Acceptance and Commitment Therapy (ACT) - Competencies

Overview
Acceptance and Commitment Therapy (ACT) has become one of the most prominent and well-researched models within Contextual Behavioral Science. The Association for Contextual Behavioral Science (ACBS) recently reported more than 1,100 randomized controlled trials (RCTs) supporting ACT’s effectiveness (see ACT Evidence Overview). ACT is widely utilized across various disciplines—including psychiatry, psychology, social work, physiotherapy, behavior analysis, chaplaincy, coaching, and nursing—and is delivered in diverse professional settings such as private practices, community clinics, college counseling centers, hospitals, schools, spiritual organizations, sports medicine, and more. ACT also addresses a broad range of populations, including veterans, adolescents, children, refugees, organizations, and individuals managing behavioral health conditions, medical concerns, or mental disorders, across multiple geographic locations.

This widespread application demonstrates the broad dissemination of ACT principles but also introduces variability in how ACT is delivered. Such variability has implications for maintaining ACT competencies across different contexts.

Several studies have investigated fidelity in ACT delivery, often using established protocols to ensure that the intervention adheres to its intended framework. These studies frequently assess the service provider’s training level and use recorded service sessions evaluated by subject matter experts. Many studies include multiple expert raters to establish inter-rater reliability. However, while these methods assess fidelity, they provide limited insights into the competency level of ACT delivery.

Moreover, as Perepletchikova et al. (2007) noted, traditional methods for establishing treatment fidelity may not align well with process-oriented approaches like ACT. This misalignment can result in a loss of the contextual sensitivity that is central to ACT’s effectiveness. This highlights the need for more nuanced approaches to evaluating competency and fidelity in ACT practice.

Measurement of Competency in ACT
Various methodologies have been employed to develop competency tools for assessing the quality of services delivered under the ACT model. The most common approach involves using expert consensus to construct or select assessment items. Typically, these tools focus on evaluating simulated video material, where observer ratings are compared against expert ratings. These evaluations often distinguish between "ACT-consistent" and "inconsistent" actions depicted in the videos. However, these methods do not deliver insight into how the delivered service impacts the service recipient.

Knowledge questionnaires are also commonly used in competency assessments. While they test basic understanding, they do not sufficiently measure competency. As prior research indicates, knowledge alone represents the lowest level of competence development and does not guarantee the ability to deliver high-quality practice (Dreyfus & Dreyfus, 1986; Lysaght & Altschuld, 2000).

Summary of Key Issues
This review highlights several methodological challenges that must be addressed to advance the field. A notable issue is the confusion between treatment fidelity and competency:

 ● Treatment Fidelity: Measures are tied to specific procedures, limiting their adaptability across the diverse practice settings, professional disciplines, and geographical locations where ACT is implemented.
 ● Competency: While progress has been made, significant gaps remain in evaluating comprehensive competence. 

Research conducted by Walser et al. (2013) within the Department of Veterans Affairs provides a robust model for assessing competency. This model incorporates standardized competency measures and outcome evaluations for service recipients. However, the study's assessment tool lacked methodological rigor, a limitation echoed in other studies examining competency measures.

The ACT-FM (ACT Fidelity Measure) shows promise as a technique for incorporating expert input to develop competency measurement tools. Nonetheless, many studies that have employed rigorous methodologies still fail to include outcome measures assessing the service recipients' experiences, a critical component of comprehensive evaluation. Addressing these methodological limitations will be essential for refining competency measures and ensuring ACT is delivered effectively across diverse settings.

Materials/Assessments
ACT Core Competency Self-Assessment for Clinicians:
This self-assessment tool outlines primary behaviors that align with the ACT model, aiding clinicians in evaluating and enhancing their ACT skills.

Focused Acceptance and Commitment Therapy Competency Assessment Tool (FACT-CAT):
Designed to help practitioners assess their competence in delivering Focused ACT (FACT) across various client populations, this tool uses a rating scale to evaluate specific competencies.

Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT):
The CompACT is a general measure of psychological flexibility and its sub-processes within the ACT model.

Walser, R. D. & Mazina, B. (2017). Acceptance and commitment therapy rating scale training manual. Unpublished manual (email robyn.walser@va.gov for information).

Walser, R. D. et al. (2006). Acceptance And Commitment Therapy Tape Rating Scale.

References:
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