Acceptance & Commitment Therapy (ACT)

source: the Association for Contextual Behavioral Science (ACBS)

Psychological Inflexibility: An ACT View of Suffering

The core conception of ACT is that psychological suffering is usually caused by the interface between human language and cognition, and the control of human behavior by direct experience. Psychological inflexibility is argued to emerge from experiential avoidance, cognitive entanglement, attachment of a conceptualized self, loss of contact with the present, and the resulting failure to take needed behavioral steps in accord with core values. Buttressed by an extensive basic research program on a associated theory of language and cognition, Relational Frame Theory (RFT), ACT takes the view that trying to change difficult thoughts and feelings as a means of coping can be counter productive, but new, powerful alternatives are available, including acceptance, mindfulness, cognitive diffusion, values, and committed action.

The ACT Model

ACT is an orientation to psychotherapy that is based on functional contextualism as a philosophy and RFT as a theory. As such, it is not a specific set of techniques. ACT protocols target the processes of language that are hypothesized to be involved in psychopathology and its amelioration, such as:

• cognitive fusion -- the domination of stimulus functions based on literal language even when that process is harmful,
• experiential avoidance -- the phenomenon that 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 occasion them, even when doing so causes psychological harm
• the domination of a conceptualized self over the "self as context" that emerges from perspective taking and deictic relational frames
• lack of values, confusion of goals with values, and other values problems that can underly the failure to build broad and flexible repertoires
• inability to build larger unit of behavior through commitment to behavior that moves in the direction of chosen values

and other such processes. Technologically, ACT uses both traditional behavior therapy techniques (defined broadly to include everything from cognitive therapy to behavior analysis), as well as others that are more recent or that have largely emerged from outside the behavior tradition, such as cognitive defusion, acceptance, mindfulness, values, and commitment methods.

ACT for Physical Therapists

ACT can be very useful for patients suffering from chronic pain. For many of these patients the persisting pain starts to interfere with life. Most often the response to this situation is that patients stop doing the things they want to do at work and in their private life. For many of these patients avoiding pain and struggling with it becomes the focus of their life.

In challenging the patients to notice the pain and notice all the things the mind tells you about it (whether they are true or not).

This training in noticing of awareness is a mindfulness therapy. ACT does not aim to eliminate pain but tries to turn the focus back to what the patients want their lives to be about.

Pain is not the same as pain behavior  Pain behavior is what we do in response to pain and pain behavior is subject to all the usual influences on behavior and can be reinforced just like other behaviors.