Acceptance and Commitment Therapy Process

Acceptance and Commitment Therapy, known as “ACT” (pronounced as the word “act”) is a mindfulness-based behavioural therapy that challenges the ground rules of most Western psychology. It utilizes an eclectic mix of metaphor, paradox, and mindfulness skills, along with a wide range of experiential exercises and values-guided behavioural interventions. ACT has proven effective with a diverse range of clinical conditions:

Depression
OCD
Workplace Stress
Chronic pain
Stress (arising out of terminal stages in diseases like cancer)
Anxiety
PTSD
Anorexia
Heroin Abuse
Marijuana Abuse
Schizophrenia

How Does ACT Differ from Other Mindfulness-based Approaches?

ACT is one of the so-called “third wave” of behavioural therapies—along with Dialectical Behaviour Therapy (DBT), Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR) —all of which place a major emphasis on the development of mindfulness skills.

ACT differs from DBT, MBCT, and MBSR in many ways. For a start, MBSR and MBCT are essentially annualized treatment protocols, designed for use with groups for treatment of stress and depression. DBT is typically a combination of group skills training and individual therapy, designed primarily for group treatment of Borderline Personality Disorder.

In contrast, ACT by MindYog – Kolkata’s Best Psychological Wellness Centre can be used with individuals, couples and groups, both as brief therapy or long term therapy, in a wide range of clinical populations. Furthermore, rather than following an annualized protocol, ACT allows the therapist to create and individualize their own mindfulness techniques, or even to co-create them with clients.

Acceptance and Commitment Therapy (ACT) Process at MindYog:

Therapists at MindYog while practicing ACT focuses on a shift from the content of experience to the context of experience. MindYog describes six core processes of ACT:

Acceptance
Cognitive Defusion
Being Present
Self AsContext
Valuing
Committed Action

There is a sample model for intervention from Wilson and others:

1. Clients often present with a goal of erasing the past or the pain associated with it.
They have struggled for a long time with “the problem” in many different ways. Thus, avoidant behaviours are initially assessed.

2.Examine strategies that have not worked. The paradox is that working hard to solve the problem makes the problem seem worse. ACT sees the logic of the problem-solving system as flawed because it is based on culturally sanctioned, language-based rules for solving problems. These rules are taken for granted, such as the presence of unpleasant inner experiences (feelings, thoughts, sensations) is equivalent to a psychological problem. By default then, being healthy means the absence of these negative experiences. The ACT therapist works to challenge these rules by showing that efforts based on these rules can actually be the source of problems.

3.Establish control with different strategies. A lifetime of distracting oneself from aversive private experiences is akin to constantly running away from one’s shadow. The result is that in the attempt to control the negative thoughts and feelings, one is at a loss for control in other life situations.

4. Identify that self as context, distinguished from self in content, is similar to the process of externalizing the problem in narrative approaches. Clients are taught to get in touch with an observant self—the one that watches and experiences yet is distinct from one’s inner experiences.

5.A lack of values or a confusion of goals with values can underlie the inability to be psychologically flexible. Thus, the next step in the ACT process is “choosing a direction and establishing willingness”, to identify motivating values and establish a willingness to help regain control of life, not necessarily just to control thoughts and feelings.

6. In the last stages of therapy, commitment is the focus. The commitment is to give up the war of denying or fighting one’s history and emotional states and find opportunities for empowering behaviours.

Specially designed ACT Technique at MindYog:

With ACT, metaphors, paradoxes, and experiential exercises are frequently used. Many interventions are playful, creative, and clever. ACT protocols can vary from short interventions done in minutes to those that extend over many sessions.

1.Facing the current situation (“creative hopelessness”) -Therapist at MindYog encourages its clients to draw out what they have tried to make better, examine whether they have truly worked, and create space for something new to happen. Confronting the unworkable reality of their multiple experiences often leaves the client not knowing what to do next, leaving him in a state of “creative hopelessness.”

2. Acceptance techniques are geared toward reducing the motivation to avoid certain situations. An emphasis is given to “unhooking”—realizing that thoughts and feelings don’t always lead to actions. Often these techniques are done “in vivo,” while structuring experiences in the session. Discriminating between thoughts, feelings, and experiences is a salient focus.

4. Valuing as a choice clarifies what the client values for his or her own sake: What gives life meaning? The goal is to help clients understand the distinction between a value and a goal, choose and declare their values, and set behavioral tasks linked to these values.

5. Self as context by Therapist at MindYog teaches the client to view his or her identity as separate from the content of his or her experience.