See attachment below

See also Spanish version submitted by Ramiro

Russ Harris has this to say about the form which is attached below: I've attached a word doc of a brief summary of ACT that I give my clients on the first session. Anyone can easily re-edit it to suit their clientele. (I also usually give them a copy of the "Embracing your Demons" article; it's pitched at a level the average layperson can understand.)

ACT in plain language Submitted by Joel Guarna on February 1, 2006 - 10:38pm. I agree that explaining ACT plainly is difficult. With my clients, I often compare and contrast ACT with CBT more generally, since CBT is more widely known. I discuss similarities and refer to some common roots to both. I then illustrate some contrasts to traditional CBT by saying that an ACT approach is "not so much about changing the content of thinking (give examples, +/- thinking, etc) or fixing 'distortions' as about changing your relationship to your thoughts, feelings, memories, and other so-called private events (relate these to their presenting issues). ACT is less about making anxiety or depression go away and more about getting you untangled from the thoughts, feelings and rxns you have and getting you (client) moving in a direction that is important to you." I give a very lay summary that ACT is related to a basic science and theory about human language and thinking (I do NOT attempt to explain RFT in much detail) and their role in our suffering (I sometimes give examples of our pain/suffering and how it differs from nonverbal animals...if the client seems interested and appears to be following). I add that, since human language seems to complicate our dealing with private events, doing ACT as a "talk therapy" is tricky: "so, if you are up for it, we will use a lot of exercises, mindfulness practice, metaphors, and other methods to keep us both from getting tangled up in the words and ideas." I try to relate all of this to their personal issues as much as possible and use examples. I discuss this in "we" terms throughout. Once their interest is piqued (& it usually is) and I am satisfied they have a sufficient grasp on the approach to give informed consent, I implore them to hold whatever "understanding" of this that they now have VERY lightly. I then try to back out of all this wordiness and shift back into a more experiential mode. The process is a difficult balancing act b/n providing enough info for informed consent and getting ahead of ourselves and getting too didactic and wordy.

Explaining ACT - A comment submitted by Nicole Rensenbrink on October 2, 2010 - 10:37am.

I have a fairly low educated clientele and teens. I'm describing treatment to them in these terms:

I use a kind of therapy (ACT) that helps people figure out what's really important to them, develop goals that'll have them live according to what's most important, and then work through the barriers that get in their way of achieving these goals. There are three typical barriers:

1) Feelings: Lots of times people can't let their feelings be what they are so they act them out or create other problems for themselves by avoiding them.

2) Thoughts: Our brains are constantly busy and people often get so wedded to what their brains are telling them that they loose sight of what's really important to them.

3) Being present: Sometimes people are so distracted or preoccupied that they aren't there enough to follow through with what's important.

So that's I'll be doing with you in counseling, if you're interested. 

This list was updated in November 2021. The State of ACT Evidence webpage has an up-to-date list.

A number of different organizations, external to ACBS, have stated that ACT is empirically supported in certain areas or as a whole according to their standards. These include:

i. American Psychological Association, Society of Clinical Psychology (Div. 12), Research Supported Psychological Treatments:

Chronic Pain - Strong Research Support
Depression - Modest Research Support
Mixed anxiety - Modest Research Support
Obsessive-Compulsive Disorder - Modest Research Support
Psychosis - Modest Research Support
For more information on what the "modest" and "strong" labels mean, click here

ii. California Evidence-Based Clearinghouse for Child Welfare (click here for the report)

Depression Treatment (Adult) - Scientific Rating 1 (Well Supported by Research Evidence)

iii. U.S. VA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder

http://www.healthquality.va.gov/guidelines/MH/mdd/MDDCPGClinicianSummaryFINAL5192016.pdf

iv. Title IV-E U.S. Department of Health and Human Services (HHS) Prevention Services Clearinghouse (under review, 2021: mental health; substance use).

v. The World Health Organization

Pain (Children and Adolescents) - WHO lists ACT as empirically supported ("moderate certainty") in the reduction of functional disability in children and adolescents with chronic pain (click here for the 2020 report).

vi. The UK National Institute for Health and Care Excellence (NICE)

Pain - NICE recommends ACT for people aged 16 years and over with chronic primary pain. (click here for the full report).
Tinnitus - NICE recommends group-based ACT for tinnitus-related distress. (click here for the full report).

vii. Australian Psychological Society, Evidence Based Psychological Interventions in the Treatment of Mental Disorders (2018):

Adults
Anxiety disorders - Generalised anxiety disorder – Level II Evidence
Anxiety disorders - Social anxiety disorder – Level II Evidence
Anxiety disorders - Panic disorder – Level II Evidence
Borderline personality disorder – Level II Evidence
Depression – Level II Evidence
Hypochondriasis – Level II Evidence
Obsessive compulsive disorder – Level II Evidence
Pain Disorders – Level II Evidence
Psychotic disorders – Level II Evidence
Substance use disorders – Level II Evidence
Binge eating disorder – Level IV Evidence
Body dysmorphic disorder – Level IV Evidence

Children (age 10-14 years)
Pain Disorders – Level II Evidence

viii. Netherlands Institute of Psychologists: Sections of Neuropsychology and Rehabilitation, Richtlijn Neuropsychologie Revalidate (2017)

The Netherlands Institute of Psychologists (NIP) recommends ACT for patients with MS with depressive symptoms

ix. Sweden Association of Physiotherapists, Fysioterapi Profession och vetenskap (2016)

The Swedish Association of Physiotherapy (physical therapy) includes ACT as a physiotherapeutic theory and practice in the definition of the profession.

x. SAMHSA's National Registry of Evidence-based Programs and Practices, ACT, last review July 2010. (NREPP was shut down in 2018, so this will not be updated unfortunately)

In case they are of use to anyone, I am attaching a couple of ACT orientation diagrams - variations on a theme really.

I hasten to say that these are not in any way intended to challenge the Hexaflex. Rather, they are intended for use with clients (or colleagues etc) to give a quick introduction or summary of what ACT is all about. Perhaps they might also have a role in therapy (individual or group), say in aiding discrimination training (e.g., "whereabouts on the diagram are you now?").

Get Out of Your Mind and Into Your Life (4x4) diagram:

Steve was kind enough to look at an earlier draft of this diagram which, as the name suggests, is intended to provide an overview of the book. Perhaps it could also be used as a structure for collecting client examples (e.g., pain, unworkable control attempts, etc). (I nicknamed it 4x4 because of the 4 circles and 4 arrows and it's quicker to write in the notes!) The 4 arrows of course represent 4 of the hexaflex processes, being the ACT skills enabling the client to get out of their mind (lower circles - pain/ struggle > suffering) and into their life (upper circles - values/ commitment > action).

(Putting this together made me wonder if the sequence of the arrows could suggest a sequence for the teaching of ACT skills, each building on the previous one - i.e., being in the present moment facilitating the observer perspective - in turn facilitating defusion - in turn facilitating acceptance.)

Four Cycles diagram:

Similar idea but generally a bit more detailed, though amalgamating the "self-as-context" and "being present" processes in a single "noticing" item (and a similar amalgamation - "Overthinking" - in the Struggle cycle). In this one the pivot point is in the middle ("Pain") and from there you either shuttle round the Struggle and Suffering cycles - the former specifically includes the processes associated with psychopathology according to ACT (e.g., fusion) - or, after some ACT (it is hoped), the Acceptance and Commitment cycles.

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I got a bit of feedback regarding these diagrams from my ACT follow-up group today. The view seemed to be that the 4x4 diagram provides a quicker reminder of the central ACT messages, that might be more useful in times of trouble, whereas the Four Cycles looks more complicated, but might have a role when learning ACT in more relaxed contexts. On the issue of using "noticing" to represent "self-as-context" and "being present", my group felt that "noticing" has the helpful connotation of something that is readily accessible in everyday life, whereas accessing an observer self seemed to suggest something more formal and effortful - perhaps less natural in everyday life. However, it was also said that being introduced to living in the present and the observer-self separately might be better when first learning ACT, moving to the more accessible noticing concept later.

Finally, I must mention that conversations with Mark Webster have influenced the development of these diagrams, and I believe that he in turn has been influenced by the Life Manual approach of Kevin Polk and colleagues.

From my website - https://www.joelguarna.com/:

Treatment Approaches

Cognitive-Behavioral Therapy
What is Cognitive-Behavioral Therapy (CBT)? The history of CBT dates back to the seminal work of B.F. Skinner, the father of modern behavior therapy. At that time, behavior therapy was a reaction to the traditional Freudian forms of psychotherapy that were only loosely based on scientific principles and were difficult to subject to rigorous scientific study. Skinner held psychology accountable as a science of human behavior, forever changing the face of psychotherapy. Techniques drawn from Skinner's basic behavioral science continue to be employed with good effect in modern psychotherapy. Skinner's account, however, had its limitations. The most notable limitation was that his account of human language and cognition failed to generate a vigorous line of basic research, limiting its evolution to forms that could be employed with patients with complicated psychological problems. Instead, the field opened to the work of Albert Ellis and Aaron T. Beck, the founders of modern cognitive therapy. Ellis and Beck, and their many successors, transformed the practice of psychotherapy by emphasizing therapy techniques that aimed to change the content and manner of one's thinking, not just their overt behavior. Cognitive therapy and behavior therapy continued to cross-fertilize each other over the past several decades. Modern CBT incorporates both cognitive and behavioral techniques. CBT has become the most well-known, mainstream approach to therapy, partly because it has, by far, the strongest research support for its effectiveness in treating a wide range of emotional and behavioral problems. CBT has been found effective in treating depression, anxiety disorders, the effects of trauma, substance abuse and addiction, complications related to medical conditions, and many other conditions.

Acceptance and Commitment Therapy
What is Acceptance and Commitment Therapy (ACT, said as the word "act")? ACT, just approaching its 30th anniversary since its inception, is an innovative form of behavioral and cognitive therapy that has built upon both the strengths and the weaknesses of traditional cognitive-behavioral therapy (CBT). ACT is based on a behavioral account of human language and cognition called Relational Frame Theory (RFT), which has "filled in the holes" left by Skinner's theories. RFT, in contrast to Skinner's accounts, has generated a vigorous body of basic research into human language and cognition, providing fuel for the development of new treatment approaches. The "fruit" of this progress can be found in the philosophy and basic concepts underlying ACT. ACT has moved away from the traditional CBT emphasis on changing or correcting one's thoughts in order to alleviate suffering. Instead, ACT aims to alter the functions of our private experiences (thoughts, feelings, memories, bodily reactions), so they no longer entangle us. Said another way, ACT aims to change our relationship with these private events so we can become free from their grip, and free from the patterns that bind us and prevent us from living a flexible, meaningful, and enjoyable life. In the service of these aims, ACT incorporates acceptance strategies, mindfulness techniques, and a wide range of behavioral approaches already known to be effective from CBT. ACT is one of a family of interventions inside the CBT tradition writ large that are focusing on the person's relationship to experiences rather than on the content of these experiences. The data on ACT and related approaches are moving CBT itself toward a new model that emphasizes being open, centered, mindful and actively pursuing values. Because of that, ACT and CBT as a larger tradition are becoming more difficult to distinguish over time.

Some metaphors that can be used when introducing ACT to clients include:

The Two Mountains Metaphor

The Titanic Metaphor

The Battlefield Metaphor

These and many others are available in the Metaphors section of Resources for Clinicians.

Hi All, 

I did a blog on the agency website last year and wanted to share it.  Sometimes, I find, that giving a client a story, having it hanging in the waiting room, helps to get a sense of what we are doing in the ACT community.  Please share as you need, it is basically a "witness" to the principles we live by in our clinical offices, schools and corporations.  Peace

This handout can be used to generate discussion and introduce ACT processes. We use it with young people (teens) but it is also an easy introduction for adult clients. Adapted from earlier hexaflex question sheets, with simpler language (and pretty colours).