Acceptance and Commitment Therapy
Acceptance and Commitment Therapy
Issue 23 – July 2010Author: Phil Houghton (firstname.lastname@example.org)
- The Acceptance and Commitment Therapy (ACT) model argues that much suffering is caused by trying to avoid or control painful experiences.
- ACT focuses on helping people to accept their painful experiences, choose valued directions in life and take action towards those values.
- A criticism of the ACT model is that it pays little attention to people’s social context and the inequality that means some people experience more aversive and painful events than others, and also have less resources to address these difficulties.
Implications for practice
- The model argues that the primary focus of clinical interventions should be on helping people move towards valued goals rather than focusing on trying to rid them of distress.
- Getting caught up in trying to directly challenge and alter peoples thoughts and beliefs is likely to be unproductive
The main points of ACTWithin ACT distress is separated out into natural “pain” versus “suffering” 3. Pain is seen as a natural and unavoidable part of human existence, caused by historical and current adverse situations, whereas suffering is viewed as arising out of our efforts to avoid or control pain. The drive to try to avoid and control our painful thoughts, memories, feelings, as well as our tendency to treat our thoughts about ourselves as if they are true (e.g. someone feeling depressed has the thought that they are “bad” and sees this as the truth rather than simply a product of their mind), are seen as core in leading to suffering. Changing how someone feels or thinks is therefore not seen as a therapeutic goal of ACT (although this may occur as part of the process), rather ACT attempts to assist people to live more meaningful lives through a variety of strategies aimed at: Accepting, or being willing to experience in the present moment whatever thoughts, feelings, urges, memories, external events etc that one has no direct control over. Choosing, the valued directions and value based behaviours that would add meaning, purpose and vitality to life. Taking action, to move towards those valued directions.
WeaknessesACT pays very little attention to the broader social context we live in and which has a profound influence on our ability to accept, choose and take action. It describes pain as a natural and unavoidable part of human existence, whilst this is partially true, it conceals the fact that some groups of people are born into circumstances (dependent on poverty. class, ethnicity and gender and so forth) where they are more likely to experience aversive and painful events than other groups. Therefore these sources of pain are not natural, but stem from the way society is structured. For example someone who is unemployed with few qualifications would probably be trying to accept a great deal more “pain” that someone employed in a well paid job. Furthermore, if these two people were struggling with depression and choosing to adopt a new valued direction in life (for example getting fitter and doing more exercise) they are likely to have significantly different amounts of resources to do so. Taking the example of exercise, one may have the resources to access a private gym, have a personal trainer, live in a pleasant area to exercise, money for equipment, whereas the other would not. Therefore, the amount of “pain”, and resources at our disposal to support value based actions may be very different depending on our social context. In addition, ACT can at times be difficult to grasp for both worker and client, as whilst some of the main messages are relatively straightforward, some of the concepts and explanations are quite complex, even when one reads the self-help book. In this way, it is perhaps less accessible than more straightforward theoretical models.
StrengthsNotwithstanding the above, I feel ACT has a number of strengths, noticeably in comparison with CBT. Comparing ACT with CBT, one of the fundamental differences is that within CBT one of the driving aims is to challenge and alter “dysfunctional” thoughts, whereas within ACT the content of the thought is not seen as the focus for intervention. The model argues that the cultural and therapeutic norm of trying to get rid of, or control distressing thoughts and feelings (a “mastery and control” strategy) is unproductive and can even lead to more suffering. This is also consistent with the growing body of evidence which suggests that challenging thoughts has little or no impact4. The message that we are able to move towards valued behaviours with our painful experiences feels a more genuine and hopeful message than feeling we need to be free of such experiences to enable us to get on with our lives. It is also a message which chimes with the recovery model. With regard to the basis for the model, unlike CBT which primarily developed from clinical practice rather than underlying theory, ACT stems from and relates back to experimental science. Furthermore, whether one agrees with it or not, ACT has a theoretically coherent base and explicit philosophical underpinnings. Furthermore, there is also an inherent pragmatism within ACT, which looks at finding what is a useful way of understanding or acting, rather than getting the “right” understanding.
Clinical ImplicationsI see the main message of ACT as being one of moving away from trying to change people’s thoughts and beliefs and getting bogged down by our excessive focus of trying to rid people of their painful experiences, at the cost of focusing on the broader context of helping people move towards their values. Rather, where possible, by helping reduce situational sources of pain, and helping to widen individuals’ choices through identifying and bolstering their resources, we can support people in doing valued activities which in turn help to develop a meaningful life. Where this is achievable I suspect the person’s level of distressing psychological experiences will naturally decrease. REFERENCES
- Hayes, S., Strosahl, K. & Wilson, K. (1999). Acceptance and Commitment Therapy, An experiential approach to behavior change. The Guidford Press: New York
- Hayes, S. & Strosahl, K. (Eds.) (2004). A practical guide to Acceptance & Commitment Therapy. Springer.
- Hayes, S. (2005). Get out of your mind & into your life. The new Acceptance & Commitment Therapy. New Harbinger Publications, Inc. Oakland, CA.
- Longmore, R. & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, 17, 173-187.
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