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A ‘third wave’ cognitive approach, Acceptance and Commitment Therapy (ACT) is a behavioural model of human suffering. It works on the assumption that distress is created and maintained through ‘psychological inflexibility’.
Flexibility is made up of two aspects: experiential avoidance and cognitive fusion. Experiential avoidance is when a person attempts to suppress or avoid unwanted internal experiences (e.g. emotions, thoughts and sensations). The unwillingness to ‘stick with’ these experiences often results in behaviours that allow a person to tolerate the situation but are often self-defeating. Cognitive fusion is defined as engaging with thoughts as if they are ‘true’ rather than cognitive events.
Therapists using ACT do not consider any internal event (e.g. thoughts, feelings) as essentially problematic: it depends on the context in which they exist. For example, thoughts and feelings may impact in significantly different ways depending on whether they are thought of as objective truth (something to fear and avoid) or simply accepted (painful but not reducing valued living).
ACT aims to alter your verbal connections to thoughts and feelings and uses a number of techniques including:
- Value identification
- Commitment to change
Ultimately, ACT therapists focus on changing behaviour. Therapists believe worrying or going over and over difficulties in your mind essentially keeps you 'stuck'. Rather than asking why, ACT aims to support people to accept reality and work with what you have to help you move towards the things that are important to you.
Evidence for ACT
Recent reviews of ACT’s clinical efficacy have indicated support for a range of difficulties and diagnoses. This includes work stress, depression, anxiety disorders, pain, smoking, substance abuse, OCD, low quality of life and psychosis. Furthermore, ACT interventions have been successfully developed to compliment interventions already offered, such as Dialectical Behavioural Therapy.