Acceptance and commitment therapy
Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy, as well as a branch of clinical behavior analysis.[1] It is an empirically based psychological intervention that uses acceptance and mindfulness strategies[2] along with commitment and behavior-change strategies to increase psychological flexibility.
Acceptance and commitment therapy
This approach was first called comprehensive distancing.[3] Steven C. Hayes developed it around 1982 to integrate features of cognitive therapy and behavior analysis, especially behavior analytic data on the often negative effects of verbal rules and how they might be ameliorated.[4]
ACT protocols vary with the target behavior and the setting. For example, in behavioral health, a brief version of ACT is focused acceptance and commitment therapy (FACT).[5]
The goal of ACT is not elimination of difficult feelings, but to be present with what life brings and to "move toward valued behavior".[6]: 240 Acceptance and commitment therapy invites people to open up to unpleasant feelings, not to overreact to them, and not to avoid situations that cause them.
Its therapeutic effect aims to be a positive spiral, in which more understanding of one's emotions leads to a better understanding of the truth.[7] In ACT, "truth" is measured through the concept of "workability", or what works to take another step toward what matters (e.g., values, meaning).
Technique[edit]
Basics[edit]
ACT is developed within a pragmatic philosophy, functional contextualism. ACT is based on relational frame theory (RFT), a comprehensive theory of language and cognition that is derived from behavior analysis. Both ACT and RFT are based on B. F. Skinner's philosophy of radical behaviorism.[8]
ACT differs from some kinds of cognitive behavioral therapy (CBT) in that, rather than try to teach people to 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, "self-as-context"—the one who is always there observing and experiencing and yet distinct from one's thoughts, feelings, sensations, and memories. ACT tries to help the individual clarify values and then use them as the basis for action, bringing more vitality and meaning to life in the process, while increasing psychological flexibility.[3]
While Western psychology has typically operated under the "healthy normality" assumption, which states that humans naturally are psychologically healthy, ACT assumes that the psychological processes of a normal human mind are often destructive.[9] 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.[10] 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:[11]
Professional organizations[edit]
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 2023 it had over 8,000 members worldwide, about half outside of the United States. It holds annual "world conference" meetings each summer, with the location alternating between North America, Europe, and South America.[25]
The Association for Behavior Analysis International (ABAI) has a special interest group for practitioner issues, behavioral counseling, and clinical behavior analysis ABA:I.[26] ABAI has larger special interest groups for autism and behavioral medicine. ABAI serves as the core intellectual home for behavior analysts.[27][28] ABAI sponsors three conferences/year—one multi-track in the U.S., one specific to autism 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.
Doctoral-level behavior analysts who are psychologists belong to the American Psychological Association's (APA) Division 25—Behavior analysis.[29] ACT has been called a "commonly used treatment with empirical support" within the APA-recognized specialty of behavioral and cognitive psychology.[30]