Cognitive · 1999
Acceptance and Commitment Therapy (ACT)
Psychological freedom grows when a person stops living governed by avoiding what they feel and acts from their values.
Acceptance and Commitment Therapy (ACT) is a contextual-behavioural approach whose central aim is to increase psychological flexibility: the capacity to contact present experience — thoughts, emotions, sensations, memories, impulses and external circumstances — as it appears, and to choose effective behaviour in the service of personal values. ACT shifts the clinical focus away from the direct elimination of symptoms and towards transforming the function that private events serve in a person's life: thoughts cease to operate as literal commands, emotions cease to function as barriers that must be removed before acting, the self ceases to be reduced to rigid stories about oneself, and values come to guide observable decisions. Suffering is conceptualised as psychological inflexibility, maintained by cognitive fusion, experiential avoidance, attentional rigidity, attachment to the conceptualised self, disconnection from values, and inaction or impulsivity. The intervention combines functional analysis, experiential exercises, metaphors, mindfulness, defusion, acceptance, self-as-context, values clarification and committed action, so that the person can live more broadly and more deliberately even when the mind criticises, anticipates threat or produces emotional pain.
Theory of change
A person changes when they loosen their relationship with their internal experience and begin to act in a sustained way from their values, even with distress present.
Core ideas
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Psychological flexibility is the central aim
ACT defines psychological health as the capacity to contact the present and act effectively in the direction of values, even with internal distress present. Symptom reduction may appear as a consequence, but the principal criterion is a broader, more deliberate life that is less governed by avoidance, fusion or rigidity. (Hayes, Strosahl & Wilson, 1999; 2012).
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The clinical problem is formulated by function, not by content
A thought, emotion or memory is not considered problematic merely for being unpleasant, intense or negative, but for the function it serves: whether it governs behaviour, narrows life or activates persistent avoidance. ACT therefore analyses what happens when the person obeys, fights or avoids their internal experience. (Hayes, Strosahl & Wilson, 1999; 2012).
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Experiential avoidance maintains suffering at the cost of living
A person may obtain rapid relief by avoiding emotions, thoughts or memories, but that relief tends to reinforce the pattern and reduce contact with values, relationships and action. ACT makes this cost visible in order to open up an alternative based on willingness and commitment. (Hayes et al., 1999; Hayes et al., 2006).
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Human language amplifies both freedom and suffering
Symbolic capacity makes it possible to plan, remember and construct meaning, but also to fuse with rules, comparisons and painful narratives. RFT provides the basis for understanding how an internal sentence can govern behaviour as though it were a present threat. (Hayes, Barnes-Holmes & Roche, 2001; Hayes, Strosahl & Wilson, 2012).
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Defusion changes the relationship with the mind
To defuse means to notice thoughts as thoughts, not as commands, identities or absolute facts. The aim is neither to think better nor to think positively, but to reduce the behavioural control exerted by language when it leads away from values. (Hayes, Strosahl & Wilson, 1999; 2012).
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To accept is to make room in the service of action
Acceptance in ACT is an active stance: allowing difficult private experiences when struggling against them prevents living. It differs from resignation because it is tied to a valued direction and to chosen behaviour. (Hayes, Strosahl & Wilson, 2012; Eifert & Forsyth, 2005).
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Self-as-context reduces the prison of labels
ACT distinguishes the person who observes from the stories the mind tells about them. This perspective makes it possible to hold thoughts such as ‘I am a failure’ or ‘I am worthless’ without being reduced to them, widening identity and freedom of response. (Hayes, Strosahl & Wilson, 2012).
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Values are direction, not demand
Values guide continuous, chosen behaviour; they are not goals to be ticked off or duties imposed by the inner critic. When well formulated, they help decide what to do with fear present and turn therapy into the construction of a life, not merely the management of symptoms. (Hayes, Strosahl & Wilson, 2012; Wilson & DuFrene, 2009).
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Committed action translates therapy into real life
Change is consolidated through concrete, repeated and revisable behavioural steps that express values in everyday contexts. ACT prevents therapy from stopping at insight, momentary calm or comprehension of the model: the criterion is to move deliberately. (Hayes, Strosahl & Wilson, 1999; 2012).
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The therapeutic relationship models flexibility
The therapist does not merely explain ACT, but embodies it: listening with openness, defusing from their own control agenda, validating pain, repairing ruptures and returning to clinical values. The session becomes a living laboratory of presence, acceptance and choice. (Hayes, Strosahl & Wilson, 2012; Wilson & DuFrene, 2009).
Influences
- Contextual behaviourism
- Radical behaviourism
- Functional contextualism
- Relational Frame Theory (RFT)
- Mindfulness
- Third-wave behavioural therapies
- Functional analysis of verbal behaviour
Key references
- Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press.
- Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd ed.). New York: Guilford Press.
- Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational Frame Theory: A Post-Skinnerian Account of Human Language and Cognition. New York: Kluwer Academic/Plenum.
- 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.
- Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and Commitment Therapy for Anxiety Disorders: A Practitioner's Treatment Guide to Using Mindfulness, Acceptance, and Values-Based Behavior Change Strategies. Oakland, CA: New Harbinger.
- Wilson, K. G., & DuFrene, T. (2009). Mindfulness for Two: An Acceptance and Commitment Therapy Approach to Mindfulness in Psychotherapy. Oakland, CA: New Harbinger.
- Harris, R. (2009/2019). ACT Made Simple: An Easy-to-Read Primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Polk, K. L., Schoendorff, B., Webster, M., & Olaz, F. O. (2016). The Essential Guide to the ACT Matrix: A Step-by-Step Approach to Using the ACT Matrix Model in Clinical Practice. Oakland, CA: New Harbinger.
- Villatte, M., Villatte, J. L., & Hayes, S. C. (2015). Mastering the Clinical Conversation: Language as Intervention. New York: Guilford Press.
- Hayes, S. C. (2019). A Liberated Mind: How to Pivot Toward What Matters. New York: Avery.