22/12/2014 Acceptance and commitment therapy ­ Wikipedia, the free encyclopedia

Acceptance and commitment therapy

From Wikipedia, the free encyclopedia

Acceptance and commitment therapy or ACT (typically pronounced as the word "act") is a form of
clinical behavior analysis (CBA)[1] used in psychotherapy. It is an empirically­based psychological
intervention that uses acceptance and mindfulness strategies mixed in different ways[2] with commitment
and behavior­change strategies, to increase psychological flexibility. The approach was originally called
comprehensive distancing.[3] It was developed in the late 1980s[4] by Steven C. Hayes, Kelly G. Wilson,
and Kirk Strosahl.[5]

Noam Shpancer describes acceptance and commitment therapy as getting to know unpleasant feelings,
then learning not to act upon them, and to not avoid situations where they are invoked. Its therapeutic
effect is according to him a positive spiral where feeling better leads to a better understanding of the
truth.[6]

Contents
1 Basics
2 Core principles
3 Evidence
4 Similarities
5 Criticisms
6 Professional organizations
7 See also
8 Notes
9 References
10 External links

Basics
ACT is developed within a pragmatic philosophy called functional contextualism. ACT is based on
relational frame theory (RFT), a comprehensive theory of language and cognition that is an offshoot of
behavior analysis. ACT differs from traditional cognitive behavioral therapy (CBT) in that rather than
trying to teach people to better control their thoughts, feelings, sensations, memories and other private
events, ACT teaches them to "just notice," accept, and embrace their private events, especially
previously unwanted ones.

ACT helps the individual get in contact with a transcendent sense of self known as "self­as­context"—
the you that is always there observing and experiencing and yet distinct from one's thoughts, feelings,
sensations, and memories. ACT aims to help the individual clarify their personal values and to take
action on them, bringing more vitality and meaning to their life in the process, increasing their
psychological flexibility.[3]

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While Western psychology has typically operated under the "healthy normality" assumption which states
that by their nature, humans are psychologically healthy, ACT assumes, rather, that psychological
processes of a normal human mind are often destructive.[7] The core conception of ACT is that
psychological suffering is usually caused by experiential avoidance, cognitive entanglement, and
resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core
values. As a simple way to summarize the model, ACT views the core of many problems to be due to the
concepts represented in the acronym, FEAR:

Fusion with your thoughts

Evaluation of experience
Avoidance of your experience
Reason­giving for your behavior

And the healthy alternative is to ACT:

Accept your reactions and be present

Choose a valued direction
Take action

Core principles
ACT commonly employs six core principles to help clients develop psychological flexibility:[7]

1. Cognitive defusion: Learning methods to reduce the tendency to reify thoughts, images,
emotions, and memories.
2. Acceptance: Allowing thoughts to come and go without struggling with them.
3. Contact with the present moment: Awareness of the here and now, experienced with openness,
interest, and receptiveness.
4. Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is
unchanging.
5. Values: Discovering what is most important to one's true self.[8]
6. Committed action: Setting goals according to values and carrying them out responsibly.

Evidence
ACT had, as of October 2006, been evaluated in about 30 controlled time series studies or randomized
clinical trials for a variety of client problems.[9] As of 2011 that number had approximately doubled[10]
and new controlled studies were regularly being published. Overall, when compared to other treatments
designed to be helpful, the effect size for ACT is a Cohen's d of around 0.6 which is considered a
medium effect size. In some studies ACT has exceeded the performance of gold standard
treatments,[11][12][13] in others it has been equally effective,[14] and in one or two studies with minor
problems it has not done as well.[15]

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As compared to treatments that are already known to be effective, the effect size so far is about .3, which
is small.[16] Across the whole empirical clinical psychology literature the average effect size for such
comparisons approaches zero, however. All of these comparisons and their effect sizes need to be
viewed with caution, because many of the trials are unfunded and are based on a relatively small number
of patients; and in some cases might be contaminated by the allegiance effect.

A large and well done trial by a major CBT research team on mixed anxiety disorders that showed
superiority of ACT to gold standard CBT on the primary outcome measure has recently appeared
however and in that study allegiance effects should have worked in the opposite direction, suggesting
that at least some of the effects in favor of ACT are replicable by teams that are skeptical of this
approach[17]

In recent years larger and better controlled trials have begun to appear[18] and the number of areas to
which it has been successfully applied is growing. ACT is considered an empirically validated treatment
by the American Psychological Association, with the status of "Modest Research Support" in depression
and "Strong Research Support" in chronic pain, with several others specific areas such as psychosis and
work site stress currently under review.[19] ACT is also listed as evidence­based by the Substance Abuse
and Mental Health Services Administration of the United States federal government which has examined
randomized trials for ACT in the areas of psychosis, work site stress, and obsessive compulsive disorder,
including depression outcomes.[20]

ACT is still relatively new in the development of its research base with the randomized trials beginning
in earnest only after the 1999 publication of the original book on ACT. ACT has shown preliminary
research evidence of effectiveness in randomized trials for a variety of problems including chronic pain,
addictions, smoking cessation, depression, anxiety, psychosis, workplace stress, diabetes management,
weight management, epilepsy control, self­harm, body dissatisfaction, eating disorders, burn out, and
several other areas.[21] ACT has more recently been applied to children, adolescents and
trainees,.[12][22][23]

Mediational analyses have provided evidence for the possible causal role of key ACT processes,
including acceptance, defusion, and values, in producing beneficial clinical outcomes.[24] Correlational
evidence has also found that absence of these processes predicts many forms of psychopathology. A
recent meta­analysis showed that ACT processes, on average, account for 16–29% of the variance in
psychopathology (general mental health, depression, anxiety) at baseline, depending on the measure,
using correlational methods.[9]:12–13 A recent meta­analysis of 68 laboratory­based studies on ACT
components has also provided support for the link between psychological flexibility concepts and
specific components.[25]

In New Zealand, the Department of Psychology at the University of Waikato, in conjunction with the
local DHB approved research, to evaluate the effectiveness of ACT therapy (through self­help books)
for people with chronic pain.[26] The sample size was twenty­four with eligibility being reading
comprehensive ability, no psychiatric disorder, stable medication and no childhood history of trauma.

The method was randomised two group study conducted over a six­week period with some participants
required to read the self­help book and complete exercises.[26] Pre­intervention and post­intervention
questionnaires for acceptance, values illness, quality of life, satisfaction with life, depression, anxiety,
and pain were completed. Interestingly, data demonstrated that those who completed the intervention
evidenced statistically significant improvements (with large effect sizes) for acceptance, satisfaction

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with life and quality of life. Medium effect sizes were also established for enhancement in pain ratings.
The findings maintained the proposition that utilising the self­help book, with minimal therapist contact
adds value to the well­being of people who encounter chronic pain.[26]

Similarities
ACT, Dialectical Behavior Therapy, Functional Analytic Psychotherapy, Mindfulness­based Cognitive
Therapy and other acceptance and mindfulness based approaches are commonly grouped under the name
The Third Wave of Behavior Therapy,[27][28] with the first wave commencing in the 1920s that related to
Pavlov’s classical (respondent) and operant conditioning that was correlated to reinforcing
consequences. The second wave emerged in the 1970s and included cognition in the form of irrational
beliefs, dysfunctional attitudes or depressogenic attributions.[29] In the late 1980s empirical limitations
and philosophical misgivings of the second wave gave rise to Steven Hayes ACT theory which modified
the focus of abnormal behaviour away from the content or form towards the context in which it
occurs.[29] ACT research has suggested that many of the emotional defences individuals use with
conviction, to solve disorders, actually entangle humans into suffering.[30]

Steven C. Hayes described this group in his ABCT President Address as follows:

Grounded in an empirical, principle­focused approach, the third wave of behavioral and

cognitive therapy is particularly sensitive to the context and functions of psychological
phenomena, not just their form, and thus tends to emphasize contextual and experiential
change strategies in addition to more direct and didactic ones. These treatments tend to seek
the construction of broad, flexible and effective repertoires over an eliminative approach to
narrowly defined problems, and to emphasize the relevance of the issues they examine for
clinicians as well as clients. The third wave reformulates and synthesizes previous
generations of behavioral and cognitive therapy and carries them forward into questions,
issues, and domains previously addressed primarily by other traditions, in hopes of
improving both understanding and outcomes.

ACT has also been adapted to create a non­therapy version of the same processes called Acceptance and
Commitment Training. This training process, oriented towards the development of mindfulness,
acceptance, and values skills in non­clinical settings such as businesses or schools, has also been
investigated in a handful of research studies with good preliminary results.[31] This is somewhat similar
to the awareness–management movement in business training programs, where mindfulness and
cognitive­shifting techniques are employed.

The emphasis of ACT on ongoing present moment awareness, valued directions and committed action is
similar to other psycho­therapeutic approaches that, unlike ACT, are not as focused on outcome research
or consciously linked to a basic science program, including more humanistic or constructivist
approaches such as Gestalt Therapy, Morita Therapy and Voice Dialogue, IFS and others.

Wilson, Hayes & Byrd explore at length the compatibilities between ACT and the 12­step treatment of
addictions and argue that, unlike most other psychotherapies, both approaches can be implicitly or
explicitly integrated due to their broad commonalities. Both approaches endorse acceptance as an
alternative to unproductive control. ACT emphasizes the hopelessness of relying on ineffectual
strategies to control private experience, similarly the 12­step approach emphasizes the acceptance of
powerlessness over addiction. Both approaches encourage a broad life­reorientation, rather than a

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narrow focus on the elimination of substance use, and both place great value on the long­term project of
building of a meaningful life aligned with the clients' values. ACT and 12­step both encourage the
pragmatic utility of cultivating a transcendent sense of self (higher power) within an unconventional,
individualized spirituality. Finally they both openly accept the paradox that acceptance is a necessary
condition for change and both encourage a playful awareness of the limitations of human thinking.[32]

Criticisms
Some published studies in clinical psychology have concluded that ACT is no different than other
interventions.[33][34] A meta­analysis by Öst concluded that ACT did not qualify as an “empirically
supported treatment,” that the research methodology for ACT was less stringent than cognitive
behavioral therapy, and that the mean effect size was moderate.[35] Supporters of ACT have challenged
those conclusions and discussed the limitations of Öst's review.[36]

Professional organizations
The Association for Contextual Behavioral Science is committed to research and development in the
area of ACT, RFT, and contextual behavioral science more generally. As of mid­2012 it had nearly
5,700 members world wide, about half outside of the United States. It holds annual "world conference"
meetings: The 12th will be held in Minneapolis in June, 2014; the 13th will be held in Berlin in July,
2015.[37]

The Association for Behavior Analysis International (ABAI) has a special interest group for practitioner
issues, behavioral counseling, and clinical behavior analysis ABA:I. ABAI has larger special interest
groups for autism and behavioral medicine. ABAI serves as the core intellectual home for behavior
analysts.[38][39] ABAI sponsors two conferences/year—one in the U.S. and one international.

The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior
analysis, which focuses on clinical behavior analysis. ACT work is commonly presented at ABCT and
other mainstream CBT organizations.

The British Association for Behavioural and Cognitive Psychotherapies (BABCP) has a large special
interest group in ACT, with over 1,200 members.

Doctoral­level behavior analysts who are psychologists belong to the American Psychological
Association's division 25—Behavior analysis. APA offers a diplomate in behavioral psychology.

The World Association for Behavior Analysis offers certification in behavior therapy which covers
knowledge of ACT.

See also
Behavior therapy
Behavioral psychotherapy
Clinical behavior analysis
Contextualism
Experiential avoidance

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Jhana
Morita therapy

Notes

1. ^ Jennifer C Plumb, Ian Stewart, Galway JoAnne Dahl, Tobias Lundgren (Spring 2009). "In Search of
Meaning: Values in Modern Clinical Behavior Analysis"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686995). Behav Anal. 32 (1): 85–103. PMC 2686995
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686995). PMID 22478515
(https://www.ncbi.nlm.nih.gov/pubmed/22478515).
2. ^ Hayes, Steven. "Acceptance & Commitment Therapy (ACT)" (http://www.contextualpsychology.org/act).
ContextualPsychology.org.
3. ^ a b Zettle, Robert D. (2005). "The Evolution of a Contextual Approach to Therapy: From Comprehensive
Distancing to ACT" (http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?
_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ844315&ERICExtSearch_SearchType_0=no&accno=EJ8
44315). International Journal of Behavioral Consultation and Therapy 1 (2): 77–89.
4. ^ Murdock, N. L. (2009). Theories of counseling and psychotherapy: A case approach. Upper Saddle River,
N.J: Merrill/Pearson
5. ^ "Getting in on the Act ­ The Irish Times ­ Tue, Jun 07, 2011"
(http://www.irishtimes.com/newspaper/health/2011/0607/1224298494422.html#.Te5oANHU5AB;facebook).
The Irish Times. 2011­06­07. Retrieved 2012­03­16.
6. ^ Shpancer, Noam (September 8, 2010). "Emotional Acceptance: Why Feeling Bad is Good"
(http://m.psychologytoday.com/blog/insight­therapy/201009/emotional­acceptance­why­feeling­bad­is­good).
Psychology Today.
7. ^ a b Harris, Russ (August 2006). "Embracing your demons: an overview of Acceptance and Commitment
Therapy" (http://actmindfully.com.au/upimages/Dr_Russ_Harris_­_A_Non­technical_Overview_of_ACT.pdf).
Psychotherapy in Australia 12 (4): 2–8.
8. ^ Robb, Hank (2007). "Values as Leading Principles in Acceptance and Commitment Therapy"
(http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?
_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ801192&ERICExtSearch_SearchType_0=no&accno=EJ8
01192). International Journal of Behavioral Consultation and Therapy 3 (1): 118–23.
9. ^ a b Hayes, Steven C.; Luoma, Jason B.; Bond, Frank W.; Masuda, Akihiko; Lillis, Jason (2006).
"Acceptance and Commitment Therapy: Model, processes and outcomes". Behaviour Research and Therapy
44 (1): 1–25. doi:10.1016/j.brat.2005.06.006 (http://dx.doi.org/10.1016%2Fj.brat.2005.06.006).
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11. ^ Lappalainen, R.; Lehtonen, T.; Skarp, E.; Taubert, E.; Ojanen, M.; Hayes, S. C. (2007). "The Impact of
CBT and ACT Models Using Psychology Trainee Therapists: A Preliminary Controlled Effectiveness Trial".
Behavior Modification 31 (4): 488–511. doi:10.1177/0145445506298436
(http://dx.doi.org/10.1177%2F0145445506298436). PMID 17548542
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(https://www.ncbi.nlm.nih.gov/pubmed/17548542).
12. ^ a b Wicksell, Rikard K.; Melin, Lennart; Lekander, Mats; Olsson, Gunnar L. (2009). "Evaluating the
effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding
pediatric pain – A randomized controlled trial". Pain 141 (3): 248–57. doi:10.1016/j.pain.2008.11.006
(http://dx.doi.org/10.1016%2Fj.pain.2008.11.006). PMID 19108951
(https://www.ncbi.nlm.nih.gov/pubmed/19108951).
13. ^ Zettle, R. D.; Rains, J. C.; Hayes, S. C. (2011). "Processes of Change in Acceptance and Commitment
Therapy and Cognitive Therapy for Depression: A Mediation Reanalysis of Zettle and Rains". Behavior
Modification 35 (3): 265–83. doi:10.1177/0145445511398344
(http://dx.doi.org/10.1177%2F0145445511398344). PMID 21362745
(https://www.ncbi.nlm.nih.gov/pubmed/21362745).
14. ^ Forman, E. M.; Herbert, J. D.; Moitra, E.; Yeomans, P. D.; Geller, P. A. (2007). "A Randomized
Controlled Effectiveness Trial of Acceptance and Commitment Therapy and Cognitive Therapy for Anxiety
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(http://dx.doi.org/10.1177%2F0145445507302202). PMID 17932235
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15. ^ Zettle, Robert D. (2003). "Acceptance and Commitment Therapy (ACT) vs. Systematic Desensitization in
Treatment of Mathematics Anxiety" (http://opensiuc.lib.siu.edu/tpr/vol53/iss2/3). The Psychological Record
53 (2): 3.
16. ^ Levin, Michael; Hayes, Steven C. (2009). "Is Acceptance and Commitment Therapy Superior to Established
Treatment Comparisons?". Psychotherapy and Psychosomatics 78 (6): 380; author reply 380–1.
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Craske, Michelle G. (2012). "Randomized clinical trial of cognitive behavioral therapy (CBT) versus
acceptance and commitment therapy (ACT) for mixed anxiety disorders". Journal of Consulting and Clinical
Psychology 80 (5): 750–65. doi:10.1037/a0028310 (http://dx.doi.org/10.1037%2Fa0028310). PMID 22563639
(https://www.ncbi.nlm.nih.gov/pubmed/22563639).
18. ^ Gifford, Elizabeth V.; Kohlenberg, Barbara S.; Hayes, Steven C.; Pierson, Heather M.; Piasecki, Melissa
P.; Antonuccio, David O.; Palm, Kathleen M. (2011). "Does Acceptance and Relationship Focused Behavior
Therapy Contribute to Bupropion Outcomes? A Randomized Controlled Trial of Functional Analytic
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(https://www.ncbi.nlm.nih.gov/pubmed/22035998).
19. ^ "APA website on empirical treatments" (http://www.div12.org/PsychologicalTreatments/treatments.html).
Retrieved 2009­09­01.
20. ^ "SAMHSA's National Registry of Evidence­Based Programs and Practices"
(http://nrepp.samhsa.gov/ViewIntervention.aspx?id=191). Retrieved 2011­09­01.
21. ^ Hayes, Steven. "State of the ACT Evidence"
(http://www.contextualpsychology.org/state_of_the_act_evidence/). ContextualPsychology.org.
22. ^ Murrell, Amy R.; Scherbarth, Andrew J. (2006). "State of the Research & Literature Address: ACT with
Children, Adolescents and Parents" (http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?
_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ804059&ERICExtSearch_SearchType_0=no&accno=EJ8
04059). International Journal of Behavioral Consultation and Therapy 2 (4): 531–43.
23. ^ Gendron, Benedicte (2012). "Le développement du capital émotionnel au service du bien­être à partir de
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23. ^ Gendron, Benedicte (2012). "Le développement du capital émotionnel au service du bien­être à partir de
l'approche de la thérapie de l'acceptation et de l'engagement" [Development of emotional capital serving the
emotional well being from the approach of acceptance and commitment therapy]. In Martin­Krumm, Charles;
Tarquinio, Cyril. Traité de psychologie positive [Treatise on Positive Psychology] (in French). De Boeck
Supérieur. ISBN 978­2­8041­6614­4.
24. ^ Lundgren, Tobias; Dahl, Joanne; Hayes, Steven C. (2008). "Evaluation of mediators of change in the
treatment of epilepsy with acceptance and commitment therapy". Journal of Behavioral Medicine 31 (3): 225–
35. doi:10.1007/s10865­008­9151­x (http://dx.doi.org/10.1007%2Fs10865­008­9151­x). PMID 18320301
(https://www.ncbi.nlm.nih.gov/pubmed/18320301).
25. ^ Levin, Michael E.; Hildebrandt, Mikaela J.; Lillis, Jason; Hayes, Steven C. (2012). "The Impact of
Treatment Components Suggested by the Psychological Flexibility Model: A Meta­Analysis of Laboratory­
Based Component Studies". Behavior Therapy 43 (4): 741–56. doi:10.1016/j.beth.2012.05.003
(http://dx.doi.org/10.1016%2Fj.beth.2012.05.003). PMID 23046777
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Acceptance and Commitment Therapy self­help intervention for chronic pain. 26(5), 393.
27. ^ Martell, Addis & Jacobson, 2001, p. 197
28. ^ Öst, L.G. (March 2008). "Efficacy of the third wave of behavioral therapies: a systematic review and meta­
analysis". Behaviour research and therapy 46 (3): 296–321. doi:10.1016/j.brat.2007.12.005
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Commitment Therapy Santa Rosa, CA.: New Harbinger Publications.
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References
Hayes, Steven C.; Spencer Smith (2005). Get Out of Your Mind and Into Your Life: The New
Acceptance and Commitment Therapy. New Harbinger Publications. ISBN 1­57224­425­9.
Hayes, Steven C.; Kirk D. Strosahl (2004). A Practical Guide to Acceptance and Commitment
Therapy. Springer. ISBN 0­387­23367­9.
Hayes, Steven C.; Kirk D. Strosahl; Kelly G. Wilson (2003). Acceptance and Commitment
Therapy: An Experiential Approach to Behavior Change. The Guilford Press. ISBN 1­57230­955­
5.
Eifert, Georg H.; John P. Forsyth (2005). Acceptance and Commitment Therapy for Anxiety
Disorders: A Practitioner's Treatment Guide to Using Mindfulness, Acceptance, and Value­Guide
Behavior Change Strategies. Oakland, CA: New Harbinger. ISBN 1­57224­427­5.
Forsyth, John P.; Georg H. Eifert (2007). The Mindfulness and Acceptance Workbook for Anxiety:
A Guide to Breaking Free From Anxiety, Phobias, and Worry Using Acceptance and Commitment
Therapy. Oakland, CA: New Harbinger. ISBN 1­57224­499­2.
Martell, Christopher R.; Michael E. Addis; Neil S. Jacobson (2001). Depression in Context:
Strategies for Guided Action. New York: W. W. Norton. ISBN 0­393­70350­9.

External links
Contextualpsychology.org (http://www.contextualpsychology.org/) – Home for the Association
for Contextual Behavioral Science, a professional organization dedicated to ACT, RFT, and
functional contextualism. Also helpful for training opportunities for professionals interested in
ACT and RFT. Most ACT workshops world wide are listed here.
Steven C Hayes (http://www.unr.edu/psych/shayes.html) – One of ACT's main theorists, Dr.
Hayes' is at the University of Nevada. Information can also be found at his website
(http://www.stevenchayes.com)
ACT Workshops in the UK (http://www.tir.org.uk/acceptance­and­commitment­therapy.html)
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22/12/2014 Acceptance and commitment therapy ­ Wikipedia, the free encyclopedia

An Introduction to ACT (http://www.psychologytoday.com/blog/two­takes­

depression/201102/acceptance­and­commitment­therapy)
Introduction to ACT and other mindfulness therapies (http://cogbtherapy.com/acceptance­and­
commitment­therapy­act­los­angeles)
An Introduction to Relational Frame Theory Online Tutorial (http://foxylearning.com/rft)
[1] (http://superieur.deboeck.com/titres/123844_3/traite­de­psychologie­positive.html) ­
GENDRON Benedicte, (2012), Le développement du capital émotionnel au service du bien­être à
partir de l'approche de la thérapie de l'acceptation et de l'engagement ­ACT­, Chapitre 21, in Ch.
Martin­Krumm, C. Tarquinio (dir.), Traité de psychologie positive, De Boeck. :
The ACT Formula for Self­Compassion (http://www.blakepsychology.com/2014/04/act­self­
compassion­5­ways­to­be­brave/) ­ First published on the Association for Contextual Behavioral
Science (ACBS) ListServ ­ By Dr. Russ Harris, MD and Dr. Emily Blake, PhD.

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