ACT

http://www.thehappinesstrap.com said:

What is Acceptance & Commitment Therapy?

Acceptance and Commitment Therapy (ACT) gets it name from one of its core messages: to accept what is out of your personal control, while committing to do whatever is in your personal control to improve your quality of life.

The aim of ACT is to help people create a rich full and meaningful life, while effectively handling the pain and stress that life inevitably brings. ACT (which is pronounced as the word 'act', not as the initials) does this by:

a) teaching you psychological skills to deal with your painful thoughts and feelings effectively – in such a way that they have much less impact and influence over you. (These are known as mindfulness skills.)

b) helping you to clarify what is truly important and meaningful to you - ie your values - then use that knowledge to guide, inspire and motivate you to change your life for the better.

The ACT View Of Mindfulness

Mindfulness is a “hot topic” in psychology right now - increasingly recognised as a powerful therapeutic intervention for everything from work stress to depression - and also as an effective tool for increasing emotional intelligence. Acceptance and Commitment Therapy is a powerful mindfulness-based therapy (and coaching model) which currently leads the field in terms of research, application and results.

Mindfulness is a mental state of awareness, focus and openness - which allows you to engage fully in what you are doing at any moment. In a state of mindfulness, difficult thoughts and feelings have much less impact and influence over you - so it is hugely useful for everything from full-blown psychiatric illness to enhancing athletic or business performance. In many models of coaching and therapy, mindfulness is taught primarily via meditation. However, in ACT, meditation is seen as only one way amongst hundreds of learning these skills - and this is a good thing, because most people do not like meditating! ACT gives you a vast range of tools to learn mindfulness skills - many of which require only a few minutes to master.

ACT breaks mindfulness skills down into 3 categories:

1) defusion: distancing from, and letting go of, unhelpful thoughts, beliefs and memories

2) acceptance: making room for painful feelings, urges and sensations, and allowing them to come and go without a struggle

3) contact with the present moment: engaging fully with your here-and-now experience, with an attitude of openness and curiosity

These 3 skills require you to use an aspect of yourself for which no word exists in common everyday language. It is the part of you that is capable of awareness and attention. In ACT, we often call it the 'observing self'. We can talk about 'self' in many ways, but in common everyday language we talk mainly about the 'physical self' - your body - and the 'thinking self' - your mind. The 'observing self' is the part of you that is able to observe both your physical self and your thinking self. A better term is 'pure awareness' - because that's all it is: just awareness. It is the part of you that is aware of everything else: aware of every thought, every feeling, everything you see, hear, touch, taste, smell, and do.

Acceptance and Commitment Therapy (ACT) is a unique and creative approach to behaviour change which alters the very ground rules of most Western psychotherapy. It is a mindfulness-based, values-oriented behavioural therapy, that has many parallels to Eastern philosophy, yet is firmly based on cutting-edge Western research into human behavioural psychology.

In a nutshell, ACT helps people to fundamentally change their relationship with painful thoughts and feelings, to develop a transcendent sense of self, to live in the present, and to take action, guided by their deepest values, to create a rich and meaningful life. ACT takes the view that most psychological suffering is caused by experiential avoidance, i.e. by attempting to avoid, escape, or get rid of unwanted private experiences (such as unpleasant thoughts, feelings, sensations, urges & memories). Our efforts at experiential avoidance might work in the short term, but in the long term they often fail, and in the process, they often create significant psychological suffering.

In ACT, we develop mindfulness skills (both traditional techniques, and many modern, innovative ones) which enable us to fundamentally change our relationship with painful thoughts and feelings. When we practise these skills in everyday life, painful feelings and unhelpful thoughts have much less impact and influence over us. Therefore, instead of wasting our time and energy in a fruitless battle with our inner experiences, we can invest our energy on taking action to change our life for the better - guided by our deepest values.

A steadily growing body of scientific data confirms that cultivating acceptance, mindfulness, and openness to experience is highly effective for the treatment of depression, anxiety disorders, substance abuse, chronic pain, PTSD, anorexia, and even schizophrenia. ACT is also a very effective model for life coaching and executive coaching.

To download a simple, non-technical article which gives a basic overview of ACT, click here

PSYCHOLOGICAL FLEXIBILITY & THE SIX CORE PROCESSES OF ACT

There are six core processes in ACT:

1. Connection means being in the present moment: connecting fully with whatever is happening right here, right now. (Technically in ACT, this is called "contacting the present moment".)

2. Defusion means learning to step back or detach from unhelpful thoughts and worries and memories: instead of getting caught up in your thoughts, or pushed around by them, or struggling to get rid of them, you learn how to let them come and go – as if they were just cars driving past outside your house. You learn how to step back and watch your thinking, so you can respond effectively - instead of getting tangled up or lost inside your thinking.

3. Expansion means opening up and making room for painful feelings and sensations. You learn how to drop the struggle with them, give them some breathing space, and let them be there without getting all caught up in them, or overwhelmed by them; the more you can open up, and give them room to move, the easier it is for your feelings to come and go without draining you or holding you back. (Technically in ACT this is called "acceptance".)

4. The Observing Self is the part of you that is responsible for awareness and attention. We don’t have a word for it in common everyday language – we normally just talk about the ‘mind’. But there are two parts to the mind: the thinking self – i.e. the part that is always thinking; the part that is responsible for all your thoughts, beliefs, memories, judgments, fantasies etc. And then there’s the observing self – the part of your mind that is able to be aware of whatever you are thinking or feeling or doing at any moment. Without it, you couldn’t develop those mindfulness skills. And the more you practice those mindfulness skills, the more you’ll become aware of this part of your mind, and able to access it when you need it.

5. Values are what you want your life to be about, deep in your heart. What you want to stand for. What you want to do with your time on this planet. What ultimately matters to you in the big picture. What you would like to be remembered for by the people you love.

6. Committed action means taking action guided by your values – doing what matters – even if it’s difficult or uncomfortable

When you put all these things together, you develop something called psychological flexibility. This is the ability to be in the present moment, with awareness and openness, and take action, guided by your values. In other words, it’s the ability to be present, open up, and do what matters. The greater your ability to do that, the greater your quality of life – the greater your sense of vitality, wellbeing and fulfillment.

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http://www.wisegeek.com/what-is-acceptance-and-commitment-therapy.htm said:

Acceptance and Commitment Therapy (ACT) is a relatively new form of psychotherapy, pioneered by Steven C. Hayes in the mid 1990s. It is an outgrowth of behavioral therapy and cognitive behavioral therapy (CBT), which has largely been the accepted method for treatment of conditions like depression, anxiety, and post-traumatic stress disorders. Acceptance and Commitment Therapy, like CBT, relies on the philosophy of Functional Contextualism, a school of thought suggesting that words and ideas can only be understand within context and are hence frequently misconstrued because people have individual contexts. Another influence on ACT is Relational Frame Therapy, a form of behavioral analysis examining language and learning.

CBT focuses on identifying “hot thoughts” when in the throes of an anxiety attack or deep depression, and then evaluating such thoughts to gauge how true they really are. For example, a person who is feeling unduly anxious might evaluate a thought like, “Everybody hates me,” and then list evidence as to why this is or is not true. After looking at the underlying thoughts that cause anxiety, a person evaluates whether his or her stress has been reduced. The process seems long, but after a while, people can adeptly work this process in their head, understanding that these thoughts occur but are not representative of what is really “true”. When such thoughts occur, they can be dismissed after training in CBT.

Acceptance and Commitment Therapy differs from CBT because it immediately accepts the thought, “Everybody hates me.” The thought is viewed without passion, and the statement is sometimes verbalized as, “I am having the thought that everybody hates me.” This may be repeated until the thought is defused. Hayes recognizes about 100 defusion techniques in Acceptance and Commitment Therapy.

Previous unwanted thoughts are not actively dismissed by the person undergoing Acceptance and Commitment Therapy, but are rather embraced. This is also distinctive from CBT because CBT aims to reduce unwanted and unhelpful thoughts. ACT therapists claim that the process of their therapy takes far less time than CBT, and is therefore more effective.

Mindfulness, and being present in daily living and thoughts, are particularly stressed in Acceptance and Commitment Therapy. ACT also aims to help people identify their set of inner values. Acceptance and Commitment Therapy focuses on choosing behaviors that accord with these values. ACT places emphasis on things that can be controlled, like the set of the mouth, the rapidity of breaths, or the way one’s arms and legs move.

Acceptance and Commitment Therapy prides itself on its empirical data. Since 1996, about 20 clinical studies have assessed its effectiveness in varied situations that require psychological intervention. So far, Hayes' claims have been supported by clinical trials. However, proving these claims empirically requires more study, and is sometimes a means by which other therapists reject Acceptance and Commitment Therapy. To claim a theory is empirically proven, one most rely on a far greater number of clinical trials.

Currently, Hayes and other proponents of Acceptance and Commitment Therapy teach their methods of therapies in workshops around the world. These workshops tend to be two to three days in length. Universities offering degrees in Psychology and Counseling now frequently devote a class to this therapy and other third-wave behavioral therapies.

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http://media-newswire.com/release_1078140.html said:

Media-Newswire.com) - A new grant funded by NIMH will test an intervention designed to prevent or reduce suicide among college students.

Suicidal thinking and behavior among college students can result from a wide variety of problems including drug and alcohol abuse, mood disorders, problems in social relationships and physical health problems. Some research has suggested that a tendency to avoid unwanted emotions and negative thoughts can contribute to the problems that lead to suicide. Yet many college students who die by suicide never seek help within their institutions.

Steven Hayes, Ph.D. and Jacqueline Pistorello, Ph.D., of the University of Nevada Reno, will test an intervention called Acceptance and Commitment Therapy ( ACT ), which is based on the notion that acceptance and awareness of difficult emotions can help students reduce avoidance behavior and improve their psychological flexibility, which may reduce the frequency of problems that often precede suicide attempts. About 720 college freshmen will be randomized to receive either ACT or a brief educational course on adjusting to the challenges of college life.

For up to three years, the students will be assessed on a range of psychological, behavioral, health and academic aspects that are known to be associated with suicidal thinking and behavior, including self-injury and risky behaviors. If found to be successful in reducing suicide attempts and thinking, ACT could be readily disseminated within the college experience, and may be incorporated into a classroom-based approach that could have broad public health implications, according to the researchers.

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Videotape said:

the capital of australia

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Tuesday, Mar. 03, 2009

Talk Therapy for Kids' Pain: Better than Pills?
By John Cloud

Some children, like some adults, have chronic, unexplainable pain. They have backaches every day or their legs and feet hurt every day or their necks throb constantly — and no one is sure why. Doctors call this pain idiopathic, a medical term for "we have no clue." Idiopathic pain arises spontaneously and without a known cause.

How best to treat idiopathic pain is one of medicine's great mysteries. You can anesthetize patients with painkillers, but that's not a great long-term solution, since patients become habituated (and in some cases addicted) to pain meds. In children, the situation is even more dire, since they may face decades of swallowing drugs. (See nine kid foods to avoid.)

That's why a study just published in the journal Pain is so encouraging. According to the study, clinicians who used a particular form of behavior therapy called acceptance and commitment therapy (ACT) with a group of 16 chronic-pain patients ages 10 to 18 saw remarkable results: after just 10 weeks of ACT sessions, during which patients were taught strategies for accepting chronic pain so they could pursue important goals, those kids suffered less intensely and functioned significantly better day to day than did a control group of 16 chronic-pain kids who had been treated the way kids with persistent aches are normally treated — with drugs and standard talk therapy. Both groups improved, but the children in the ACT group, who got no drugs, improved more than those who took pills.

What exactly is ACT? Where standard psychotherapy often tries to change negative thoughts by asking probing questions (does everyone at the office really hate you, or are you just indulging in your own self-doubt?), ACT therapists take the position that trying really hard to change your thoughts tends to be counterproductive. Negative thoughts have a way of coming back again and again — have you ever tried to stop obsessing about pizza when you're on a diet? (See pictures of what makes you eat more food.)

Rather, ACT promotes the acceptance of negative thoughts, emotions and bodily sensations (like chronic pain) that a patient may have struggled with for a long time. The goal is to observe and be mindful of your crummy thoughts and feelings without getting mired in them — and to be able to act in accordance with your values (like, say, going to work every day or not drinking too much) despite them. In short, ACT therapists encourage engagement with life even when it hurts. (Learn about how ACT works and the fascinating psychologist who created it.)

ACT has proved effective for a variety of conditions — from depression to drug abuse to schizophrenia — but this is the first time it has been used to treat kids with pain. Here's how the study worked.

The research team — four Swedish investigators at the Karolinska Institute and Uppsala University — recruited kids who had truly suffered. The children had headaches, backaches and neck problems; many had widespread musculoskeletal pain; a couple had internal, visceral pain. They had high depression scores; 11 of the 32 had been to the emergency room with pain symptoms; 20 had had MRIs to try to find the source of their pain (without success); 21 had had physiotherapy. In short, the kids' parents had tried everything, and nothing had worked.

Half the kids were randomly assigned to participate in 10 weekly one-hour ACT sessions (along with an extra one or two ACT sessions with their parents present). During the sessions, the therapists emphasized that the kids should go out and do what they truly loved even if they were hurting that day — in other words, that they should accept rather than try to avoid their chronic pain. To shift kids away from focusing only on alleviating their symptoms, therapists discussed how their pain was not caused by a harmful disease or injury and how previous strategies (such as taking painkillers) had not worked. Kids were encouraged instead to notice and accept discomfort and to get back into activities they had abandoned. Therapists and kids talked about what the kids really wanted out of life and how they could achieve it. (See the top 10 medical breakthroughs of 2008.)

The control group of kids was treated for far longer than 10 weeks; in fact, they had an average of 23 weekly sessions, although those sessions were divided among physicians, physical therapists and a psychologist or psychiatrist. Each day, these kids were also given up to 100 mg of amitriptyline, a sedating drug that used to be prescribed as an antidepressant but is now used more often as a treatment for chronic pain.

ACT proved to be the better approach by far. Even when the ACT kids were interviewed 18 weeks after their last session, they reported less discomfort than did the control group, as well as less fear of injury and greater capacity to do things like go to school regularly. The authors conclude that drugs, while they can help in the short term, don't stimulate long-term behavior change. By contrast, with ACT, "the target in treatment is to clarify and reduce avoidance behaviors that prevent the patient from living a vital life," the study says. (Read "On the Couch Online: Does Tele-Therapy Work?")

How this succeeds isn't entirely clear, but the researchers used a simplified version of ACT with the kids. Typical ACT sessions with adults require difficult meditation strategies, but psychologist Rikard Wicksell, who led the Swedish team, says the researchers wanted to make sure their strategy was age-appropriate, so they didn't require meditation and instead focused on behavioral activation: getting the kids moving.

"Most of the things they want to do in life are associated with having to experience pain," says Wicksell. The kids want to play soccer or basketball, they want to go to movies, they want to be able to tell friends they can spend a whole Saturday with them. But for many of these kids, just standing up from a sofa can hurt a little. "So we discuss pros and cons — the short- and long-term consequences of not doing things with friends," says Wicksell. The kids eventually learn how to take their pain along with them to social outings — how to hold it close rather than dragging it at a heavy distance. (See the most common hospital mishaps.)

Parents also must be educated. According to Lynnda Dahlquist, a professor at the University of Maryland, Baltimore County, and co-author of the chronic-pain chapter in the Handbook of Pediatric Psychology (2003), many parents reinforce avoidance behavior in kids with chronic pain by doing something that comes naturally to parents: being kind to their kids. "Let's say Johnny's back pain flares up during math class," says Dahlquist. "He feels terrible, so he says, 'I can't do my math.' Mom comes, takes him home, puts the TV on and gives him a back rub. Well, math isn't fun. And who wouldn't like a back rub?" Instead of being indulged, kids with chronic pain often need a push.

ACT can provide that push — but one that comes from within. The new study suggests a less sentimental approach for kids with chronic pain: sympathy but never pity.

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Published on Psychology Today Blogs (Psychology Today Blogs)

Hard Won Wisdom in Dealing with Anxiety
Steven C. Hayes
Created May 4 2009 - 7:26am

It is one of the ironies of life that verbal formulae are not quite the same as wisdom earned. That is why parents cannot quite save their children from having to make mistakes, and teachers cannot quite eliminate the exploration of dead ends by their students. But sometimes on the other side of actual work we find particular wisdom in words. We see that love, indeed, makes the world go 'round, or that yes there is power in going with the flow.

On a list serve for members of the public reading ACT self-help books a person who has strugged mightily with anxiety recently posted a summary of what he took away from ACT and related readings. I thought it was an awesome distillation of key ideas that reflects his hard won wisdom. I asked his permission to report it here virtually verbatim.

*********

Sometimes I've felt really good for an extended period of time, only to have anxiety return, and for it to appear unresponsive to my attempts to get rid of it.

The key phrase here is "my attempts to get rid of it". I know that for myself, I would continue to engage in daily activities, but I would do so in a way that was still unwilling to feel the feelings; still trying to push the feelings away. Any time you sense yourself trying to push the feelings away, that's experiential avoidance, which is the core pathology of anxiety disorders. It is very important to recognize this mode of mind for what it is.

In these circumstances, it has been useful for me to be very clear about what I can and cannot control, and where I can make choices. Some of the following quotes and phrases taken from various ACT sources have been helpful reminders for me:

In essence, the practice is always the same: instead of falling prey to a chain reaction of self-hatred, we gradually learn to catch the emotional reaction and drop the story lines.

Life is a choice. Anxiety is not a choice. Either way you go, you will have problems and pain. So your choice here is not about whether or not to have anxiety. Your choice is whether or not to live a meaningful life.

You choose a path; a direction, not an immediate outcome. You don't choose how to feel or what pops into your head. You can choose a path that leads towards what you value or you can choose avoidance and fusion. Your choice.

Willingness is a skill you can learn. It just takes practice and patience. But you can learn it.

Because we don't control our feelings or thoughts, it's not our job to worry about them. They rise and fall of their own accord if we don't struggle with them. Instead, we can focus on what is within our control. We do choose:

* What we pay attention to.
* How we pay attention; struggle or willingness: Am I willing to move "with" thoughts and feelings? YES or NO. Am I willing to let them be without either trying to push them away or pursue them? YES or NO. Will I "Leap"? YES or NO. Will I love? YES or NO.
* What we do.

Rather than disavowing pain, you can learn to just acknowledge it, let it be as it is (a temporary uncomfortable feeling), not as what your mind says it is (a bad, terrible, dangerous, solid thing), and bring kindness and a nonjudgmental quality to that experience. When you do that, there is nothing to fight against, nothing to eliminate. There's nothing to be fixed. Nothing to resolve. These are not solid things. No need to be anything other than what you are experiencing. This stance is powerful, and cuts the suffering right out of anxiety and fear.

This is critical to understand. Fear will keep you trapped so long as you are unwilling to have it, touch it, and let it be. Life is about pain once in a while. And, when we step in the direction of something we care about, we often risk experiencing something that we'd rather not experience -- hurt, regret, sadness, loss, anger, abandonment, anxiety, fear, remorse. If we operate from the perspective that our pain is something that mustn't be had, the trap is sprung. Pain transforms in that instant and becomes a problem to be solved just like other problems that must be solved. Yet, we cannot problem solve ourselves out of our own pain. All that effort to get a foothold on our anxiety can pull us out of our lives in a flash.



*********

Various ACT writers seem to be in that distillation (myself, Russ Harris, Georg Eifert and John Forsyth) as well as Pema Chodron and perhaps others. But it is not the words that I want to recognize. It is the hard won wisdom from a life being lived that I honor here. I see in the words he holds dear a human heart being liberated.

Steven C. Hayes, University of Nevada

If you are a member of the public reading ACT self-help books (e.g., Get Out of Your Mind and Into Your Life, or the Mindfulness and Acceptance workbooks, or the Happiness Trap and so on) and wish to join the conversation go to http://health.groups.yahoo.com/group/ACT_for_the_Public/join [1]
Source URL: Hard Won Wisdom in Dealing with Anxiety | Psychology Today Blogs

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sabbath92003 said:

what?

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CiuinAnam said:

act= Australian Capital Territory .... the territory in which our capital Canberra can be found

facts are fun!

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A new book says that trying to be happy will only make you sad, writes Albert Buhr

Imagine your happiness depended on the following instruction: for the next minute, do not think of Daffy Duck. Don’t think of his daffiness. Forget he’s a duck. Whatever you do, resist the urge to contemplate any Loony Tunes character.

Your time starts now.

How you doing? Concentrate!

Let me guess: you blew it. You should consider that you might have Daffy Duck Disorder. But, of course, you were set up.

Trying so hard to forget something is a sure way of remembering. And when it comes to unpleasant thoughts and feelings, explains Russ Harris in The Happiness Trap, it’s often our very struggle to forget about them that ensures their perpetuation.

The Happiness Trap inhabits a special spot on the self-help shelf, because it goes cheerfully against the grain of so many books dedicated to the heroic pursuit of happiness. It is based on the new Acceptance and Commitment Therapy (ACT), which presents a radical about-turn in modern, conventional forms of Western psychotherapy.

It views ongoing attempts to get rid of symptoms as creating clinical disorder. Positive thinking, it suggests, is a control strategy that merely addles the tired mind.

“ACT is a mindfulness-based behavioural therapy that challenges the ground rules of most Western psychology,” explains Dr Harris, a general practitioner and psychotherapist based in Melbourne, Australia. “It’s a therapy that makes no attempt to reduce symptoms, but gets symptom reduction as a by-product. A therapy firmly based in the tradition of empirical science, yet has a major emphasis on values, forgiveness, acceptance, compassion, living in the present moment, and accessing a transcendent sense of self.”

With a large body of empirical data to support its efficacy, ACT has proven effective with a wide range of clinical conditions: depression, OCD, workplace stress, chronic pain, the stress of terminal cancer, anxiety, PTSD, anorexia and drug addiction. A study conducted in 2002 by Steven Hayes, the co-originator of ACT, showed that with only four hours of ACT therapy, hospital readmission rates for schizophrenic patients dropped by 50% over the following six months.

“It is only through mindful action that we can create a meaningful life,” says Harris, who runs workshops for psychologists, life coaches, doctors and other healthcare professionals in the use of “mindfulness”.

“Of course, as we attempt to create such a life, we will encounter all sorts of barriers, in the form of unpleasant and unwanted ‘private experiences’ — thoughts, images, feelings, sensations, urges and memories. ACT teaches mindfulness skills as a way to handle these private experiences, allowing your feelings to be as they are, letting them come and go rather than trying to control them.

“In ACT, acceptance comes first. Y ou make room for your feelings and allow them to be exactly as they are. Then you ask, ‘What can I do now that is truly meaningful or important?’ This is very different from asking ‘How can I feel better?’”

Anyone struggling with conditions like acute anxiety or depression may at some point find themselves drawn to the philosophy of acceptance.

“Since the ’50s until her passing in 1990, another Australian, Dr Claire Weekes, dedicated her life to showing millions the route to recovery through profound acceptance. ”

Acceptance is a tricky beast, however. Many first imagine that, should they be able to flip that acceptance switch in their heads, they can sit back and watch their suffering evaporate. It can become another attempt at running from unwanted thoughts and feelings, and takes some practice to mature into an attitude of openness and willingness.

The Happiness Trap breaks the difficult job of acceptance down into chewable chunks. The first step is taking a wrecking ball to four pervasive myths. Myth one, says Harris, is that happiness is the natural state for human beings.

“The probability that you will suffer from a psychiatric disorder at some stage is about 30%. And when you add in all the misery caused by problems that are not classified as psychiatric disorders, you get some idea of how rare true happiness is. ”

T hose of us driven to despair by the contrast between our lives and Top Billing need some measure of divorce from myth two: if you’re not happy, you’re defective.

“Following logically from myth one,” Harris continues, “Western society assumes that mental suffering is abnormal. It is seen as weakness or illness, a product of a mind that is faulty or defective. ACT is based on a dramatically different assumption: the normal thinking processes of a healthy human mind will lead to psychological suffering.”

Myth three is that to create a better life we must get rid of negative feelings. “We live in a feel-good society, a culture thoroughly obsessed with finding happiness. And what does it tell us to do? To ‘eliminate’ negative feelings and ‘accumulate’ positive ones. It’s a nice theory, b ut here’s the catch: the things we value most in life bring with them a range of feelings, pleasant and unpleasant.”

Which inevitably undermines myth four: you should be able to control what you think and feel. “The fact is, we have much less control over our thoughts and feelings than we would like. But we do have control over our actions. And it’s through taking action that we create a meaningful life.”

Anyone for whom positive thinking hasn’t proven as powerful as advertised, exploding this last myth should come as some relief. The majority of self-help books subscribe to the idea that if you suppress your negative thoughts, you will find happiness.

The Happiness Trap is not that sort of book. It teaches acceptance of even our most painful experiences, making space for them, and then getting on with the business of creating a life of value.

Russ Harris agrees with Canadian novelist Robertson Davies: “Happiness is always a by-product. It is probably a matter of temperament, and for all I know it may be glandular. But it is not something that can be demanded from life and, if you are not happy, you had better stop worrying about it and see what treasures you can pluck from your own brand of unhappiness.”

# The Happiness Trap is published by Trumpeter Books, R147

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September/October 2008 Issue

The ABCs of ACT — Acceptance and Commitment Therapy
By Claudia Dewane, LCSW, DEd
Social Work Today
Vol. 8 No. 5 P. 36

From the “third generation” of behavior therapies, ACT is a contextual approach challenging clients to accept their thoughts and feelings and still commit to change.

Client: “I want to change, BUT I am too anxious.”

Social worker: “You want to change, AND you are anxious about it.”

This subtle verbal and cognitive shift is the essence of acceptance and commitment therapy (ACT). It suggests that a person can take action without first changing or eliminating feelings. Rather than fighting the feeling attached to a behavior, a person can observe oneself as having the feeling but still act (Mattaini, 1997). Acceptance-based approaches (Hayes & Wilson, 1994) postulate that instead of opting for change alone, the most effective approach may be to accept and change. The importance of acceptance has long been recognized in the Serenity Prayer.

As one of the postmodern behavioral approaches, ACT is being evaluated as another short-term intervention in a variety of populations seen by social workers.

Evolution of ACT
Psychodynamic approaches that emphasize insight imply that a change in attitude will most likely result in a change in behavior. In contrast, pure behavioral approaches suggest that altering behavior does not demand a change in attitude. However, changing a behavior may eventually result in a change in attitude or emotion. Focusing on changing behavior regardless of accompanying emotion is the emphasis.

Taking behaviorism a step further, ACT suggests that both behavior and emotion can exist simultaneously and independently. Acceptance has been described as the “missing link in traditional behavior therapy” (Jacobson & Christensen, 1996). ACT is part of a larger movement in the behavioral and cognitive realm, which includes the mindfulness approaches (Hayes, 2005).

Hayes (2006, 2005, 1994) has been credited as the founder of ACT as a contextual approach to treatment. He explores the paradoxes of context, such as separating words and actions, and distinguishing clients’ sense of self from their thoughts and behavior. For example, when a person doesn’t go to work because he or she is anxious about a confrontation with his or her boss, it is conceivable (and encouraged) that the individual can go to work while feeling anxious. Showing clients that they can live with anxiety and eliminate the control that contexts exert is a major goal of therapy (Thyer & Wodarski, 1998). Those familiar with rational emotive behavioral therapy will recognize this approach as consistent with verbal rule governance (“injunctions”).

ACT is born from the behavioral school of therapy. However, behavior therapy is divided into three generations: traditional behaviorism, cognitive-behavioral therapy (CBT), and the current “third generation” or contextual approaches to behavior (Hayes, 2005). This third wave of behaviorism has an existential bent in its premise that suffering is a basic characteristic of human life and represents a dramatic change from traditional behaviorism and CBT due to the inclusion of acceptance and mindfulness-based interventions. The third-wave, which also includes dialectical behavior therapy and mindfulness-based cognitive therapy, broadens attention to the psychological, contextual, and experiential world of its constituents.

The belief behind ACT is that a more fulfilled life can be attained by overcoming negative thoughts and feelings. The goal of ACT is to help clients consistently choose to act effectively (concrete behaviors as defined by their values) in the presence of difficult or disruptive “private” (cognitive or psychological) events. The acronym ACT has also been used to describe what takes place in therapy: accept the effects of life’s hardships, choose directional values, and take action.

Theoretical Base
Social work literature about ACT is limited. As is typical of much of social work’s derivative knowledge base, the literature from the fields of psychology and social psychology contribute to understanding ACT and its application to social work practice. The literature on ACT dates back to the early 1980s but, more recently, has been evidencing empirical promise (Hayes, 2005).

ACT is a unique psychotherapeutic approach based on relational frame theory (RFT). RFT questions the context in which rational change strategies exist based on principles of behavior analysis. By examining the interactions that people have with their natural and social environments (contexts), RFT provides an understanding of the power of verbal behavior and language. The theory holds that much of what we call psychopathology is the result of the human tendency to avoid negatively evaluated private events (what we think and feel). ACT highlights the ways that language traps clients into attempts to wage war against their internal lives. Clients learn to recontextualize and accept these private events, develop greater clarity about personal values, and commit to needed behavior change. For social workers, this philosophy is best understood as “person in environment,” with the added variable of how language is used to interpret and direct those environments.

Process
The core of ACT is a change in both internal (self-talk) and external (action) verbal behavior. Simply observing oneself having feelings and recognizing and accepting that feelings are a natural outgrowth of circumstances is freeing. Clients have feelings about feelings (e.g., they might be ashamed of being anxious, angry, or sad). ACT says that fighting emotions makes them worse. “If you can’t accept the feeling for now, you will be stuck with it, but if you can, you can change your world so you will not have that feeling later.” (Hayes & Wilson, 1994)

Mattaini (1997) explains that ACT does not mean we ask clients to accept every situation (e.g., abusive relationships), but that some circumstances should ultimately be accepted (i.e., physical reality or historical events), should be accepted for now, should be accepted with expectation of eventual change, or should be changed now.

For example, if a client is disturbed by memories of past events, he or she must accept that the event occurred; accompanying feelings can eventually be diminished. This concept is reminiscent of social work’s strengths perspective in which Saleebey (1996) advises that one can accept the verdict yet defy the sentence.

Reminiscent of the Serenity Prayer, Mattaini (1997) cautions that the initial work is to identify areas that can and cannot be changed. Physical handicaps and past trauma are examples of things that cannot be changed and are best accepted.

ACT focuses on a shift from the content of experience to the context of experience. Hayes (2005) describes six core processes of ACT: acceptance, cognitive defusion, being present, self as context, valuing, and committed action. Similarly, Wilson et al (1996) provides a sample model for intervention:

1. Clients often present with a goal of erasing the past or the pain associated with it. They have struggled for a long time with “the problem” in many different ways. Thus, avoidant behaviors are initially assessed. What has been the client’s “experiential avoidance”?—that which occurs when a person is unwilling to remain in contact with particular private experiences and takes steps to alter the form or frequency of these events and the contexts that trigger them, even when doing so causes psychological harm (Hayes, Luoma, Bond, Masuda, & Lillis, 2006).

2. Examine strategies that have not worked. The paradox is that working hard to solve the problem makes the problem seem worse. ACT sees the logic of the problem-solving system as flawed because it is based on culturally sanctioned, language-based rules for solving problems. These rules are taken for granted, such as the presence of unpleasant inner experiences (feelings, thoughts, sensations) is equivalent to a psychological problem. By default then, being healthy means the absence of these negative experiences. The ACT therapist works to challenge these rules by showing that efforts based on these rules can actually be the source of problems. A more valid and reliable source of problem solving is the client’s own direct experience and their feedback from life. “It is not the client’s life that is hopeless, but the strategies of experiential control (avoidance) that are hopeless” (Wilson, 1996).

3. Establish control with different strategies. A lifetime of distracting oneself from aversive private experiences is akin to constantly running away from one’s shadow. The result is that in the attempt to control the negative thoughts and feelings, one is at a loss for control in other life situations.

4. Identify that self as context, distinguished from self in content, is similar to the process of externalizing the problem in narrative approaches. Clients are taught to get in touch with an observant self—the one that watches and experiences yet is distinct from one’s inner experiences.

5. A lack of values or a confusion of goals with values can underlie the inability to be psychologically flexible. Thus, the next step in the ACT process is “choosing a direction and establishing willingness” and to identify motivating values and establish a willingness to help regain control of life, not necessarily just to control thoughts and feelings. Willingness is not resignation, nor is it the same as wanting. It is a willingness to experience, accept, and face “negatively evaluated emotional states” (Wilson, 1996). Again, the difference is noted between the feeling of willingness and being willing. The example given is that you may not feel willing to go to the dentist, but you may be willing to go anyway.

6. In the last stages of therapy, commitment is the focus. The commitment is to give up the war of denying or fighting one’s history and emotional states and find opportunities for empowering behaviors.

Techniques
With ACT, metaphors, paradoxes, and experiential exercises are frequently used. Many interventions are playful, creative, and clever. ACT protocols can vary from short interventions done in minutes to those that extend over many sessions. There are myriad techniques categorized under the following five protocols that are extrapolated from the clinical materials assembled by Gifford, Hayes, and Stroshal (2005). These represent only a fraction of material available as resources for clinicians (see Resource).

1. Facing the current situation (“creative hopelessness”) encourages clients to draw out what they have tried to make better, examine whether they have truly worked, and create space for something new to happen. Confronting the unworkable reality of their multiple experiences often leaves the client not knowing what to do next, in a state of “creative hopelessness.” The state is creative because entirely new strategies can be developed without using the previous rules governing their behavior.

2. Acceptance techniques are geared toward reducing the motivation to avoid certain situations. An emphasis is given to “unhooking”—realizing that thoughts and feelings don’t always lead to actions. Often these techniques are done “in vivo,” structuring experiences in session. Discriminating between thoughts, feelings, and experiences is a salient focus.

3. Cognitive defusion (deliteralization) redefines thinking and experiencing as an ongoing behavioral process, not an outcome. Techniques are designed to demonstrate that thoughts are just thoughts and not necessarily realities (Blackledge, 2007). It can involve sitting next to the client and putting each thought and experience out in front as an object in an effort to “defuse and deliteralize.”

4. Valuing as a choice clarifies what the client values for his or her own sake: What gives life meaning? The goal is to help clients understand the distinction between a value and a goal, choose and declare their values, and set behavioral tasks linked to these values.

5. Self as context teaches the client to view his or her identity as separate from the content of his or her experience.

Potential Populations
ACT has been empirically tested, and there is reason to believe that it could be beneficial for a variety of populations. Preliminary research suggested that ACT is useful for sexual abuse survivors, at-risk adolescents, and those with substance abuse or mood disorders (Wilson, 1996). Hayes (2005) suggests that the ACT model seems to be working across an unusually broad range of problems.

ACT would be appropriate for individuals with substance abuse issues, heightening motivational interviewing and enhancement approaches. ACT has been utilized with those experiencing psychotic ideation. In one study, psychiatric inpatients given ACT demonstrated improvement in affective symptoms, social impairment, and distress associated with hallucinations (Gaudiano & Herbert, 2006).

ACT has been proposed for trauma work, as well as for those with phobias and obsessive behavior (Twohig, Hayes, & Masuda, 2006). Using ACT approaches with victims of trauma seems particularly pertinent. Those who suffer from posttraumatic stress may benefit from being able to accept the experience without resigning oneself to its residuals. The unwillingness to experience pain associated with trauma creates an internal struggle (verbal battle) that keeps the trauma alive.

For social workers dealing with survivors of childhood abuse, ACT may be a potent tool. From an ACT perspective, the cognitions and emotions that result from a history of abuse are amenable to alteration. CBT might seek to change the form of self-talk. In contrast, ACT seeks to alter the function of the thoughts and feelings. Cognitive therapy views negative thoughts and feelings in terms of their logical reasonableness; ACT focuses on their psychological reasonableness (Wilson, 1996). To tell an incest survivor that her disturbing thoughts in situations of sexual intimacy are irrational is not particularly helpful. It is more useful to point out the psychological function of these thoughts (Wilson et al, 1996).

ACT has been proposed for work with couples and families. One study demonstrated that acceptance strategies increased the effectiveness of traditional behavioral marital therapy (Jacobson & Christensen, 1996). The goal is not to necessarily accept all partner behaviors but rather to effectively “generate a context where both accepting and changing will occur” (Jacobson & Christensen, 1996). Three ways in which ACT interventions assist couples are generating greater intimacy with the conflict area used as a vehicle, generating tolerance, and generating change (Jacobson & Christensen, 1996). Acceptance is not accepting another’s behavior, but letting go of the struggle to try to change another’s behavior.

Certainly, to be proficient as an ACT therapist, training is indicated. For social workers dealing with the broad range of behavioral problems that demand short and empirically-based intervention, ACT has a place. “Get off your buts” is one of the techniques used in ACT, where all “buts” are replaced with “and.” So instead of saying, “I’d like to learn about ACT but don’t have the time,” consider saying, “I’d like to learn about ACT, and it is worth the time!”

— Claudia Dewane, LCSW, DEd, is a senior lecturer at Temple University’s Graduate School of Social Administration. She is the founder of Clinical Support Associates, providing supervision, consultation, and training to professional social workers.



Resource
A comprehensive list of protocols, techniques, and training related to acceptance and commitment therapy can be found at Welcome to ACBS's Online Learning & Research Community! | Association for Contextual Behavioral Science, the official site for the Association for Contextual Behavioral Science.



References
Blackledge, J. T. (2007). Disrupting verbal processes: Cognitive defusion in acceptance and commitment therapy and other mindfulness-based psychotherapies. The
Psychological Record, 57, 555-576.

Gaudiano, B. A. & Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using acceptance and commitment therapy: pilot results. Behaviour Research and Therapy, 44, 415-437.

Gifford, E. Steve Hayes and Kirk Stroshal. (2005). Retrieved 9/20/2005. [www.acceptanceandcommitmenttherapy.com] [TM e-mailing MM]

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25.

Hayes, Steven. (May 1, 2005). Acceptance and commitment therapy (ACT). Retrieved July 9, 2008 [www.contextualpsychology.org] [TM e-mailing MM]

Hayes, S. C. & Wilson, K. G. (1994). Acceptance and commitment therapy: Altering the verbal support for experiential avoidance. The Behavior Analyst, 17, 289-303.

Jacobson, N. S. & Christensen, A. (1996). Acceptance and change in couple therapy: A therapist’s guide to transforming relationship. New York: W. W. Norton & Company.

Mattaini, M. A. (1997). Clinical practice with individuals. Washington, DC: NASW Press.

Saleeby, D. 1996. The strengths perspective in social work practice: Extensions and cautions. Social Work, 41(3), 296-305.

Thyer, B. A. & Wodarski, J. S. (1998). Handbook of empirical social work practice, volume 1, mental disorders. Hoboken, NJ: Wiley.

Twohig, M. P., Hayes, S. C., & Masuda, A. 2006. Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 37(1), 3-13.

Wilson, K. G., Follette, V. M., Hayes, S. C., & Batten, S. V. (1996). Acceptance theory and the treatment of survivors of childhood sexual abuse. National Center for PTSD Clinical Quarterly, 6(2), 34-37.

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