Edward's Reviews > Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change

Acceptance and Commitment Therapy by Steven C. Hayes
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Jul 16, 09

Read in July, 2009

Where I work (in mental health for the Dept of Veterans Affairs) ACT is being pushed as an evidence-based psychotherapy. The VA is pretty hard-nosed about these sort of things, so you know that this approach must be pretty legit. I wanted to read this, especially because it was a fresh approach with a lot of research and some of the ideas really spoke to me.

This a very dense read, intended for psychotherapists, about Acceptance and Commitment Therapy (ACT; pronounced "act"). The basic philosophical assumption underlying this approach is that people do not have to get rid of negative thoughts and feelings to get better (this is opposed to pretty mainstream psychological assumptions, for example CBT). I wonder, though, if this is such an error than how come CBT works for so many people?

A major concept is experiential avoidance: “[which:] occurs when a person is unwilling to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts, memories, behavioral dispositions) and takes steps to alter the form or frequency of these events and the context that occasion them” (58); instead, research shows that being in touch with oneself and open to experiences has the best therapeutic outcomes.

“Clients are frequently spending so much time evaluating how well they are doing, whether they are happy and what to do about it, that they lose contact with the content about which they might be happy… The result is that change—particularly that involves the visitation and working through of unpleasant events—is traumatic. The individual goes through the experience unwillingly, and the negative impact of the experience is magnified by the continual self-evaluation process it occasions" (69).

- Not FEAR:
Fusion with your thoughts
Evaluation of your experiences
Avoidance of your experiences
Reason-giving for your behavior

- But ACT:
Accept your reactions and be present
Choose a valued direction
Take committed action

“ACT is at its core, a behavioral treatment. Its ultimate goal is to help the client develop and maintain a behavioral trajectory in life that is vital and valued” (205).

A major problem for people is that the verbal over-dominates the experiential. This is espcially the case with evaluation. ACT reduces this, not by getting people so they shouldn’t say “should”, but by undermining language itself and instead “opening the window and letting a little (nonverbal) air in". This is done by using metaphors and experiential exercises (like those used in Gestalt therapy). For example, one excercise involves the therapist and client saying the word "milk" over and over again for 3 minutes.

We choose a valued direction when we ask "what do you want your life to stand for?"
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