Acceptance and commitment therapy
Acceptance and commitment therapy (or ACT) is a form of behavioural therapy that uses acceptance and mindfulness strategies to help increase psychological flexibility. It was developed in the late 1980s by Steven Hayes and associates in the U.S., and is gaining recognition as an effective treatment for a range of mental health issues and psychological disorders.
A predominantly time-limited approach, ACT therapy takes the view that by accepting negative thoughts and feelings, individuals can choose a valued direction in which to take action and make positive changes. In this way, acceptance and commitment therapy does not aim to directly change or stop unwanted problems and experiences. Instead it teaches individuals to develop a mindful relationship with them - promoting a psychological flexibility that encourages healthy contact with thoughts, reconnection with the here and now, realisation of personal values, and commitment to behaviour change.
How does ACT therapy work?
Acceptance and commitment therapy involves a range of experiential exercises to subvert the power and significance of damaging emotive, cognitive, and behavioural processes. It aims to help individuals to change their relationship with negative thoughts and feelings that are taking over their lives and in some cases are greatly impacting their health and well-being.
The approach takes a stand against 'experiential avoidance' - the attempt to avoid or get rid of unwanted unpleasant thoughts and feelings - and offers a long-term solution to future health and happiness. This is usually applied in one-to-one sessions with clients, or in groups, where metaphors, visualisation exercises and behavioural homework will be used. The number and length of sessions will depend greatly on the needs of those taking part and the practicing methods of the counsellor. The overall duration of the treatment should be relatively short, however this factor will too depend on the client and counsellor.
The ACT therapy model
Although acceptance and commitment therapy is not a specific set of techniques, there are six core processes employed to establish psychological flexibility. Each of these areas are conceptualised as a positive psychological skill - they do not serve as a way for individuals to avoid or prevent negative thoughts and feelings. They also show how ACT therapy is a combination of mindfulness - the mental state of awareness, openness and focus - and behavioural therapy, and how each of these processes support each other in helping an individual to overcome their problems.
Taught as an alternative to experiential avoidance, acceptance involves embracing painful feelings and private experiences without attempting to change their frequency or form. Clients of ACT therapy are encouraged to willingly open up and let go of their internal struggle with these unwanted problems. This can essentially help them to learn ways of coping with them.
Also known as emotional separation, cognitive defusion refers to a set of techniques that attempt to change the functions of negative thoughts and feelings, and how they affect an individual. Procedures that may be followed include encouraging the individual to externally observe their unwanted problems by giving it a shape, size, colour, speed or form. By recontextualising uncomfortable memories and experiences, individuals can learn to relate to them in a different way - one that does not involve attaching any particular value to them.
Contacting the present moment
ACT therapy encourages clients to be psychologically present - making a conscious effort to connect with whatever is happening in the here and now. Enabling individuals to experience the world more directly is thought to make their behaviour and thoughts more flexible. This is to ensure their actions are more consistent with their personal values. Language - both written and verbal - is often used as a tool for individuals to describe current events, rather than predicting and judging them.
The observing self
ACT therapy views the mind as a combination of two parts. One part is the 'thinking self', which is responsible for a person's thoughts, beliefs, judgements, fantasies and so on, whilst the second part - 'the observing self' - deals with attention and awareness. The latter is the part of the mind that enables individuals to develop mindfulness skills - the ability to be aware of one's flow of experiences without attachment to them. This helps to foster acceptance and cognitive defusion.
Values are the chosen qualities that individuals live by, and they are essential to the development of ACT therapy goals. A variety of exercises are used to help clients choose a life direction in various domains, such as family and career, and the realisation of these typically comes from an individual's ability to follow through the processes of acceptance, defusion and contacting the present moment.
The final stage of the ACT therapy model involves the establishment of concrete goals that are consistent with an individual's chosen values. It is considered essential that the person taking part commits to these goals in order to foster the necessary changes to discover a greater sense of vitality, well-being and fulfilment. This process consists of elements of traditional behavioural therapy, such as skills acquisition, shaping methods and goal setting, and often requires the individual to do homework in between of sessions. These behaviour change efforts in turn help to address psychological barriers that are addressed in other ACT therapy processes.
Who can benefit?
Acceptance and commitment therapy can be beneficial for a wide range of individuals. The empowering message of the approach - to alter the function rather than the existence of unpleasant thoughts and feelings - makes it particularly useful in helping clients to cope with problems such as anxiety, depression, obsessive compulsive disorders, trauma, substance abuse, eating disorders and even psychotic symptoms.
The mindfulness elements of ACT therapy also makes it effective for helping individuals to improve their athletic or business performance. In many models of coaching and therapy, mindfulness tends to be taught through meditation, yet ACT therapy employs a range of tools to teach mindfulness strategies. This makes it a more appealing approach for those who want to quickly and easily master mindfulness without having to meditate.
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