[vc_row][vc_column][vc_column_text]
Acceptance and Commitment Therapy, known as ACT, is a “cognitive behavioral – humanistic existential therapy,” or as Wilson and Luciano (2001) well put it, a values-oriented behavioral therapy. It uses an eclectic mix of metaphors, paradoxes, and mindfulness skills along with a wide variety of experiential exercises and behavioral interventions to create a rich and meaningful life.
As we create a meaningful life, we will encounter all kinds of barriers in the form of unwanted and unpleasant “private experiences” (thoughts, images, emotions, sensations, impulses, and memories). ACT teaches us concentration and mindfulness skills as an effective way to manage these experiences (Harris, 2012). Currently, having a master’s degree in third-generation therapies (which includes training in ACT) is almost a must for any psychologist.
Acceptance and Commitment Therapy postulates that:
“the root of people’s suffering lies in human language itself, which is a double-edged sword since it helps us create maps and models of the world, predict and plan for the future, share knowledge, learn from the past, imagine things that never existed and create them, develop rules that guide our behavior, etc., but at the same time, we use it to emphasize and “relive” painful past events, to scare ourselves by imagining unpleasant future events, to compare, judge, criticize and condemn ourselves and others, and to create rules that can be restrictive or destructive”
(Harris, 2012)
In this sense, ACT points out that Experiential Avoidance Disorder (EAD) or Destructive Experiential Avoidance is a rigid way of regulating life that ultimately results in going “against life.” That is, the person believes that to live, it is necessary to be free from discomfort, and when this arises accompanied by annoying thoughts, memories, and sensations, the person acts to avoid and escape discomfort as a necessary goal to live. The real problem arises when the result of such a strategy is paradoxical, in that, in the long run, what is intended to be avoided expands and strengthens, while life becomes increasingly small and impoverished.
Therefore, ACT focuses on two main processes:
1) developing acceptance of undesirable private experiences that are beyond personal control and
2) developing commitment and action oriented towards living a valuable life (Harris, 2012).
We exemplify EAD through the case of Miriam, 29 years old, who came to consultation presenting depressive symptoms due to the romantic relationship she maintains with her partner:
First session: data regarding the patient’s history was collected, and the BDI-II, which measures depression, was applied to rule out this diagnosis, as in that case, applying ACT would not be a priority. Since the patient showed several symptoms, but not enough to be diagnosed with severe depression, it was then decided to work with ACT so that she could make decisions, consider whether or not to continue with the relationship, consider if she should make any changes in her life, if she was satisfied with different areas, etc.
Considering all this, the patient was made to see that the solutions she had implemented so far had been useless, and therefore “the problem is not the problem, the problem is the solution,” which in this case had been inadequate or insufficient for a long time.
Second session: the “hole metaphor,” one of the tools used in ACT, was applied so that she could see that digging is not the solution, as it will only make the hole bigger. In turn, the “quicksand metaphor” was used so that she would become aware that fighting against the situation only causes her greater discomfort, so it would be advisable to take some time to relax, get in touch with the situation, and be aware of the problems and solutions that can actually be followed.
In this second session, Miriam was emphasized that sessions would not always be pleasant, as the act of making decisions itself is painful, and this, added to the patient’s effort and involvement, would make it hard work but totally comforting upon finishing the treatment.
Third session: the “swamp metaphor” was used so that she would realize that she can cross the swamp despite many adversities, or she can choose not to, but it depends on what she chooses.
Based on this example, the principles of ACT that help patients develop psychological flexibility are highlighted and are based on (Wilson and Luciano (2001):
1. Cognitive Defusion: learning to observe thoughts, images, memories, and other cognitions as what they are—words and images—as opposed to what they claim to be—threatening events, objective truths, and facts.
2. Acceptance: making room for unwanted emotions, sensations, impulses, and other private experiences; allowing them to “come and go” without fighting them, fleeing from them, or paying undue attention to them.
3. Contact with the Present Moment: giving full attention to the experience in the here and now, with openness, interest, and receptivity, fully focusing and engaging in what is being done at that moment.
4. The Observing Self: accessing the transcendent sense of self, the continuity of consciousness that is imperturbable, ever-present, and impervious to harm.
5. Values: clarifying what is most important to us, what kind of people we want to be, what is meaningful and valuable in our lives.
6. Committed Action: setting value-guided goals and engaging in effective actions to achieve them.
ISEP has designed the Master’s in Third-Generation Therapies with specific training in ACT due to its growing popularity as a psychotherapeutic tool in practice and the good results obtained.[/vc_column_text][/vc_column][/vc_row]