 2ther Creatures on the ,lanet, 3ou Cannot Avoid ,ain 'ituationally
1 Hememer a time when (
2 Imagine a future where
; Compare !ourself to
8! life would have een so much etter if
$ormal Co#nitive45erbal ,rocesses Contribute to ,sychopatholo#y
&%rediction of private events 6e(g(" pain" anxiet!)
1 &Inowledge of death
2 &1iving in the past or the future" and no longer in the moment
; &Comparison to an ideal
B &<ishing" wanting" and desiring: attachment
C &4ocial comparison J pre>udice J stigma
D &4elf7loathing
E &4ocial inhiition 6e(g(" fear of negative evaluation)
0an#ua#e developed primarily to anticipate and solve problems:
Kood <ater 4helter 4ex
:ut aove all else /+3.' ,E' II11E/#
ssence of problem solvin#:-
1 %rolem 9 4omething we don.t want
2 4olution 9 Kigure out how to change it" get rid of it" or avoid it
'his approach wor2s well in the external world" ut when we tr! this with our own unwanted
thoughts" feelings" memories etc it creates prolems:
xperiential Avoidance: simple definition & tr!ing to avoid" suppress" or get rid of unwanted
private experiences" even when it.s harmful" costl!" or ineffective to do so
1 xperiential Avoidance technical definition: 7 the tendenc! to attempt to alter
the form" fre0uenc!" or situational sensitivit! of negative private experience 6emotions"
thoughts" memories" sensations" urges" images etc() even when attempts to do so cause
ps!chological and ehavioural harm
*i#her xperiential Avoidance is associated with:
1 &=igher anxiet!
2 &8ore depression
; &8ore overall patholog!
6hy xperiential Avoidance is %asic:
=umans have een taught a wide variet! of strategies for avoiding negative events( 'hese wor2
ver! well in the material world
1 An unpleasant private experience is treated the same wa! as an external prolem*
it ecomes a negative event to avoid or eliminate(
6hen &s xperiential Avoidance -etrimental7
1( 'he process of delierate avoidance necessaril! contradicts the desired outcome
2( 'he regulation of private events is largel! unresponsive to veralJcognitive control
;( Avoidance is possile" ut the control strateg! is costl!" unhealth!" or life7distorting
B( 'he avoided event is important
*ealthy Chan#e 2ften ,roduces ,ainful xperiences
1 Change is often frightening(
2 <hat needs to e done ma! e avoided ecause it is experientiall! difficult(
3 'his suggests a ma>or reason experiential avoidance ma! lead to
ps!chopatholog!: It restricts needed change(
4 8&t is not the stron#est of the species that survive, nor the most intelli#ent,
but the ones most responsive to chan#e.9 &Charles /arwin" The rigin of !pe"ies
$.%. $2T all forms of experiential avoidance are unhealthy. )any are positively
adaptive, and others ma1e little difference to lon#-term life (uality. ACT only
tar#ets experiential avoidance that persists when it is costly, useless, or life
distortin#. &n these circumstances, experiential avoidance becomes patholo#ical.
Instead of encouraging clients to use more clever wa!s to fight and win this war with
their own thoughts" feelings" and odil! sensations" AC' helps clients step out of this war
altogether(
Acceptance7ased treatments attempt to alter the impact of emotions and cognitions !
stopping the struggle with them rather than ! attempting to change their form or
fre0uenc!(
In other words" in acceptance7ased approaches" the clientLs original aim of controlling
his or her private experiences 6e(g(" emotions" thoughts" cravings" odil! states" etc() is
itself seen as modifiale
Acceptance in this context means activel! contacting ps!chological experiences 7
directl!" full!" and without needless defense 7 while ehaving effectivel!( An acceptance
approach does not aandon direct change efforts: It simpl! targets them toward more
readil! changeale domains" such as overt ehavior or life situations" rather than personal
histor! or automatic thoughts and feelings 6=a!es" 1GGB)(
&n 'ummary: ACT uses acceptance an& min&funess processes' an& commitment an&
(eha)iour chan*e processes' to pro&uce *reater ps+choo*ica fe"i(iit+.
'ix Core ,roblems in ACT
Cognitive fusion
1 Experiential avoidance
2 %reoccupation with past or future
; +ver7identification with conceptualised self 6self7as7content)
B /isconnection from values
C Ineffective action
:ive %asic 'trate#ies in ACT
1 1 Confronting the agenda 6Creative =opelessness)
2 2 Control is the prolem
; ; <illingness is the alternative 6defusionJ acceptanceJ the present moment)
B B 4elf7as7context
C C Malues and action
D
; &n Co#nitive :usion:
1 'houghts are Healit!* it.s as if what we.re thin2ing is actuall! present" here and
now#
2 'houghts are 'he 'ruth* we literall! elieve them#
; 'houghts are Important* we ta2e them seriousl!" and give them our full attention#
B 'houghts are +rders* we automaticall! oe! them#
C 'houghts are <ise* we assume the! 2now est and we follow their advice#
&n Co#nitive -efusion:
1 'houghts are merel! sounds" words" stories" its of language" passing through our
heads(
2 'houghts ma! or ma! not e true( <e don.t automaticall! elieve them(
; 'houghts ma! or ma! not e important( <e pa! attention onl! if the!.re helpful(
B 'houghts are not orders( <e don.t have to oe! them(
C 'houghts ma! or ma! not e wise( <e don.t automaticall! follow their advice(
*elpful (uestions for unhelpful thou#hts
Is this thought in an! wa! useful or helpfulN
1 Is this an old stor!N =ave I heard this one eforeN
2 <hat would I get for u!ing into this stor!N
; Could this e helpful" or is m! mind >ust aling onN
B /oes this thought help me ta2e effective actionN
C Am I going to trust m! mind or m! experienceN
Contact 6ith The ,resent )oment
1
An! mindfulness exercise" eg reath" stretching" sounds" food

3otice !our feet on the floor* !our od!* !our reathing etc(

C7C7C techni0ue: 3otice C things !ou can: hear" see" feel 7 right now
< Acceptance
@
Acceptance 9 willingness 9 mindfulness

%asic ACT 'trate#ies: 5alues = Committed Action
5alues
1
<hat do !ou reall! wantN

<hat do !ou want !our life to stand forN

<hat sort of person do !ou want to eN

<hat sort of relationships do !ou want to uildN

=ow do !ou want to actJehave in the worldJ towards othersJ towards !ourselfN

<hat do !ou want to do with !our lifeN
Commitment
1
3ot a promise(

3ot a prediction(

3ot an attempt to e perfect(

It means: commitment to a valued direction(

'a2e it for granted that !ou will go off7course$" and stuff up$ again and again and
again(

Commit to getting ac2 on trac2 again" as soon as !ou realise what has happened(

Clarif!: values J goals J actions J arriers

/AME c!cles 6defusionJacceptanceJ valuesJengagement) 7 uild ever larger patterns of
ehaviour
Committed action > mindful, valued, effective action
%arriers to Action
)y version of the :A? acronym:
:usion with unhelpful thoughts 6especiall! evaluation and reason7giving)
1 xcessive goals 6e(g( goals too ig* time frames too small* s2ills lac2ing*
resources unavailale)(
2 Avoidance of discomfort
; ?emoteness from values
)y antidote to
the :A? acronym: -A?
/efusion Acceptance of discomfortHealistic goalsEmracing values
feelings, or sensations# $t is important that they realise this is simply to tea"h them a s%ill#
$n the world of e&eryday li&ing, the idea is that when distressing thoughts and feelings
arise, they "an be a""epted as 'ust one aspe"t of awareness (one performer among many
on the stage) * rather than "ompletely dominating awareness (one performer standing in
a spotlight)#
A :ew 6ords on Acceptance
Clients often don.t understand what acceptance is & so earl! on in therap!" I avoid the
word( Instead I usuall! sa! something li2e:
Oou don.t have to li2e it" want it" or approve of it & simpl!
allow it to e there 6simpl! ecause it alread! is)
give it permission to e where it alread! is
let go of struggling with it
stop fighting with it
ma2e peace with it
ma2e room for it
soften up around it
let it e
reathe into it
stop wasting !our energ! on pushing it awa!
The 6illin#ness-and-Action ,lan
8! goal is to:
'he values underl!ing m! goal are:
'houghts" feelings" sensations" urges I.m willing to have 6in order to achieve this goal):7
1 'houghts:
Keelings:
4ensations:
?rges:
1 It would e useful to remind m!self that
I can rea2 this goal down into smaller steps" such as
'he smallest" easiest step I can egin with is
'he time" da! and date that I will ta2e that first step" is
@ Approaches To Any ,roblematic 'ituation
In an! prolematic situation" there are B possile approaches to consider( I find it ver!
helpful to actuall! write these approaches down for clients 6and m!self" at times#) so the!
can see the! have a choice aout what to do:
1
2ption 2ne: leave the situation

2ption Two: stay, and chan#e what can be chan#ed

2ption Three: stay, and accept what can/t be chan#ed

2ption :our: stay, and rely on emotional control strate#ies
1et.s ta2e a loo2 at each in turn(
2ption 2ne: 0eave the situation.
'o leave is not alwa!s an option & for example" if !ou happen to e in prison(
=owever" if leaving a prolematic situation is possile" then it.s worth considering:
would !our overall 0ualit! of life e etter if !ou left than if !ou sta!edN +f course"
!ou can never 2now this for certain" ut !ou can ma2e a reasonale prediction ased
on what has happened up to this point(
2ption Two: 'tay = chan#e what can be chan#ed.
If !ou choose to sta! in a difficult situation" the first step is to change whatever
possil! can e changed to improve it( And in an! situation" what !ou have most
control over is the action that !ou ta2e( 4o focus !our energ! on ta2ing action" guided
! !our values" to ma2e things as good as the! possil! can e( /epending on the
context" this might involve an!thing from practicing assertiveness or communication
s2ills" to spending more 0ualit! time with !our partner" to filing a law suit or
restraining order(
2ption Three: stay, accept what can/t be chan#ed, = live by your values
If !ou.ve chosen to sta!" and !ou.ve ta2en ever! action possile to improve the
situation" and it.s still difficult" then it.s time to practise acceptance( 8a2e room for
those painful feelings( /efuse those >udgmental" hostile" despairing or self7defeating
thoughts( Catch !ourself ruminating and worr!ing" and come ac2 to the present
moment( Choose to live ! !our values" and engage in the present moment"
irrespective of the challenges !ou face( 6In fact" option two and option three ideall!
will occur simultaneousl!( 'hin2 of Mictor Kran2l" living ! his values in the midst of
that unearale suffering in the 3aPi concentration camps()
2ption :our: 'tay, #ive up, and ma1e it worse throu#h ineffective action
All too often" people sta! in a prolematic situation" ut the! don.t do ever!thing
possile to improve it" and nor do the! practice acceptance( Hather the! worr!"
ruminate" and anal!se" or get angr!" anxious" or depressed( And then the! turn to
emotional control strategies to tr! and feel etter( 'he variet! of emotional control
strategies that humans use in these situations is virtuall! endless: drugs" alcohol" 'M"
food" self7harm and suicidalit!( Invarial!" emotional control strategies >ust create
even more suffering in the long term(