ACT

Acceptance & Commitment Therapy (ACT)

Developed within a coherent theoretical and philosophical framework, Acceptance and Commitment Therapy (ACT) is a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.

Based on Relational Frame Theory, ACT illuminates the ways that language entangles clients into futile attempts to wage war against their own inner lives. Through metaphor, paradox, and experiential exercises clients learn how to make healthy contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided. Clients gain the skills to recontextualize and accept these private events, develop greater clarity about personal values, and commit to needed behavior change.

How To Start Learning About ACT

There is a vast amount of information available for browsing available on this site. When you have the time, consider browsing through the clinical resources, protocols, measures, books, visual aids, and videos available on the site (under the Resources tab). However, there is so much information available that it can be a little overwhelming.

To get started, we've compiled a comprehensive list of resources for learning more about ACT.

If you are a member of the public, you are welcome to look around the website or join our association to get full access to videos, attachments, publications, etc. You can find publications, find ACT therapists, join the ACT for the Public listserv, and so on.

ACBS members can click here to join our email listservs: ACT for Professionals listserv, RFT listserv, Student listserv, special interest group listservs, and chapter listservs. We have found that participation in these listservs predicts whether you will stay an ACBS member, probably because you can get your questions answered so easily and come to appreciate the importance of being part of a helpful and values-based community.

Steven Hayes September 16, 2009 - 11:51am

About ACT

Psychological Inflexibility: An ACT View of Suffering and Failure to Thrive

The core conception of Acceptance and Commitment Therapy (ACT) or (as it is usual called outside of a therapy context, Acceptance and Commitment Training ... also "ACT") is that psychological suffering and a failure to prosper psychologically is usually caused by the interface between the evolutionarily more recent processes of human language and cognition, and more ancient sources of control of human behavior, particular those based on learning by direct experience. Psychological inflexibility is argued to emerge from six basic processes. Stated in their most general fashion these are emotional inflexibility, cognitive inflexibility, attentional inflexibility, failures in perspective taking, lack of chosen values, and an inability to broaden and build habits of values-based action. Buttressed by an extensive basic research program on an linked theory of language and cognition, Relational Frame Theory (RFT), ACT takes the view that trying to change difficult thoughts and feelings in a subtractive or eliminative way as a means of coping can be counter productive, but new, powerful alternatives are available to deal with psychological events, including acceptance, cognitive defusion, mindful attention to the now, contacting a deeper "noticing" sense of self or "self-as-context", chosen values, and committed action. These six flexibility processes are argued to be inter-related aspects of psychological flexibility. Each of these in turn can be extended socially. For example, acceptance of emotions can extend to compassion for others; chosen values can extend to social values; a "noticing" sense of self to healthy social attachment; and so on.

The ACT Model

ACT is an orientation to behavior change and well-being that is based on functional contextualism as a philosophy of science, and behavioral and evolutionary science principles as expanded by RFT. As such, it is not a specific set of techniques or a specific protocol. ACT methods are designed to establish a workable and positive set of psychological flexibility processes in lieu of negative processes of change that are hypothesized to be involved in behavioral difficulties and psychopathology including

cognitive fusion -- the domination of stimulus functions based on literal language even when that process is harmful,
experiential avoidance -- the phenomenon that occurs when a person is unwilling to remain in contact with particular private experiences and takes steps to eliminate the form or diminish the frequency of these events and the contexts that occasion them, even when doing so causes psychological harm
the domination of a conceptualized self over the "self as context" that emerges from perspective taking and deictic relational frames
lack of values, confusion of goals with values, and other values problems that can underlie the failure to build broad and flexible repertoires linked to chosen qualities of being and doing
inability to build larger and larger unit of behavior through commitment to behavior that moves in the direction of chosen values

and other such processes. Technologically, ACT uses both traditional behavior therapy techniques (defined broadly to include everything from cognitive therapy to behavior analysis), as well as others that are more recent "3rd wave" methods, and those that have largely emerged from outside the behavior tradition, such as cognitive defusion, acceptance, mindfulness, values, and commitment methods.

Research Support

Research seems to be showing that these methods are beneficial for a broad range of clients and positive psychological goals as well, not just in mental health areas but also in behavioral health, and social wellness areas. ACT teaches clients and therapists alike how to alter the way psychological experiences function rather than having to eliminate them from occurring at all. This empowering message has been shown to help clients cope with a wide variety of clinical problems, including depression, anxiety, stress, substance abuse, and even psychotic symptoms; to step up to the challenges of diet, sleep, exercise, or the behavioral challenges of physical disease; to help address social problems such as stigma or prejudice; or to seek positive outcomes in areas like relationships, cooperation, business, social justice, climate change, gender bias, and so on. The benefits are as important for the clinician as they are for clients. ACT has been shown empirically to alleviate therapist burnout, for example. By focusing on processes of change what began as a way of dealing with mental health issues is now a model that is used to understand and change human behavior more generally.

How Do You Learn and Apply ACT to Your Practice?

The list of resources below are a great, easy-to-access way to learn more about ACT, it's theoretical and philosophical background. We recommend checking out these pages, as they will provide an important foundation of knowledge. We've also compiled a list of ways to learn about ACT by reading ACT books, as well as getting consultation from others as you begin to apply the work to your work and practice. This additional list of resources will help you do so as well. ACBS members are strongly encouraged to join the ACT for Professionals email listserv. Once on that listserv you can ask virtually any question, or raise virtually any issue, and thousands of ACBS members will read it ... and you can almost be guaranteed of interesting and helpful responses. We've found that members of this listserv are nearly eight times more likely to remain as ACBS members over the years than those who are not on the listserv, and we think the reason is that listserv members come to appreciate the value of being part of a helpful and values-based knowledge development community. If you are not sure, join and lurk for a while. If you do not like it, it easy to step off later on -- you can do so with a single click in your membership dashboard.

Steven Hayes July 2, 2005 - 4:32pm

Philosophical roots

Functional Contextualism

ACT is rooted in the pragmatic philosophy of functional contextualism, a specific variety of contextualism that has as its goal the prediction and influence of events, with precision, scope and depth. Contextualism views psychological events as ongoing actions of the whole organism interacting in and with historically and situationally defined contexts. These actions are whole events that can only be broken up for pragmatic purposes, not ontologically.

Because goals specify how to apply the pragmatic truth criterion of contextualism, functional contextualism differs from other varieties of contextualism that have other goals. ACT thus shares common philosophical roots with constructivism, narrative psychology, dramaturgy, social constructionism, feminist psychology, Marxist psychology, and other contextualistic approaches, but its unique goals leads to different qualities and different empirical results than these more descriptive forms of contextualism, seeking as they do a personal appreciation of the complexity of the whole rather than prediction and influence per se.

ACT itself reflects its philosophical roots in several ways. ACT emphasizes workability as a truth criterion, and chosen values as the necessary precursor to the assessment of workability because values specify the criteria for the application of workability. Its causal analyses are limited to events that are directly manipulable, and thus it has a consciously contextualistic focus. From such a perspective, thoughts and feelings do not cause other actions, except as regulated by context.

Therefore, it is possible to go beyond attempting to change thoughts or feelings so as to change overt behavior, to changing the context that causally links these psychological domains.

Further information on functional contextualism is available here

Steven Hayes January 11, 2006 - 11:03am

Theoretical roots

RFT: A Theory of Language and Cognition

ACT is based on Relational Frame Theory (RFT), which is a comprehensive basic experimental research program into human language and cognition. RFT has become one of the most actively researched basic behavior analytic theories of human behavior, with over 70 empirical studies focused on it tenets. In ACT, virtually every component of the technology is connected conceptually to RFT, and several of these connections have been studied empirically.

According to RFT, the core of human language and cognition is the learned and contextually controlled ability to arbitrarily relate events mutually and in combination, and to change the functions of specific events based on their relations to others. For example, very young children will know that a nickel is larger than a dime by physical size, but not until later will the child understand that a nickel is smaller than a dime by social attribution. In addition to being arbitrarily applicable (a nickel is “smaller” than a dime merely by social convention), this more psychologically complex relation is mutual (e.g., if a nickel is smaller than a dime, a dime is bigger than a nickel), combinatorial (e.g., if a penny is smaller than a nickel and a nickel is smaller than a dime then a penny is smaller than a dime), and alters the function of related events (if a nickel has been used to buy candy a dime will now be preferred even if it has never actually been used before).

The applied implications of RFT derived from the following key features:

Human language and higher cognition is a specific kind of learned behavior. RFT researchers have shown that arbitrarily applicable comparative relations (the nickel and dime situation just mentioned) can be trained as an overarching operant in young children; similar evidence has emerged with frames of opposition and coordination.
Relational frames alters the effects of other behavioral processes. For example, a person who has been shocked in the presence of B and who learns that B is smaller than C, may show a greater emotional response to C than to B, even though only B was directly paired with shock
Cognitive relations and cognitive functions are regulated by different contextual features of a situation.

The primary implications of RFT in the area of psychopathology and psychotherapy extend from the three features just described. RFT argues that:

verbal problem solving and reasoning is based on some of the same cognitive processes that can lead to psychopathology, and thus it is not practically viable to eliminate these processes,
much as extinction inhibits but does not eliminate learned responding, the common sense idea that cognitive networks can be logically restricted or eliminated is generally not psychologically sound because these networks are the reflection of historical learning processes;
direct change attempts focused on key nodes in cognitive networks creates a context that tends to elaborate the network in that area and increase the functional importance of these nodes, and
since the content and the impact of cognitive networks are controlled by distinct contextual features, it is possible to reduce the impact of negative cognitions whether or not they continue to occur in a particular form. Taken together, these four implications mean that it is often neither wise nor necessary to focus primarily on the content of cognitive networks in clinical intervention. Fortunately, the theory suggests that it is quite possible instead to focus on their functions.

RFT has proven itself successful so far in modeling higher cognition in a number of areas, and the neurobiological data collected so far comport with the theory. RFT is meant to be a comprehensive contextualistic account of human language and cognition and thus its goals extend far beyond ACT or even the behavioral and cognitive therapies in general. Because all of the key features of the theory are cast in terms of manipulable contextual variables, it has readily lead to applied interventions in such areas as education.

Steven Hayes January 11, 2006 - 11:05am

Theory of Psychopathology

Core Problem Processes

From an ACT / RFT point of view, while psychological problems can emerge from the general absence of relational abilities (e.g., in the case of mental retardation), a primary source of psychopathology (as well as a process exacerbating the impact of other sources of psychopathology) is the way that language and cognition interact with direct contingencies to produce an inability to persist or change behavior in the service of long term valued ends. This kind of psychological inflexibility is argued in ACT and RFT to emerge from weak or unhelpful contextual control over language processes themselves, and the model of psychopathology is thus linked point to point to the basic analysis provided by RFT. This yields an accessible and clinically useful middle level theory bound tightly to more abstract basic principles.

A core process that can lead to pathology is cognitive fusion, which refers to the domination of behavior regulatory functions by relational networks, based in particular on the failure to distinguish the process and products of relational responding. In contexts that foster such fusion, human behavior is guided more by relatively inflexible verbal networks than by contacted environmental contingencies. This is fine in some circumstances, but in others it increases psychological inflexibility in an unhealthy way. As a result, people may act in a way that is inconsistent with what the environment affords relevant to chosen values and goals. From an ACT / RFT point of view, the form or content of cognition is not directly troublesome, unless contextual features lead this cognitive content to regulate human action in unhelpful ways.

The functional contexts that tend to have such deleterious effects are largely sustained by the social / verbal community. There are several. A context of literality treats symbols (e.g., the thought, “life is hopeless”) as one would referents (i.e., a truly hopeless life). A context of reason-giving bases action or inaction excessively on the constructed “causes” of one's own behavior, especially when these processes point to non-manipulable “causes” such as conditioned private events. A context of experiential control focuses on the manipulation of emotional and cognitive states as a primary goal and metric of successful living.

Cognitive fusion supports experiential avoidance -- the attempt to alter the form, frequency, or situational sensitivity of private events even when doing so causes behavioral harm. Due to the temporal and comparative relations present in human language, so-called “negative” emotions are verbally predicted, evaluated, and avoided. Experiential avoidance is based on this natural language process – a pattern that is then amplified by the culture into a general focus on “feeling good” and avoiding pain. Unfortunately, attempts to avoid uncomfortable private events tend to increase their functional importance – both because they become more salient and because these control efforts are themselves verbal linked to conceptualized negative outcomes – and thus tend to narrow the range of behaviors that are possible since many behaviors might evoke these feared private events.

The social demand for reason giving and the practical utility of human symbolic behavior draws the person into attempts to understand and explain psychological events even when this is unnecessary. Contact with the present moment decreases as people begin to live “in their heads.” The conceptualized past and future, and the conceptualized self, gain more regulatory power over behavior, further contributing to inflexibility. For example, it can become more important to be right about who is responsible for personal pain, than it is to live more effectively with the history one has; it can be more important to defend a verbal view of oneself (e.g., being a victim; never being angry; being broken; etc) than to engage in more workable forms of behavior that do not fit that that verbalization. Furthermore, since emotions and thoughts are commonly used as reasons for other actions, reason-giving tends to draw the person into even more focus on the world within as the proper source of behavioral regulation, further exacerbating experiential avoidance patterns. Again psychological inflexibility is the result.

In the world of overt behavior, this means that long term desired qualities of life -- values -- take a backseat to more immediate goals of being right, looking good, feeling good, defending a conceptualized self, and so on. People lose contact with what they want in life, beyond relief from psychological pain. Patterns of action emerge and gradually dominate in the person’s repertoire that are detached from long term desired qualities of living. Behavioral repertoires narrow and become less sensitive to the current context as it affords valued actions. Persistence and change in the service of effectiveness is less likely.

Steven Hayes January 11, 2006 - 11:14am

Quick & Dirty ACT Analysis of Psychological Problems

Most psychological difficulties have to do with the avoidance and manipulation of private events.

All psychological avoidance has to do with cognitive fusion and its various effects.

Conscious control belongs primarily in the area of overt, purposive behavior.

All verbal persons have the “self” needed as an ally, but some have run from that too.

Clients are not broken, and in the areas of acceptance and defusion they have the psychological resources they need if they can be harnessed.

To take a new direction, we must let go of an old one. If a problem is chronic, the client's solutions are probably part of them.

When you see strange loops, inappropriate verbal rules are involved.

The value of any action is its workability measured against the client's true values (those he/she would have if it were a free choice). The bottom line issue is living well, not having small sets of “good” feelings.

Two things are needed to transform the situation: accept and move.

Steven Hayes July 2, 2005 - 4:33pm

The Six Core Processes of ACT

The Psychological Flexibility Model

The general goal of ACT is to increase psychological flexibility – the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends. Psychological flexibility is established through six core ACT processes. Each of these areas are conceptualized as a positive psychological skill, not merely a method of avoiding psychopathology.

Acceptance

Acceptance is taught as an alternative to experiential avoidance. Acceptance involves the active and aware embrace of those private events occasioned by one’s history without unnecessary attempts to change their frequency or form, especially when doing so would cause psychological harm. For example, anxiety patients are taught to feel anxiety, as a feeling, fully and without defense; pain patients are given methods that encourage them to let go of a struggle with pain, and so on. Acceptance (and defusion) in ACT is not an end in itself. Rather acceptance is fostered as a method of increasing values-based action.

Cognitive Defusion

Cognitive defusion techniques attempt to alter the undesirable functions of thoughts and other private events, rather than trying to alter their form, frequency or situational sensitivity. Said another way, ACT attempts to change the way one interacts with or relates to thoughts by creating contexts in which their unhelpful functions are diminished. There are scores of such techniques that have been developed for a wide variety of clinical presentations. For example, a negative thought could be watched dispassionately, repeated out loud until only its sound remains, or treated as an externally observed event by giving it a shape, size, color, speed, or form. A person could thank their mind for such an interesting thought, label the process of thinking (“I am having the thought that I am no good”), or examine the historical thoughts, feelings, and memories that occur while they experience that thought. Such procedures attempt to reduce the literal quality of the thought, weakening the tendency to treat the thought as what it refers to (“I am no good”) rather than what it is directly experienced to be (e.g., the thought “I am no good”). The result of defusion is usually a decrease in believability of, or attachment to, private events rather than an immediate change in their frequency.

Being Present

ACT promotes ongoing non-judgmental contact with psychological and environmental events as they occur. The goal is to have clients experience the world more directly so that their behavior is more flexible and thus their actions more consistent with the values that they hold. This is accomplished by allowing workability to exert more control over behavior; and by using language more as a tool to note and describe events, not simply to predict and judge them. A sense of self called “self as process” is actively encouraged: the defused, non-judgmental ongoing description of thoughts, feelings, and other private events.

Self as Context

As a result of relational frames such as I versus You, Now versus Then, and Here versus There, human language leads to a sense of self as a locus or perspective, and provides a transcendent, spiritual side to normal verbal humans. This idea was one of the seeds from which both ACT and RFT grew and there is now growing evidence of its importance to language functions such as empathy, theory of mind, sense of self, and the like. In brief the idea is that “I” emerges over large sets of exemplars of perspective-taking relations (what are termed in RFT “deictic relations”), but since this sense of self is a context for verbal knowing, not the content of that knowing, it’s limits cannot be consciously known. Self as context is important in part because from this standpoint, one can be aware of one’s own flow of experiences without attachment to them or an investment in which particular experiences occur: thus defusion and acceptance is fostered. Self as context is fostered in ACT by mindfulness exercises, metaphors, and experiential processes.

Values

Values are chosen qualities of purposive action that can never be obtained as an object but can be instantiated moment by moment. ACT uses a variety of exercises to help a client choose life directions in various domains (e.g. family, career, spirituality) while undermining verbal processes that might lead to choices based on avoidance, social compliance, or fusion (e.g. “I should value X” or “A good person would value Y” or “My mother wants me to value Z”). In ACT, acceptance, defusion, being present, and so on are not ends in themselves; rather they clear the path for a more vital, values consistent life.

Committed Action

Finally, ACT encourages the development of larger and larger patterns of effective action linked to chosen values. In this regard, ACT looks very much like traditional behavior therapy, and almost any behaviorally coherent behavior change method can be fitted into an ACT protocol, including exposure, skills acquisition, shaping methods, goal setting, and the like. Unlike values, which are constantly instantiated but never achieved as an object, concrete goals that are values consistent can be achieved and ACT protocols almost always involve therapy work and homework linked to short, medium, and long-term behavior change goals. Behavior change efforts in turn lead to contact with psychological barriers that are addressed through other ACT processes (acceptance, defusion, and so on).

Taken as a whole, each of these processes supports the other and all target psychological flexibility: the process of contacting the present moment fully as a conscious human being and persisting or changing behavior in the service of chosen values. The six processes can be chunked into two groupings. Mindfulness and acceptance processes involve acceptance, defusion, contact with the present moment, and self as context. Indeed, these four processes provide a workable behavioral definition of mindfulness (see the Fletcher & Hayes, in press in the publications section). Commitment and behavior change processes involve contact with the present moment, self as context, values, and committed action. Contact with the present moment and self as context occur in both groupings because all psychological activity of conscious human beings involves the now as known.

A Definition of ACT

ACT is an approach to psychological intervention defined in terms of certain theoretical processes, not a specific technology. In theoretical and process terms we can define ACT as a psychological intervention based on modern behavioral psychology, including Relational Frame Theory, and evolutionary science, that applies mindfulness and acceptance processes, and commitment and behavior change processes, to the creation of psychological flexibility.

Steven Hayes January 11, 2006 - 11:19am

ACT Video Series - Six Core Processes of ACT

The Veterans Health Administration, part of the US Department of Veterans Affairs, has a video series about ACT that provides an introduction to the six core processes of ACT.

Steven Hayes July 22, 2022 - 12:31pm

ACT Therapeutic Posture

Whatever a client is experiencing is not the enemy. It is the fight against experiencing experiences that is harmful and traumatic.

You can't rescue clients from the difficulty and challenge of growth.

Compassionately accept no reasons—the issue is workability not reasonableness.

If the client is trapped, frustrated, confused, afraid, angry or anxious be glad—this is exactly what needs to be worked on and it is here now. Turn the barrier into the opportunity.

If you yourself feel trapped, frustrated, confused, afraid, angry or anxious be glad: you are now in the same boat as the client and your work will be humanized by that.

In the area of acceptance, defusion, self, and values it is more important as a therapist to do as you say than to say what to do

Don't argue. Don't persuade. The issue is the client's life and the client's experience, not your opinions and beliefs. Belief is not your friend.

You are in the same boat. Never protect yourself by moving one up.

The issue is always function, not form or frequency. When in doubt ask yourself or the client “what is this in the service of.”

Readings on this topic

Follette, V. M., & Batten, S. V. (2000). The role of emotion in psychotherapy supervision: A contextual behavioral analysis. Cognitive and Behavioral Practice, 7(3), 306-312.

Pierson, H. & Hayes, S. C. (2007). Using Acceptance and Commitment Therapy to empower the therapeutic relationship. Chapter in P. Gilbert & R. Leahy (Eds.), The Therapeutic Relationship in Cognitive Behavior Therapy (pp. 205-228). London: Routledge.

Wilson, K. G., & Sandoz, E. K. (2008). Mindfulness, values, and the therapeutic relationship in Acceptance and Commitment Therapy. In S. F. Hick & T. Bein (Eds.), Mindfulness and the therapeutic relationship. New York: Guilford Press.

Steven Hayes July 2, 2005 - 4:34pm

ACT Therapeutic Steps

Compassionately confront the unworkable agenda, appealing always to the client's experience as the ultimate arbiter

Support the client in feeling and thinking what they directly feel and think already—as it is not as what it says it is—and to find a place from which that is possible.

In the service of that goal, teach acceptance and defusion skills.

Help the client make a richer and less defended contact with the present moment, and with their own on-going thoughts, feelings, and sensations.

Help the client contact a transcendent sense of self.

Help the client become more consistently mindful.

Help the client move in a value direction, with all of their history and automatic reactions.

Help the client detect traps, fusions, and strange loops.

Repeat, expand the scope of the work, and repeat again, until the clients generalizes.

(and don't believe a word you are saying).

Steven Hayes July 2, 2005 - 4:35pm

Common Misunderstandings About ACT / RFT

Here are a number of common misunderstandings about ACT and RFT and CBS. I've listed only ones that I think are demonstrably false. Ones that could be true I have not listed since this page is about misunderstandings, not legitimate weaknesses. Comments follow each. If you know of others, let me know - Steven Hayes

ACT is just _____ (fill in your favorite: Buddhism, CT, BT, CBT, Logotherapy, a psychology of the will, Gestalt, existential, est, Morita, constructive living, solution focused therapy, Kelly role therapy, and so on and so on)
Resemblance is a fun game to play but I have yet to have anyone say these things in strong form (it is just _____) when they have really delved into the philosophy, theory, data, and technology. It is actually a positive sign when you see that others are pointing to somewhat similar issues. If multiple paths lead in a direction perhaps that is a direction worth exploring. If folks want to draw the connections above, it would be good to do them seriously and in print so people can understand the connections. The only ones I could see myself fully agreeing to is "ACT is just behavior analysis" ... or, properly understood, "ACT is just behavior therapy," but I'd quickly want to add "but that area itself has to be understood in a different way to say that." As far as roots, some of these are indeed influences on ACT. You could find some historical connections with CT, BT, CBT, Logotherapy, Gestalt, existential, and est for example. Maybe Buddhism if you mean "estern thought" -- as a child of the 60's it would be hard to avoid that. Probably a few more and as it expands lots of new things come in. ACT is a vast community now.

ACT is a cult
James Herbert has a great powerpoint on this site walking through why that comparison is unfair and inaccurate. Cults are closed off; they avoid criticism; they are hierarchical; they suppress open expression. ACBS is the exact opposite in all of these areas.

ACT is just the latest fad
ACT will ultimately die, as will we all, and it may indeed do so in a matter of decades or sooner, as what is worthwhile inside it become better understood and enters into the mainstream (that process of assimilation is happening at light speed right in front of our eyes), but if you mean that it is frivolous or insubstantial, that is just factually incorrect. When you last 35 years, do over 1000 basic and applied studies, and train over 50,000 people, "fad" is just not an applicable term. Is it? Inside the ACBS community we suspect that the applied and basic theory underlying ACT and RFT (etc) is wrong but that is because so far in science all theories have ultimately been shown to be incorrect. We just don't know where it is wrong yet ... but we are chasing that rabbit! Come help us prove ourselves wrong!

ACT is new on the scene
It is just under 35 years old. The first ACT workshop was given in 1982 at Broughton Hospital in North Carolina.

ACT is old on the scene and thus its outcome studies should be __ times more
When I first posted this page in the early 2000s I had to explain our slow start, but now the criticism is just so far out of date even that explanation seems unneeded. OK, here is the explanation I used to give: ACT followed a different development path linked to philosophy, basic research, and process measurement. There was a 14 year gap in outcome studies from 1986 to 2000. That gap should not be held against the tradition because the detour was linked to even higher standards and goals. During that time, functional contextualism, the psychological flexibility model, RFT, measures of psychological flexiblity, and a contextual behavioral science approach were created -- and it seemed responsible to do that before larding up with RCTs after the first 3 successful ones in the mid 1980s. ACT is willing to be held to RCT-linked standards but RCTs alone are not enough to create a progressive field. You need a theory and development strategy that works. Once we had that better worked out we did indeed come back to outcome studies. If you look at the outcome studies since 2000 it would be a hard case to make that ACT does not care about outcome data. In 2000 there were 3 RCTs in ACT but it began to pick up in the mid 2000s. When I first rewrote this page as 2011 began it was up to 37 RCTs. Wow. Now it is five years later and I'm rewriting the page again in early 2016. The number of RCTs is hard to say precisely because a new one appears every week or less and no one can keep up anymore and still have a life. My best guess is that it is sliding past 200 (I have 153 in a file but a new paper my students wrote for a class tells me that there are about 70 more studies I missed that are not in English). And meanwhile ACT has more and more consistent mediation outcomes than any approach in existence. Our guess is over 50 studies. And it is the ONLY psychotherapy with a vigorous basic science of cognition underneath it, with hundreds of studies on RFT. An entire book has been written on the ACT Research Journey (Hooper & Andersson, 2015: http://www.amazon.com/Research-Journey-Acceptance-Commitment-Therapy/dp/1137440163/ref=sr_1_1?s=books&ie=UTF8&qid=1459110186&sr=1-1&keywords=ACT+research+journey). So, really, anyone suggesting we are slack in terms of research just does not know what he or she is talking about. Counting all areas of CBS my best guess based on search engines is that there are over 2000 studies if you apply a liberal set of search criteria and about 1000 if you apply a strict set.

ACT seeks ridiculously high goals and thus is making grandiose predictions or claims. Aspirations are not predictions or claims. Seeking a comprehensive account of behavior that would apply to all human action has always been the goal of behavior analysis as is shown in things such as Walden II. Why is a grand aspiration grandiose?

ACT works only with the well-educated
There are many trials indicating ACT is helpful for those who are poor, uneducated, intellectually disabled, children, those diagnosed with psychotic disorders, and so on and on. This criticism comes because the theory can be hard to understand (especially RFT). But we do not teach theory to client, we do therapy. That is different.

ACT works only for white middle class Americans
There are ACT studies from 15 countries includinging countries in Asia, the Middle East, and Africa. Successful studies have been done with poor urban black populations; unemployed poor Asian American populations; institutionalized South African blacks, etc. As of early 2016 there are 45 RCTs done on ACT in Iran; over 30 RCTs in Korea. The outcomes are equally good. The criticism is simply invalid.

ACT is not committed to science
Come on; wake up. Put in key ACT and RFT terms into the Web of Science or Google Scholar and look at what is out there dude. Download the studies. It after you do all that you repeat this claim that within arm's reach of me or you'd better be able to duck fast.
The ACT research base is weak
ACT has drawn a lot of interest from funded researchers and ACT funded studies are as good as any out there. There are a lot of them too (perhaps 50 RCTs of that kind) and the outcomes are often (not always) impressive. Yes, in some areas the research base is lean -- but ACT is not just for one problem area. In some areas, such as smoking or chronic pain, you'd have to distort the meaning of evidence to say that they ACT research base is weak. And these are areas where people have worked for years to dial in how to move ACT processes. So overall the research base seems impressive given the scope of ACT work. Having said that, we need to add three things. First, ACT draws a lot of interest from students, the developing world, or parts of the developed world without a grant infrastructure. These studies often have methodological issues (sample size; controls; etc) but jeez, how do they DECREASE what we know if they ADD to what we know from the best studies? Can someone please explain that to me? It happens IMHO only if people doing meta-analyses average methodology ratings. I'm sorry, that is just a dumb idea. Sure, weight findings study by study in light of methodological issues. But if a person in Liberia shows that ACT is helpful for problem x, and a huge grant-based study at a Western academic medical center with all of the bell and whistles showed that ACT is helpful for that same problem, the one in Liberia added to what we know regardless of its weaknesses. It showed that these approaches to not just apply to the western world, for one thing. It is fine to use the well controlled one to estimate effect sizes. But don't average the methodology ratings from the two and then say that the overall knowledge is weak in problem area x because the average methdology score is humble. Aaaagh. That is just stupid. Second, you need a string of studies in a given area with a given population to learn how to move psychological flexibility processes. If the technology has weak outcomes but did not move the processes, that is an unfortunate technology error, not a model failure. If you move the processes and the outcomes are poor that is a model failure. Yes, there are technology failures in ACT, but usually with new populations, settings, or modes of delivery. I know of no replicated model failures in 35 years of ACT / RFT / CBS research. Finally, some meta-analyses are biased. They are. Look at the overall pattern of meta-analyses and look carefully for responses to meta-analyses. For example, Ost claimed in 2008 that 13 ACT RCTs were weaker than 13 matched CBT RCTs; but then Gaudiano showed that effect was 100% due to grant funding, and furthermore 12 of the 13 ACT studies published mediational outcomes while 1 of the 13 CBT studies did so. An objective reader should reject Ost's comparison. You have to look at the criteria too. For example, if you rightly put "well defined population" on a list of methodological criteria, and then in small print insist on a DSM diagnosis as the only metric for a "well defined population," ACT will look methodologically weaker due to intellectually defensible choices that the reader might not realize is at play. CBS researchers generally despise the DSM. Including such a scoring approach behind an item will lead to a biased "criterion" (one that even NIMH has abandoned!). But the reader has to dig deep to sniff out bias liek that when it is there -- and sometimes not matter how much care, the reader will be bamboozled (e.g., if the ratings themselves have horrible kappas that are not reported). But the ACT community does not lay back on such things. We keep asking for the information and we keep trying to understand findings. As a reader: Keep your powder dry; be careful before leaping; look at the entire set of criticisms, responses, and meta-analyses; use your best judgment.

ACT is just a technology
It is a far more ... do your reading. It is a model linked to a philosophy, basic science, and a strategy of development.

ACT is just a philosophy
Ditto.

ACT is just acceptance
Ditto.

ACT is just commitment
Ditto.

ACT is just acceptance and commitment
Aw, come on. This kind of thing comes from folks reading the titles of books and studies instead of books and studies.

Acceptance is important because it is a way to change the content of emotion (so ACT is really about that)
The data suggest otherwise. Emotion do often change, but that change predicts behavioral outcomes more poorly than changes in the functions of emotions -- and sometimes good outcomes come without a change in emotion within the extant ACT literature.

Defusion is important because it is a way to change the content of thought (so ACT is really about that)
Double ditto. Same point. Also decent data supporting it. Will thoughts change? Sure! RFT is all about changing thoughts and of course ACT changes thoughts.

The ACT model of cognition is no different than any CBT model -- it is just different in its terminology
If you believe that, have the courage to do your homework in detail and write it up in article form. Then be prepared to have others go after your ideas. We have so far responded to every single serious criticism in print in ACT or RFT, so anyone can read the criticisms and the response and judge the arguments. So far no one, I mean no one, has made the claim above in a careful scholarly article. But it is not the ACT world's obligation to prevent the claim from being made in the hallways of convention hotels or on listserves. Even here we do what we can, however. You are reading exhibit A in that area.

Defusion is just distancing as that concept is used in CT
They are indeed related. That is one of the real historical sources of ACT. But in ACT there are scores of such techniques, the are emphasized a great deal, and they are put to a quite different purpose than in traditional CT.

ACT is just mindfulness as that concept is used by Buddhists or ______ (fill in the blank)
ACT is clearly broader at the level of theory and technology. Mindfulness is itself a broad term that ican be vague if it is left at that level. That is why we have written 4-5 articles walking through the concept of mindfulness and trying to come up with a tighter analysis of it. When defined in the right way, ACT is a mindfulness-based approach but it is more than that as well.

Defusion is just exposure in a traditional sense
Research shows that defusion supports exposure. If you say it is exposure then you have expanded exposure to conver most contact of human beings with events and that is troublesome. Besides exposure itself is not well understood, and ACT folks have a flexibility and pattern-based account of exposure that comports with the ACT model.

Acceptance is just exposure in a traditional sense
Research shows that it supports exposure and appears to empower the impact of exposure. ACT is an exposure-based technology and we said in the first chapter on ACT in 1987. But the ACT view of exposure is that it is organized contact with previously repertorie narrowing events for the purpose of creating response flexibility. That is why our goal is teaching more flexible contact with private events and more flexible patterns of responding. We want patients to be able to label emotions; to feel them openly; and to be able to approach their values in action. The most recent work in traditional exposure in CBT is finally catching up that approach. We do not do exposure to reduce emotions (thought they usually are reduced) -- but it turns out that is not why exposure works even in traditional CBT.

ACT does not care about the relationship
We have a model of it; we teach it; we emphasize it. We have data showing that ACT gets high aliance scores; they predict outcome; but they are themselves explained in part by changes in acceptance/defusion/valued action. So no only do we care about the relationship, we care enough to be able to teach clinicans how to create powerful ones: create a psychologically flexibile relationship.

ACT eschews meditation and contemplative practice
Contemplative practice is often in our protocols (about 40% of the RCTs); Guided meditations is in nearly 100% of the protocols; ACT targets mindfulness at the level of process in multiple ways; it moves and is mediated by these processes; psychological flexibility impacts the brain or telomere length (etc) similarly. Now if you insist that mindfulness = sitting and following the breath, yes ACT is mostly not that. But if you insist on that narrow definition you now have to go to war with ancient mindfulness traditions too. Is a koan about mindfulness? Is chanting? This is why I resisted the word "mindfulness" in early ACT writing. I did not want to enter into arguments that were thousands of years old. ACT cares about mindfulness as a process.

You should not mix behavioral procedures with ACT
The model says you should. ACT is part of behavior therapy. With all due respect, you don't get to peel it away from its model just because that makes you uncomfortable in your sorting of things into cubby holes.

If you do mix behavioral procedures with ACT you now have a combined treatment
ACT is a model. Since the model says you should do this, it does not become a combination treatment to follow the model. In early ACT work we often deliberately hobbled the model so we could be heard by others (e.g., taking out formal exposure in studies on OCD). Times up. After 200 RCTs, no more hobbling the model to avoid science critics and their cubby holes.

The other aspects of ACT add nothing to the behavioral elements
We know that these other elements are helpful and that they can support the behavioral elements. If you mean that the other elements are inert, that is clearly untrue. We published a meta-analysis of the first 60 or so component studies and all of the components matter [Levin, M. E., Hildebrandt, M. J., Lillis, J., & Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: A meta-analysis of laboratory-based component studies. Behavior Therapy, 43, 741–756. DOI: 10.1016/j.beth.2012.05.003.] More formal component analysese are beginning to appear [Villatte, J. L., Vilardaga, R., Villatte, M., Vilardaga, J. C. P., Atkins, D. A., & Hayes, S. C. (2016). Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes. Behaviour Research & Therapy, 77, 52-61. doi:10.1016/j.brat.2015.12.001]. And we know that all of the aspects of the psychological flexibility model contribute to outcomes (McCracken and colleagues have a study on that in the chronic pain area).

The data on traditional CBT is far stronger
Well, duh. Your father's retirement account is bigger than yours too. ACT is part of the CBT / BT / BA family but its specific research program takes a large community to mount. The CBS community is focused on basic science, processes of change, micro-studies, prevention, social change, link to evolution science, and so on and on. But dig deeper. The vast majority of what is specifically supported in traditional CBT is stuff that ACT folks agree with anyway. If you insist on drag race studies --OK. Be patient. But you can't start outcomes studies in 2000 and expect 16 years later to have the same amount of data as the biggest dog on the block. But our research productivity is now obvious for anyone to see. If you know how to de searches

It is surely safe to mix ACT techniques with other techniques I'm more comfortable with while I wait passively to understand the model
Ah, no. Down that path lies chaos. It is such a poor model of scientific development. Understand first. Get the data. Then add anything that makes sense for good theoretical and practical reasons, not just because you feel like it. One great benefit we have in ACT: if the thinks you like to do already improve psychological flexibility (measure it regularly) than by all means include those things.

When I do that I should be able to rename it and get famous tomorrow because what I added (here you can pick any of the other misunderstandings -- relationship, emotion, mindfulness, etc etc) is obviously missing from the model
You can rename it and still come and talk at our conventions etc. We don't care about names. Some folks in the CBS community call ACT "Acceptance Based Behavior Therapy" for example. It turns out that psychological flexibility still mediates the outcomes. But branding helps people find the work so at least rename it for a good reason (e.g., sometimes it make it hard to do meta-analysises). It's up to you.

You can mix ACT with the cognitive elements of CT / CBT easily
With some, but be careful. Incoherence is not usually helpful and patients will detect the incoherence if it is there.

It is safe to do research on ACT without doing any training in ACT
Is it safe to do surgery that way? You cannot read a book and do this well. Get some training. It is cheap and available and non-proprietary. ACT folks will collaborate and consult. Reach out.

It is safe to criticize ACT based on what you've heard about it from others who are not expert in it
What is it about reading carefully that is so aversive?

ACT contains nothing new
If you've studied it thoroughly, just say it in print and say why you say that and let us all look at it dispassionately. If you've not done your homework yet, see above.

ACT is behavioral in an S-R sense
ACT is actively hostile to S-R psychology.

ACT is behavioral in a traditional behavior analytic sense
ACT / RFT is part of behavior analysis, but RFT changes everything. ACT is part of post-Skinnerian behavior analysis -- which is a new form. We call it "contextual behavioral science." Read the RFT book for why we say that.

For these reasons ACT is not oriented toward cognition
200 studies on cognition later, how can folks still say that?! Come to a training at least.

For these reasons ACT is not oriented toward emotion
Come to a training! Watch some tapes! Go look at my TEDx talk: www.bit.ly/StevesFirstTED

Because ACT is broadly applicable it is primarily based on a non-specific clinical process
The theory says why it is broadly applicable and the process data so far say it is successful due to specific process changes. We now have socres of mediational analyses out or in press.

Anything that works for such a broad range of problems must be bulls**t
The theory says why it is broadly applicable. Who are you to say a priori what nature is like?

There are not many outcome studies on ACT
About 200 RCTs and scores more controlled time series designs and counting.

ACT / RFT is a small minority
Maybe. But there are about 3000 folks on the ACT / RFT listserves and over 8000 in the association. ACBS is bigger than ABCT or ABAI. Its one of the the fastest growing associations of its kind out there. Besides, minority or not, we are speaking of ideas and data, not politics.

ACT proponents make excessive claims that go beyond the data
A quote would be nice.

ACT is hierarchical and you have to pledge allegiance to a leader to be involved with it
It's an open list serve; an open website; no certification of therapists; no cut goes to originators from members/trainers/etc; you can get our protocols for free; anyone can become a trainer. There are more ACT books by others than by the originators, by far. This is just so unfair. Its a cartoon, and an ignorant one at that.

ACT processes have not been studied
Download the list of studies and read them. We think our process data are stronger than just about any other approach in all of applied psychology, and our link to basic science is excellent.

RFT can't explain anything other models of cognition cannot explain
RFT researchers have explained phenomena that other approaches have had hard times with. For example, we are learning how to establish a sense of self, we know a lot about how metaphor works, we know a core process in human cognition. And it appears that RFT programs raise IQs more dramatically than anything else out there; it helps with acquisition of language in disabled children; it has better implicit measures than anyone; it can predict who will suceed for fail clinically; etc.

RFT is just jargon
How much have you carefully read so far? Until you read carefully you cannot distinguish jargon and a technical language. RFT has a techical language, but only when technical terms are needed. If you disagree, pick a technical term and show how it is the same as a common sense one. Maybe there was a slip.

ACT is just jargon
Same reaction as above.

No one can understand RFT
Do the RFT tutorial on this website. Yes the basic studies are damn hard to understand ... you are languaging about language and that is just confusing. But it is not beyond anyone reading this website. Physics is hard too -- so?

No one can understand ACT
You can. And "understanding" in a purely intellectual sense is not the point for clients anyway. Usually what therapists mean when they say this is that they are afraid that if they don't understand it thoroughly they can't do it effectively. Folks like Raimo Lappalainen have shown that ACT works even when delivered by beginning therapists who don't really understand it. In fact most of the outcome data on ACT was not done with experienced ACT therapists. It's a miracle these studies work at all -- but they do. Understsanding does help: we have studies

RFT has little to do with ACT
ACT and RFT co-evolved. There are many, many links are there and in both directions. It is not a matter of point to point correspondence and it should not be if we are right and applied and basic science should relate in a reticulated way.

ACT folks don't want CT people to be involved and they look down on them
Ask some CT people who got involved in ACT work what they think about how they were treated. Just ask.

We don't know which components work because there are no dismantling studies
ACT comes from an inductive tradition. Rather than wait decades for dismantling studies we've done over 60 technique building and micro-analytic studies (see the reference above) and every aspect of the model has at least some targetted research data. And we do have some studies that dismantle the methods to a degree (an example was listed above)

I hate the enthusiasm of students who do these workshops -- it scares me
We can all agree that enthusiasm is not the same as substance ... but suppose that enthusiasm is hostile to substance? Besides this concern itself sounds emotional so why let emotions substitute for data just because it is now your emotions we are talking about (it scares me) ? Be consistent. If enthusism creeps you out, try to make room for being creeped out, hang on to your legitimate skepticism, and follow the data.

I just don't like ACT
See above.

Talk of spirituality in ACT is creepy
It is treated as a naturalistic concept. ACT is not a religion.

I don't want to be told my values
ACT folks will never do that ... your values are your choice.

There is no data on ACT in groups
About a third of the RCTs on ACT are done in groups, so that means scores of studies.

ACT works through the same process as ____ (fill in your favorite)
Show me the actual research please. The reverse is much more likely to be true so far (the psychological flexibility model explains your favorite). But that is cool, no? Now that we know how things work we can chase the outcomes together.

ACT is not self-critical
Lurk on the list serve and see. Come to a WorldCon and see.

Steve Hayes is a jerk -- I saw him do a mean joke or a mean comment at ABCT or ABAI
ACT is not Steve Hayes -- there are scores of leaders in ACT / RFT. Besides, distinguish the message from the messenger. Some of us are confrontational about intellectual issues, but we don't go after people or traditions: just ideas. The list serve NEVER has flame wars, and that includes toward others. We are just playing hard. Why not? It is fun and can be helpful. Not everyone inside CBS plays the same way. if you hate folks who like to argue, go to ACT talks (etc) by softer folks. As for mean humor, sometimes roast humor can slip across the line a bit, but we tease those we respect. In the ACT community we use humor to remind us all that this work is not about the muckity mucks (including those inside ACBS) ... it is a shared enterprise and everyone is part of it who wants to be part and is willing to bring science based values and caring to the table. If you come to an ACBS conference you will see that the ACT / RFT leadership is outright ridiculed in the "follies" and it is just great fun. Anyone has access to the stage. Even cognitive therapists! : )

ACT is crazy (or my personal favorite variant since I'm writing this, Steve is crazy)
Ah, finally you are getting somewhere. But as that Time guy said in 2006 in the last line of the story on me and on ACT -- we may just be crazy enough to pull it off. If you are nutty enough to want to help us, come help us succeed!

Steven Hayes April 7, 2006 - 1:25am

Criticisms of ACT

Given the values of ACBS, there has been efforts from the beginning of the ACBS community to encourage responsible criticism, to give thoughtful critics a stage to speak to the group, of trying to respond thoughtfully in writing to knowledgeable critics, and of trying to resolve issues empirically where possible. Criticisms of ACT have appeared in published forms. The written criticisms of RFT (and to a lesser degree, functional contextualism) are extensive and in writing, as are the defenses. They can be found in the other sections of the website.

Self-Criticism

Part of the core of the ACT / RFT tradition is the openness to criticism, including self-criticism. At the LaSalle ACT Summer Institute (Philadelphia, 2005) James Herbert gave a really solid paper walking through many of the criticisms he knew about, under the title "Is ACT a fad?" He considers not just whether the criticisms are correct, but what those in the ACT / RFT community should do about them. You can look at that talk by clicking on the link below.

Criticisms of ACT, ACT Summer Institute II (July 2005, PowerPoint file)

Published Criticisms and Responses: An Ongoing Conversation Below is a list of papers that have been published criticizing ACT as well as replies that have been published when available. If you know of other criticisms or replies please email us or add a child page to this page.

Corrigan, P. (2001). Getting ahead of the data: A threat to some behavior therapies. The Behavior Therapist, 24(9), 189-193.

This was the first strong criticism of ACT published. Corrigan argued that the ratio of non-empirical to empirical articles could be used to argue that third-wave CBT was ahead of its data.

A reply: Hayes, S. C. (2002). On being visited by the vita police: A reply to Corrigan. The Behavior Therapist, 25, 134-137.

The reply argued that the ratio of non-empirical to empirical articles could not be meaningfully used as a measure of getting ahead of data since there were many good reasons to write theoretical discussion pieces. Instead, actual claims that got ahead of the data had to be identified and none have been. Pat has been helpful to ACT researchers in various capacities over the years since that article.

Corrigan, P. (2002). The data is still the thing: A reply to Gaynor and Hayes. The Behavior Therapist, 25, 140.

Asmundson, G. J. G., & Hadjistavropolous, H.D. (2006). Acceptance and Commitment Therapy in the Rehabilitation of a Girl With Chronic Idiopathic Pain: Are We Breaking New Ground? Cognitive and Behavioral Practice, 13, 178–181.

Hofmann, S. G., & Asmundson, G. J. G. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28, 1-16.

Hofmann, S. G. (2008). Acceptance and Commitment Therapy: New Wave or Morita Therapy? Clinical Psychology, Science and Practice, 5, 280-285.

The theme of these two articles is that ACT and other mindfulness-based treatments is the same as CBT, and that ACT is the same as Morita Therapy. After these articles were written Stefan Hofmann was invited and funded to speak to the ACBS community in Chicago (2007). We had a great time in respectful dialogue. Read more about this criticism in non-peer-reviewed settings and the ensuing dialogue, click on the child page"ACT is Outright Taken from Morita Therapy" below.

Öst, L. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46(3), 296-321.

This article is in part based on proactive efforts by the ACBS community to encourage knowledgeable criticism. Lars-Goran Öst has been invited and funded to come to several ACT conferences beginning even before he was knowledgeable of ACT work, given that he was asked to play the role of an outside critic at the first World Conference in Linkoping, Sweden (2003). He was later also invited to London (2006), and Enschede, The Netherlands (2009), that last invitation coming after the article itself was available.

The theme of Lar-Goran's criticisms have been that ACT research has methodological weaknesses, and that it is not as well done as mainstream CBT research. The latter was based on a comparison of ACT studies with a matched set of traditional CBT studies. His conclusion is that ACT is not an evidence-based treatment.

Gaudiano reply: Gaudiano, B. A. (2009). Öst's (2008) methodological comparison of clinical trials of acceptance and commitment therapy versus cognitive behavior therapy: Matching apples with oranges? Behaviour Research and Therapy, 47, 1066-1070.

Öst reply: Öst, L. -G. (2009). Inventing the wheel once more or learning from the history of psychotherapy research methodology: Reply to Gaudiano's comments on Öst's (2008) review. Behaviour Research and Therapy, 47, 1071-1073.

Gaudiano rejoinder: Gaudiano, B. (2009b) Reinventing the Wheel Versus Avoiding Past Mistakes when Evaluating Psychotherapy Outcome Research: Rejoinder to Öst (2009). Brandon has replied again in a piece self-published online (in an attempt to keep the conversation flowing without the confines of the lengthy peer-review process).

The theme of the replies was that errors were made in Lar-Goran's matching and coding process, resulting in a distorted comparison, and that ACT studies are not weaker when resulting differences in population and funding are weeded out. Further, it is noted that ACT is already listed by APA as an evidence-based treatment. Lars-Goran admits that the two sets of studies are not matched in areas such as funding, and that APA lists ACT as evidence-based, but holds to his original views.

Arch, J. J., & Craske, M. G. (2008). Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar mechanisms? Clinical Psychology: Science & Practice, 5, 263-279.

A reply: Hayes, S. C. (2008). Climbing our hills: A beginning conversation on the comparison of ACT and traditional CBT. Clinical Psychology: Science and Practice, 5, 286-295.

The theme of the response was that ACT is part of the CBT tradition, but it is not possible to compare intellectual similarities until CBT says what it is. Efforts of the authors to do so were argued to change long standing mainstream views, which explain some of why the two could be argued to be very similar. Both the critical article and response agreed that there were good empirical issues to be explored.

Reflective of the tone of this dialogue, several ACT researchers (Georg Eifert, John Forsyth, Steve Hayes, Mike Twohig) are doing work with Michelle Craske and her colleagues trying to study the issues raised. Michelle has been invited to speak at an ACBS World Conference. She was not able to come in 2009 but we hope to hear her in the future.

Powers, M.B., Vörding, M.B., & Emmelkamp, P. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 8, 73-80.

A reply: Levin, M., & Hayes, S.C. (2009). Is Acceptance and commitment therapy superior to established treatment comparisons? Psychotherapy & Psychosomatics, 78, 380.

Author response: Powers, M. B., & Emmelkamp, P. M. G. (2009). Response to ‘Is acceptance and commitment therapy superior to established treatment comparisons?’ Psychotherapy & Psychosomatics, 78, 380–381.

ACT researchers have critically examined the method of the meta-analysis and have published a response to the study, with a revised analysis. A counter response by Powers and colleagues is also available. We invited Paul Emmelkamp to come to Enschede but he could not ... we hope to get him to an ACBS conference in the future.

Replies to Critiques in General: Articles Describing the CBS Strategy Extensive reviews of the issued raised in this article are out or in press, but they are too extensive to simply call them "replies." The theme of the articles (which you can read by clicking the link above) has been to describe the ACT approach, its knowledge development strategy and to show its distinctive features.

Steven Hayes January 15, 2010 - 5:27am

Criticism: "ACT is Outright Taken from Morita Therapy"

In June 2008 list serve post to the Academy of Cognitive Therapy, Bob Leahy, 2008 President-Elect of ACBT, made this claim: "Moreover, the claim for a new, unique model of treatment made by ACT does not seem justified. As some of those on this Listserve know, many of the ideas and techniques that Hayes has advanced are directly taken from Morita therapy. And without attribution. See http://en.wikipedia.org/wiki/Morita_Therapy or http://www.clcma.com/morita1.htm Pay attention to the discussion about mindfulness, acceptance, character, values, etc. This was 1928. That's a long time ago. Does this remind you of anything? Is this a coincidence?" ****************** This is a response written by Steve Hayes (on 6/29/08): The claim is false. Maybe folks in recent years have added things that I am unaware of ... ACT is a vast community .... but I am certain that no concepts or methods in the formative work on ACT came from Morita whatsoever. I never heard of Morita therapy until well after the ACT model was developed and published. I am not sure when I first heard of it but I do recall that the person knew Japanese and told me that the English translations are not very accurate and they had been made too much like CBT by Westerners. That decreased my interest in reading the secondary sources. The methods I saw in the limited reading I did (e.g., keeping depressed folks in sensory deprivation, etc) it just seemed way too far away from our work to be useful, especially since I recall seeing no controlled data. We have cited Morita several times as being relevant to the ACT work, however. For example in Hayes, S. C., & Ju, W. (1997). The applied implications of rule-governed behavior. Chapter in W. O'Donohue (Ed.), Learning and behavior therapy (pp. 374-391). New York: Allyn & Bacon, we said: "Conversely, the more traditionally non-empirical approaches, like Gestalt (Perls, 1969) and Morita (Morita, 1929), may be more consistent with the basic behavioral literature on rule-governance." Rather than a dark vision of scientific theft the more plausible reason for the connection is that many traditions have gathered together things that seem to work, and some of these overlap to a degree with ACT. ACT is a more bottom up, Western science account but it has arrived at places other traditions inhabit to a degree. That is particularly true with just about any Eastern tradition since all you really need to overlap a bit with where ACT ended up is mindfulness (which always includes acceptance somewhere) and some kind of right action (values). Because of the history of development, ACT partitions these broad chunks into technical processes that are linked to a basic account. That quality is part of what distinguishes ACT from these traditions. ACT is a model linked to a basic theory, clear philosophy, and successful applied technology. In other words, what is most new about ACT is that it is part of contextual behavioral science, with all of the progressive features this brings.

Steven Hayes June 29, 2008 - 6:49pm

Getting Beyond the Way of the Guru and Other Scientific Deadends

ACT is drawing a great deal of attention and many of the folks now connecting with the work are not behavior analysts. In addition, behavior analysis itself is not necessarily evolving fast enough for visitors to see through to its core and to its potential without a bit of a roadmap. Many of the folks who visit this site would recoil from ACT's intellectual home base if dropped into an Association for Behavior Analysis convention, say, without a friend. Much of what is there will seem foreign or even hostile to an ACT / RFT perspective. But do the same with someone knowledgeable -- especially someone to help deal with the confusion because both mechanists and contextualists co-exist inside this tradition and to help find the right resources -- and the vast majority of those who connect with the ACT work will see the relevance of behavior analysis. If the ACT / RFT agenda is successful this problem will eventually resolve itself because RFT (especially) and perhaps to a lesser degree ACT will move the home base itself. But we are not there yet. The grand strategy here is this (this is not so much sequential and linear as it is an interconnected web): build the contextualistic wing of BA, build the RFT research program, build the ACT program, build the links between ACT and RFT, build the other applied extensions of RFT, use ACT to draw mainstream clinical to the work, expose mainstream CBT to the value of RFT, expose mainstream cognitive psychology to the value of RFT and use RFT to do hard work in that area, expose other areas of psychology (prevention, education, etc etc etc) to the value of ACT / RFT and use ACT/RFT to do substantial work in those areas, use the support for ACT and RFT to build support in academic departments for basic behavior analysis, bump behavior analysis itself along, end up with a revitalized form of behavior analysis inside the mainstream of psychology. Whew This is not politics, though it may look like it in some of its features. It makes sense only if you believe that for the good of humanity functional contextual psychology should play far more of a role in the future of psychology than it otherwise seems destined to, and that to do that it needs not just to be understood but to develop itself. But if you look at the list above you will see a problem. This agenda cannot work if the work begins and ends with ACT. The explosion of popularity of ACT is both a blessing and a danger. Folks come to the work and think it is just a neat technology. Some immediately start to modify it based not on theory or development of needed processes but on comfort (I like doing X, X is not in there, I will do ACT + X). Some folks are doing ACT studies without ever having been to an ACT / RFT conference, or even an extended ACT training, etc. So just when we have a chance to leverage attention for even more dramatic change, we risk crumbling into incoherence. Once ACT is a technology only, it is done. Because then, how doe sit develop? If you just let the technology stay as it is you have: Option A. The Way of the Empirically Supported Treatment Manual. The technology is it. Sell the manuals. Validate them. Sell them some more. Then let them gather dust. If you are going to let it develop then you have other options: Option B: The Way of the Guru. A charismatic leader declares new things to be in or out. Yuck. Option C: The Way of Politics. Anything goes provided enough folks support it, thus create subgroups to support innovations/styles/techniques etc. Eventually this option becomes Option B, or ACT just splinters into nothingness and you are left just with a name and canonical texts. Option D: The Way of Scientific Battleships. Anything goes provided you have some data. The kitchen sink is useful, too, so don't forget to throw that in. And, way the way, where did those ideas you threw in come from in the first place? Ahhh. Hmmm. Brute force science linked to commonsense cannot see through to the essence of things. Precision, but no scope. Eventually this becomes a sequential version of Option A. There is another option. It is the way bieng followed in the ACT / RFT approach. ACT is a model, based on processes and techniques that modify those processes. The processes are linked to basic principles and a basic research program on those principles. All of that stands on a philosophy of science and on an intellectual and methodological tradition. This is Option E: The Way of an Evolving Science. But to do this, we have to take responsibility for it. Folks drawn into ACT, for example, need to take seriously the possibility that overtime they will need to learn more about RFT, and then about behavior analysis itself (even if they are, say, psychoanalysts, or existentialists, or cognitive therapists). If you force that too early or too rudely and it is a barrier. But ignore it altogether, and it is a recipe for ultimate irrelevance. Thus ACBS. Thus, the World Conferences. Thus this website. We cannot expect someone else to do it. Together, as a community, we have to work together to create a progressive science more adequate to the challenge of the human condition. - Steve Hayes

Steven Hayes April 24, 2006 - 4:29am

Books

There are many books, audiobooks, and other materials to help you learn more about ACT, RFT, Contextual Behavioral Science, and related topics such as mindfulness and other third wave interventions.

There may seem like a lot of choices in some areas. And there are, which is a testament to how quickly the ACT/RFT/CBS work has grown.

admin May 11, 2009 - 8:09pm

ACT Books: General Purpose

(The following list of books is from the LEARNING ACT RESOURCE GUIDE: The complete guide to resources for learning Acceptance & Commitment Therapy by Jason Luoma, Ph.D. Updated July 2020 learningact.com)

The following list only includes ACT self help books in English. Click here for the list of books in 20+ languages.

BOOKS FOR LEARNING ACT

LEARNING ACT

Acceptance and Commitment Therapy (Theories of Psychotherapy)
Acceptance and Commitment Therapy, Second Edition: The Process and Practice of Mindful Change
Acceptance and Commitment Therapy: 100 Key Points and Techniques
Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change
Acceptance and Commitment Therapy: Contemporary Theory Research and Practice
Acceptance and commitment Therapy: The CBT distinctive features series
Acceptance and Commitment Therapy For Dummies
The ACT Approach: A Comprehensive Guide for Acceptance and Commitment Therapy
The Act in Context: The Canonical Papers of Steven C. Hayes
ACT in Practice: Case Conceptualization in Acceptance and Commitment Therapy
ACT in Steps: A Transdiagnostic Manual for Learning Acceptance and Commitment Therapy
ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy (The New Harbinger Made Simple Series)
The ACT Matrix: A New Approach to Building Psychological Flexibility Across Settings and Populations
The ACT Practitioner’s Guide to the Science of Compassion: Tools for Fostering Psychological Flexibility
ACT Questions and Answers: A Practitioner’s Guide to 150 Common Sticking Points in Acceptance and Commitment Therapy
The Art and Science of Valuing in Psychotherapy: Helping Clients Discover, Explore, and Commit to Valued Action Using Acceptance and Commitment Therapy
The Big Book of ACT Metaphors: A Practitioner’s Guide to Experiential Exercises and Metaphors in Acceptance and Commitment Therapy
Interventions for Radical Change: Principles and Practice of Focused Acceptance and Commitment Therapy
A CBT Practitioner’s Guide to ACT: How to Bridge the Gap Between Cognitive Behavioral Therapy and Acceptance and Commitment Therapy
Committed Action in Practice: A Clinician’s Guide to Assessing, Planning, and Supporting Change in Your Client (The Context Press Mastering ACT Series)
A Contextual Behavioral Guide to the Self: Theory and Practice
Contextual Schema Therapy: An Integrative Approach to Personality Disorders, Emotional Dysregulation, and Interpersonal Functioning
The Essential Guide to the ACT Matrix: A Step-by-Step Approach to Using the ACT Matrix Model in Clinical Practice Essentials of Acceptance and Commitment Therapy
Evolution and Contextual Behavioral Science: An Integrated Framework for Understanding, Predicting, and Influencing Human Behavior
Experiencing ACT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists (Self-Practice/Self-Reflection Guides for Psychotherapists)
The Heart of ACT: Developing a Flexible, Process-Based, and Client-Centered Practice Using Acceptance and Commitment Therapy
Innovations in Acceptance and Commitment Therapy: Clinical Advancements and Applications in ACT
Inside This Moment: A Clinician’s Guide to Promoting Radical Change Using Acceptance and Commitment Therapy
Introduction to ACT: Learning and Applying the Core Principles and Techniques of Acceptance and Commitment Therapy
Learning Acceptance and Commitment Therapy: The Essential Guide to the Process and Practice of Mindful Psychiatry
Learning ACT for Group Treatment: An Acceptance and Com-mitment Therapy Skills Training Manual for Therapists
A Liberated Mind: How to Pivot Toward What Matters
The Little ACT Workbook
Metaphor in Practice: A Professional’s Guide to Using the Science of Language in Psychotherapy
Mindfulness, Acceptance, and the Psychodynamic Evolution: Bringing Values into Treatment Planning and Enhancing Psychodynamic Work with Buddhist Psychology (The Context Press Mindfulness and Acceptance Practica Series)
Mindfulness, Acceptance, and Positive Psychology: The Seven Foundations of Well-Being (The Context Press Mindfulness and Acceptance Practica Series)
Mindfulness- and Acceptance-Based Behavioral Therapies in Practice (Guides to Individualized Evidence-Based Treatment)
Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition
Mindfulness and Acceptance in Social Work: Evidence-Based Interventions and Emerging Applications (The Context Press Mindfulness and Acceptance Practica Series)
The Mindfulness-Informed Educator: Building Acceptance and Psychological Flexibility in Higher Education
A Practical Guide to Acceptance and Commitment Therapy
Talking ACT: Notes and Conversations on Acceptance and Commitment Therapy
Values in Therapy: A Clinician’s Guide to Helping Clients Explore Values, Increase Psychological Flexibility, and Live a More Meaningful Life
The Wiley Handbook of Contextual Behavioral Science

ADVANCED PRACTICE IN ACT

ACT Questions and Answers: A Practitioner’s Guide to 150 Common Sticking Points in Acceptance and Commitment Therapy
ACT Verbatim for Depression and Anxiety: Annotated Transcripts for Learning Acceptance and Commitment Therapy
Advanced Acceptance and Commitment Therapy: The Experienced Practitioner’s Guide to Optimizing Delivery
Advanced Training in ACT: Mastering Key In-Session Skills for Applying Acceptance and Commitment Therapy
Cognitive Defusion in Practice: A Clinician’s Guide to Assessing, Observing, and Supporting Change in Your Client (The Context Press Mastering ACT Series)
Getting Unstuck in ACT: A Clinician’s Guide to Overcoming Common Obstacles in Acceptance and Commitment Therapy
Inside This Moment: A Clinician’s Guide to Promoting Radical Change Using Acceptance and Commitment Therapy
Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists
Learning ACT for Group Treatment: An Acceptance and Com-mitment Therapy Skills Training Manual for Therapists
Metaphor in Practice: A Professional’s Guide to Using the Science of Language in Psychotherapy
Mindfulness for Two: An Acceptance and Commitment Therapy Approach to Mindfulness in Psychotherapy

MORE ACT BOOKS

admin May 11, 2009 - 8:12pm

ACT Books: Specific Populations

ACT Books: Specific Populations

The following list only includes ACT self help books in English. Click here for the list of books in 20+ languages.

ANGER

Therapist guides

Contextual Anger Regulation Therapy: A Mindfulness and Acceptance- Based Approach (Practical Clinical Guidebooks)

Client books

Act on Life Not on Anger: The New Acceptance & Commitment Therapy Guide to Problem Anger
The Moral Injury Workbook: Acceptance and Commitment Therapy Skills for Moving Beyond Shame, Anger, and Trauma to Reclaim Your Values

ANXIETY

Therapist guides

Acceptance and Commitment Therapy: The Ultimate Guide to Using ACT to Treat Stress, Anxiety, Depression, OCD, and More, Including Mindfulness Exercises and a Comparison with CBT and DBT
Acceptance and Commitment Therapy for Anxiety Disorders
Acceptance-Based Behavioral Therapy: Treating Anxiety and Related Challenges
ACT-Informed Exposure for Anxiety: Creating Effective, Innovative, and Values-Based Exposures Using Acceptance and Commitment Therapy
The Clinician’s Guide to Exposure Therapies for Anxiety Spectrum Disorders: Integrating Techniques and Applications from CBT, DBT, and ACT
Trichotillomania: An ACT-Enhanced Behavior Therapy Approach Therapist Guide (Treatments That Work)

Client books

The ACT on Anxiety Workbook
The ACT Workbook for OCD: Mindfulness, Acceptance, and Exposure Skills to Live Well with Obsessive-Compulsive Disorder
Anxiety Happens: 52 Ways to Find Peace of Mind
Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, and Stress Using Mindfulness and Acceptance
Cognitive Behavioral Therapy: How to Use CBT to Overcome Anxiety, Depression and Intrusive Thoughts + A Guide to Acceptance and Commitment Therapy and ACT Techniques
The Confidence Gap: A Guide to Overcoming Fear and Self-Doubt
In This Moment: Five Steps to Transcending Stress Using Mindfulness and Neuroscience
Living Beyond OCD Using Acceptance and Commitment Therapy: A Workbook for Adults
The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free from Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy (2nd Edition)
The Mindfulness and Acceptance Workbook for Social Anxiety and Shyness: Using Acceptance and Commitment Therapy to Free Yourself from Fear and Reclaim Your Life
Outsmart Your Anxious Brain: Ten Simple Ways to Beat the Worry Trick
Social Courage: Coping and thriving with the reality of social anxiety
Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety
Trichotillomania: An ACT-Enhanced Behavior Therapy Approach Workbook (Treatments That Work)
The Worry Trap: How to Free Yourself from Worry & Anxiety Using Acceptance and Commitment Therapy

CANCER

Client books

Flying over Thunderstorms: Living Your Life with Cancer through Acceptance and Commitment Therapy

CHILDREN/ADOLESCENTS/PARENTING

Therapist guides

Acceptance and Commitment Therapy: The Clinician’s Guide for Supporting Parents
Acceptance & Mindfulness Treatments for Children & Adolescents: A Practitioner’s Guide
ACT for Adolescents: Treating Teens and Adolescents in Individual and Group Therapy
ACT for Treating Children: The Essential Guide to Acceptance and Commitment Therapy for Kids
Challenging Perfectionism: An Integrative Approach for Supporting Young People Using ACT, CBT and DBT
Mindfulness and Acceptance for Counseling College Students: Theory and Practical Applications for Intervention, Prevention, and Outreach (The Context Press Mindfulness and Acceptance Practical Series)
Teen Anxiety: A CBT and ACT Activity Resource Book for Helping Anxious Adolescents
The Thriving Adolescent: Using Acceptance and Commitment Therapy and Positive Psychology to Help Teens Manage Emotions, Achieve Goals, and Build Connection

Client books

Acceptance and Mindfulness Toolbox for Children and Adolescents: 75+ Worksheets & Activities for Trauma, Anxiety, Depression, Anger & More
The ACT Workbook for Kids: Fun Activities to Help You Deal with Worry, Sadness and Anger Using Acceptance and Commitment Therapy
The ACT Workbook for Teens with OCD
Becoming Mum
Dark Agents, Book One: Violet and the Trial of Trauma
Get Out of Your Mind and Into Your Life for Teens: A Guide to Living an Extraordinary Life
The Gifted Kids Workbook: Mindfulness Skills to Help Children Reduce Stress, Balance Emotions, and Build Confidence
The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years
The Mental Health and Wellbeing Workout for Teens: Skills and Exercises from ACT and CBT for Healthy Thinking
The Mindfulness and Acceptance Workbook for Teen Anxiety: Activities to Help You Overcome Fears and Worries Using Acceptance and Commitment Therapy (Instant Help Book for Teens)
Nuna and the Fog
Parenting a Troubled Teen: Manage Conflict and Deal with Intense Emotions Using Acceptance and Commitment Therapy
Parenting Your Anxious Child with Mindfulness and Acceptance: A Powerful New Approach to Overcoming Fear, Panic, and Worry Using Acceptance and Commitment Therapy
Stuff That Sucks: Accepting What You Can’t Change and Committing to What You Can

DEPRESSION

Therapist guides

ACT for Depression: A Clinician’s Guide to Using Acceptance & Commitment Therapy in Treating Depression

Client books

The ACT Workbook for Depression and Shame: Overcome Thoughts of Defectiveness and Increase Well-Being Using Acceptance and Commitment Therapy
The Mindfulness and Acceptance Workbook for Depression: Using Acceptance and Commitment Therapy to Move Through Depression and Create a Life Worth Living (2nd Edition)

DEVELOPMENTAL DISABILITIES

Derived Relational Responding Applications for Learners with Autism and Other Developmental Disabilities: A Progressive Guide to Change

DIVERSE POPULATIONS

Therapist guides

ACT for Gender Identity
Mindfulness and Acceptance for Gender and Sexual Minorities: A Clinician’s Guide to Fostering Compassion, Connection, and Equality Using Contextual Strategies
Mindfulness and Acceptance in Multicultural Competency: A Contextual Approach to Sociocultural Diversity in Theory and Practice (The Context Press Mindfulness and Acceptance Practica Series)

EATING DISORDERS/BODY IMAGE

Therapist guides

Acceptance and Commitment Therapy for Body Image Dissatisfaction: A Practitioner’s Guide to Using Mindfulness, Acceptance, and Values-Based Behavior Change Strategies
Acceptance and Commitment Therapy for Eating Disorders: A Process-Focused Guide to Treating Anorexia and Bulimia
A Clinician’s Guide to Acceptance-Based Approaches for Weight Concerns: The Accept Yourself! Framework
ACT for Anorexia Nervosa: A Guide for Clinicians
Mindfulness and Acceptance for Treating Eating Disorders and Weight Concerns: Evidence-Based Interventions

Client books

The Anorexia Workbook: How to Accept Yourself, Heal Your Suffering, and Reclaim Your Life
Living with Your Body and Other Things You Hate: How to Let Go of Your Struggle with Body Image Using Acceptance and Commitment Therapy
The Diet Trap: Feed Your Psychological Needs and End the Weight Loss Struggle Using Acceptance and Commitment

HEALTH/CHRONIC PAIN/INTEGRATED CARE

Therapist guides

Acceptance and Commitment Therapy for Chronic Pain
Behavioral Consultation and Primary Care: A Guide to Integrating Services
Contextual Cognitive-Behavioral Therapy for Chronic Pain
Mindfulness and Acceptance in Behavioral Medicine: Current Theory and Practice
Psychological Treatment for Patients With Chronic Pain (Clinical Health Psychology)
Real Behavior Change in Primary Care: Improving Patient Outcomes and Increasing Job Satisfaction
Somatoform and Other Psychosomatic Disorders: A Dialogue Between Contemporary Psychodynamic Psychotherapy and Cognitive Behavioral Therapy Perspectives

Client books

Better Living With IBS: A step-by-step program to managing your symptoms so you can enjoy life to the full!
The Diabetes Lifestyle Book
End the Insomnia Struggle: A Step-by-Step Guide to Help You Get to Sleep and Stay Asleep
Living Beyond Lyme: Reclaim Your Life From Lyme Disease and Chronic Illness
Living Beyond Your Pain: Using Acceptance & Commitment Therapy to Ease Chronic Pain

INTERPERSONAL/RELATIONSHIP ISSUES

Therapist guides

Acceptance and Commitment Therapy for Couples: Using Mindfulness, Values, and Schema Awareness to Rebuild Relationships
Acceptance and Commitment Therapy for Interpersonal Problems: Using Mindfulness, Acceptance, and Schema Awareness to Change Interpersonal Behaviors
ACT and RFT in Relationships: Helping Clients Deepen Intimacy and Maintain Healthy Commitments Using Acceptance and Commitment Therapy and Relational Frame Theory
The Interpersonal Problems Workbook: ACT to End Painful Relationship Patterns

Client books

ACT with Love: Stop Struggling, Reconcile Differences, and Strengthen Your Relationship with Acceptance and Commitment Therapy
The Mindful Couple: How Acceptance and Mindfulness Can Lead You to the Love You Want

LOSS/GRIEF

Client books

The Reality Slap: Finding Peace and Fulfillment When Life Hurts

OCCUPATIONAL/COACHING

Acceptance and Mindfulness at Work: Applying Acceptance and Commitment Therapy And Relational Frame Theory to Organizational Behavior Management
Maximize Your Coaching Effectiveness with Acceptance and Commitment Therapy
The Mindful and Effective Employee: An Acceptance and Commitment Therapy Training Manual for Improving Well-Being and Performance

PSYCHOSIS

Therapist guides

Acceptance and Commitment Therapy and Mindfulness for Psychosis
ACT for Psychosis Recovery: A Practical Manual for Group- Based Interventions Using Acceptance and Commitment Therapy
Incorporating Acceptance and Mindfulness into the Treatment of Psychosis: Current Trends and Future Directions
Treating Psychosis: A Clinician’s Guide to Integrating Acceptance and Commitment Therapy, Compassion-Focused Therapy, and Mindfulness Approaches within the Cognitive Behavioral Therapy Tradition

RELIGION/SPIRITUALITY

Therapist guides

Acceptance and Commitment Therapy for Christian Clients: A Faith-Based Workbook
ACT for Clergy and Pastoral Counselors: Using Acceptance and Commitment Therapy to Bridge Psychological and Spiritual Care
Faith-based ACT for Christian clients: An integrative treatment approach

SOCIAL WORK

Mindfulness and Acceptance in Social Work

SPORTS/HUMAN PERFORMANCE

The Psychology of Enhancing Human Performance: The Mindfulness-Acceptance-Commitment Approach
The Winner’s Mind: Strengthening Mental Skills in Athletes

SUBSTANCE ABUSE/ADDICTION

Therapist guides

Acceptance and Commitment Therapy for Pathological Gamblers
Acceptance and Commitment Therapy for Substance Abuse: A Clinician’s Guide to Using Practical Mindfulness and Acceptance- Based Interventions for Alcoholism and Drug Addiction
Investigating Acceptance and Commitment Therapy within Addictions
Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions
Mindfulness-Based Sobriety: A Clinician’s Treatment Guide for Addiction Recovery Using Relapse Prevention Therapy, Acceptance and Commitment Therapy, and Motivational Interviewing

Client books

Power Over Addiction: A Harm Reduction Workbook for Changing Your Relationship with Drugs
The Wisdom to Know the Difference: An Acceptance and Commitment Therapy Workbook for Overcoming Substance Abuse

TRAUMA/PTSD

Therapist guides

Acceptance and Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder and Trauma-Related Problems: A Practitioner’s Guide to Using Mindfulness and Acceptance Strategies

Client books

Dark Agents, Book One: Violet and the Trial of Trauma
Finding Life Beyond Trauma: Using Acceptance and Commitment Therapy to Heal from Post-Traumatic Stress and Trauma-Related Problems
The PTSD Survival Guide for Teens: Strategies to Overcome Trauma, Build Resilience, and Take Back Your Life (The Instant Help Solutions Series)

WORK/COACHING/BUSINESS

Acceptance and Commitment Coaching (Coaching Distinctive Features)
Acceptance and Mindfulness at Work: Applying Acceptance and Commitment Therapy And Relational Frame Theory to Organizational Behavior Management
Maximize Your Coaching Effectiveness with Acceptance and Commitment Therapy
Prosocial: Using Evolutionary Science to Build Productive, Equitable, and Collaborative Groups
The Mindful and Effective Employee: An Acceptance and Commitment Therapy Training Manual for Improving Well-Being and Performance
The psychology of enhancing human performance: The Mindfulness-Acceptance-Commitment (MAC) approach

YOGA

Mindful Yoga-Based Acceptance and Commitment Therapy: Simple Postures and Practices to Help Clients Achieve Emotional Balance

MORE ACT BOOKS

admin May 11, 2009 - 8:30pm

ACT Books: Self Help

Self-Help and Life Enhancement Resources

Please note that not all ACT self help books have been specifically empirically validated. A list of such studies is here and you can search for additional RCT studies here.

The World Health Organization also distributes an extensively validated free ACT self-help book Doing What Matters in Times of Stress: An Illustrated Guide and audio recordings to go with it: https://www.who.int/publications-detail/9789240003927

The following list only includes ACT self help books in English. Click here for the list of books in 20+ languages.

Self-Help, Self-Improvement, and Skills Workbooks

ACT SELF HELP BOOKS

Acceptance and Commitment Therapy: Principles of Becoming More Flexible, Effective, and Fulfilled
The ACT Deck: 55 Acceptance & Commitment Therapy Practices to Build Connection, Find Focus and Reduce Stress
ACTivate Your Life: Using acceptance and mindfulness to build a life that is rich, fulfilling and fun
Break Free: Acceptance and Commitment Therapy in 3 Steps: A Workbook for Overcoming Self-Doubt and Embracing Life
Cognitive Behavioral Therapy: A Guide to Self-Empowerment with CBT, DBT, and ACT: How to Build Brain Strength and Reshape Your Life with Behavioral Therapy
The Courage Habit: How to Accept Your Fears, Release the Past, and Live Your Courageous Life
The Diet Trap: Feed Your Psychological Needs and End the Weight Loss Struggle Using Acceptance and Commitment Therapy
Escaping the Emotional Roller Coaster: ACT for the emotionally sensitive
Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy
Get the Life You Want: Finding Meaning and Fulfillment through Acceptance and Commitment Therapy
The Happiness Trap: How to Stop Struggling and Start Living
How to Be Nice to Yourself: The Everyday Guide to Self Compassion: Effective Strategies to Increase Self-Love and Acceptance
The Illustrated Happiness Trap: How to Stop Struggling and Start Living
Learning to Thrive: An Acceptance and Commitment Therapy Workbook
The Mindfulness and Acceptance Workbook for Self Esteem
The Mindfulness and Acceptance Workbook for Stress Reduction: Using Acceptance and Commitment Therapy to Manage Stress, Build Resilience, and Create the Life You Want (A New Harbinger Self-Help Workbook)
The Power of Small: Making Tiny Changes When Everything Feels Too Much
Reclaim Your Life: Acceptance and Commitment Therapy in 7 Weeks
Sex ACT: Unleash the Power of Your Sexual Mind with Acceptance & Commitment Therapy
Stress Less, Live More: How Acceptance and Commitment Therapy Can Help You Live a Busy yet Balanced Life
Therapy Quest: An Interactive Journey Through Acceptance And Commitment Therapy
Your Life on Purpose: How to Find What Matters and Create the Life You Want

Self Help Books for Specific Populations

ANGER

Act on Life Not on Anger: The New Acceptance & Commitment Therapy Guide to Problem Anger
The Moral Injury Workbook: Acceptance and Commitment Therapy Skills for Moving Beyond Shame, Anger, and Trauma to Reclaim Your Values

ANXIETY

The ACT on Anxiety Workbook
The ACT Workbook for OCD: Mindfulness, Acceptance, and Exposure Skills to Live Well with Obsessive-Compulsive Disorder
Anxiety Happens: 52 Ways to Find Peace of Mind
Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, and Stress Using Mindfulness and Acceptance
Cognitive Behavioral Therapy: How to Use CBT to Overcome Anxiety, Depression and Intrusive Thoughts + A Guide to Acceptance and Commitment Therapy and ACT Techniques
The Confidence Gap: A Guide to Overcoming Fear and Self-Doubt
In This Moment: Five Steps to Transcending Stress Using Mindfulness and Neuroscience
Let Go of Anxiety: Climb Life’s Mountains with Peace, Purpose, and Resilience
Living Beyond OCD Using Acceptance and Commitment Therapy: A Workbook for Adults
The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free from Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy (2nd Edition)
The Mindfulness and Acceptance Workbook for Social Anxiety and Shyness: Using Acceptance and Commitment Therapy to Free Yourself from Fear and Reclaim Your Life
Outsmart Your Anxious Brain: Ten Simple Ways to Beat the Worry Trick
Social Courage: Coping and thriving with the reality of social anxiety
Ten Little Ways to Beat the Worry Trick: Outsmart Anxiety, Fear, and Panic
Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety
Trichotillomania: An ACT-Enhanced Behavior Therapy Approach Workbook (Treatments That Work)
The Worry Trap: How to Free Yourself from Worry & Anxiety Using Acceptance and Commitment Therapy

CANCER

Flying over Thunderstorms: Living Your Life with Cancer through Acceptance and Commitment Therapy

CHILDREN/ADOLESCENTS/PARENTING

Acceptance and Mindfulness Toolbox for Children and Adolescents: 75+ Worksheets & Activities for Trauma, Anxiety, Depression, Anger & More
The ACT Workbook for Teens with OCD
Becoming Mum
Dark Agents, Book One: Violet and the Trial of Trauma
Get Out of Your Mind and Into Your Life for Teens: A Guide to Living an Extraordinary Life
The Gifted Kids Workbook: Mindfulness Skills to Help Children Reduce Stress, Balance Emotions, and Build Confidence
The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years
The Mental Health and Wellbeing Workout for Teens: Skills and Exercises from ACT and CBT for Healthy Thinking
The Mindfulness and Acceptance Workbook for Teen Anxiety: Activities to Help You Overcome Fears and Worries Using Acceptance and Commitment Therapy (Instant Help Book for Teens)
Nuna and the Fog
Parenting a Troubled Teen: Manage Conflict and Deal with Intense Emotions Using Acceptance and Commitment Therapy
Parenting Your Anxious Child with Mindfulness and Acceptance: A Powerful New Approach to Overcoming Fear, Panic, and Worry Using Acceptance and Commitment Therapy
Stuff That Sucks: Accepting What You Can’t Change and Committing to What You Can

DEPRESSION

The Mindfulness and Acceptance Workbook for Depression: Using Acceptance and Commitment Therapy to Move Through
Depression and Create a Life Worth Living (2nd Edition)

EATING DISORDERS/BODY IMAGE

The Anorexia Workbook: How to Accept Yourself, Heal Your Suffering, and Reclaim Your Life
Living with Your Body and Other Things You Hate: How to Let Go of Your Struggle with Body Image Using Acceptance and Commitment Therapy

HEALTH/CHRONIC PAIN/INTEGRATED CARE

Better Living With IBS: A step-by-step program to managing your symptoms so you can enjoy life to the full!
The Diabetes Lifestyle Book
End the Insomnia Struggle: A Step-by-Step Guide to Help You Get to Sleep and Stay Asleep
Living Beyond Lyme: Reclaim Your Life From Lyme Disease and Chronic Illness
Living Beyond Your Pain: Using Acceptance & Commitment Therapy to Ease Chronic Pain

INTERPERSONAL/RELATIONSHIP ISSUES

ACT with Love: Stop Struggling, Reconcile Differences, and Strengthen Your Relationship with Acceptance and Commitment Therapy
The Mindful Couple: How Acceptance and Mindfulness Can Lead You to the Love You Want

LOSS/GRIEF

The Reality Slap: Finding Peace and Fulfillment When Life Hurts

SPORTS/HUMAN PERFORMANCE

The Psychology of Enhancing Human Performance: The Mindfulness-Acceptance-Commitment Approach
The Winner’s Mind: Strengthening Mental Skills in Athletes

SUBSTANCE ABUSE/ADDICTION

Power Over Addiction: A Harm Reduction Workbook for Changing Your Relationship with Drugs
The Wisdom to Know the Difference: An Acceptance and Commitment Therapy Workbook for Overcoming Substance Abuse

TRAUMA/PTSD

Dark Agents, Book One: Violet and the Trial of Trauma
Finding Life Beyond Trauma: Using Acceptance and Commitment Therapy to Heal from Post-Traumatic Stress and Trauma-Related Problems
The PTSD Survival Guide for Teens: Strategies to Overcome Trauma, Build Resilience, and Take Back Your Life (The Instant Help Solutions Series

MORE ACT BOOKS

admin May 11, 2009 - 8:48pm

RFT/Behavior Analysis Books

Dixon, M.R., Hayes, S.C., & Belisle, J. (2023). Acceptance and Commitment Therapy for Behavior Analysts. New York: Routledge.
Ming, S., Gould, E., & Fiebig, J. (2023). Understanding and Applying Relational Frame Theory: Mastering the Foundations of Complex Language in Our Work and Lives as Behavior Analysts. Context Press.
Fryling, M., Rehfeldt, R. A., Tarbox, J., & Hayes, L. J. (Eds.). (2020). Applied Behavior Analysis of Language and Cognition: Core Concepts and Principles for Practitioners. New Harbinger Publications.
Villatte, M., Villatte, J. L., & Hayes, S. C. (2019). Mastering the clinical conversation: Language as intervention. New York: The Guilford Press.
Törneke, N., Luciano, C., Barnes‐Holmes, Y., & Bond, F. W. (2015). RFT for clinical practice: Three core strategies in understanding and treating human suffering. Chapter in The Wiley handbook of contextual behavioral science, 254-272.
Dahl, J., Stewart, I., Martell, C., Kaplan, J. (2014) ACT and RFT in Relationships: Helping Clients Deepen Intimacy and Maintain Healthy Commitments Using Acceptance and Commitment Therapy and Relational Frame Theory.
Dymond, S., & Roche, B. (Eds.) (2013). Advances in relational frame theory: Research and application. New Harbinger Publications.
McHugh, L., & Stewart, I. (2012). The self and perspective taking: Contributions and applications from modern behavioral science. Oakland: New Harbinger Publications.
Törneke, N. (2010). Learning RFT: An Introduction to Relational Frame Theory and Its Clinical Application. Reno, NV: Context Press.
- German Translation: Törneke, N. (2012). Bezugsrahmentheorie : Eine Einführung. Paderborn: Junfermann Verlag. (translated by Guido Plata)
- Korean translation: Törneke, N. (2019). Learning RFT: An Introduction to Relational Frame Theory and Its Clinical Application. Hakjisa (translated by Lee, S.).
- Spanish Transation: Törneke, N. (2016). Aprendiendo TMR : una introducción a la Teoría del Marco Relacional y sus aplicaciones clínicas. Úbeda, Jaén: Didacbook.
Rehfeldt, R. A., Barnes-Holmes, Y. (2009). Derived relational responding: Applications for learners with autism and other developmental disabilities. Oakland, CA: New Harbinger Publications, Inc.
- Derived Relational Responding offers a series of revolutionary intervention programs for applied work in human language and cognition targeted at students with autism and other developmental disabilities. It presents a program drawn from derived stimulus relations that you can use to help students of all ages acquire foundational and advanced verbal, social, and cognitive skills. The first part of Derived Relational Responding provides step-by-step instructions for helping students learn relationally, acquire rudimentary verbal operants, and develop other basic language skills. In the second section of this book, you'll find ways to enhance students' receptive and expressive repertoires by developing their ability to read, spell, construct sentences, and use grammar. Finally, you'll find out how to teach students to apply the skills they've learned to higher order cognitive and social functions, including perspective-taking, empathy, mathematical reasoning, intelligence, and creativity. This applied behavior analytic training approach will help students make many substantial and lasting gains in language and cognition not possible with traditional interventions.
Dahl, J. C., Plumb, J. C., Stewart, I., & Lundgren, T. (2009). The Art and Science of Valuing in Psychotherapy: Helping Clients Discover, Explore, and Commit to Valued Action Using Acceptance and Commitment Therapy. Oakland, CA; New Harbinger Publications, Inc.
- The Art and Science of Valuing in Psychotherapy is an applied volume in purpose, but includes an RFT account of each of the ACT processes, and in particular an in depth RFT perspective on personal values and the clinical interventions employed to enhance them and promote committed action.
Ramnero, J., & Törneke, N. (2008). ABCs of human behavior: Behavioral principles for the practicing clinician. Oakland, CA: New Harbinger & Reno, NV: Context Press.
- The ABCs of Human Behavior offers the practicing clinician a solid and practical introduction to the basics of modern behavioral psychology. The book focuses both on the classical principles of learning as well as more recent developments that explain language and cognition in behavioral and contextual terms. These principles are not just discussed in the abstract—rather the book shows how the principles of learning apply in a clinical context. Practical and easy to read, the book walks you through both common sense and clinical examples that will help you use behavioral principles to observe, explain, and influence behavior in a therapeutic setting.
Miltenberger, R.G., (2008). Behavior modification: Principles and procedures (4th Ed.). Pacific Grove, CA: Thomson/Wadsworth.
Woods, D. W., & Kanter, J. W. (Eds.). (2007). Understanding behavior disorders: A contemporary behavioral perspective. Reno, NV: Context Press.
- Understanding behavior disorders presents a contemporary behavioral model of behavior disorders that incorporates the findings of current RFT and ACT research. Rich in possibilities for clinical work, this view of disordered behavior is an important milestone in clinical psychotherapy - an opportunity for behavioral clinicians to reintegrate their clinical practice with an experimental analysis of behavior.
Cooper, J.O., Heron, T.E. & Heward, W.L. (2007). Applied Behavior Analysis (2nd Edition). Prentice Hall.
- Applied Behavior Analysis (2nd Edition) is great resource to get you ready for the BCBA exam and to understand basic principals.
Baum, W. M. (2004). Understanding Behaviorism: Behavior, Culture, and Evolution (2nd edition). Wiley-Blackwell.
Pierce, W.D. & Cheney, C.D. (2003). Behavior Analysis and Learning, 3rd edition.Lawrence Erlbaum.
- The "focus on research" and "on the applied side" sections in various chapters add an excellent generalization of concepts into interesting areas. There is a section on Bandura and the Bobo doll, review of Sidman's comments on coercion, review of the intrinsic/extrinsic reinforcement debates, a creativity section, respondent conditioning and heroin overdose, medical conditioning, and much more.
Barnes-Holmes, Y., Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. In H. W. Reese & R. Kail (Eds.), Advances in Child Development and Behavior, Volume 28 (pp. 101-138). New York: Academic.
Baldwin, J.D. & Baldwin, J.I. (2000). Behavior Principles in Everyday Life (4th Edition). Prentice Hall.
- Behavior Principles in Everyday Life (4th Edition) is a really accessible account of behavioral principles. Great accompaniment to ABCs of Human Behavior.
Dougher, M. J. (Ed.). (2000). Clinical Behavior Analysis. Reno, NV: Context Press.
Chiesa, M. (1994). Radical Behaviorism: The philosophy and science. Cambridge Center.
Leigland, S. (1992). Radical behaviorism: Willard Day on psychology and philosophy. Reno, NV: Context Press.
Puts Skinner's work in context; links history/philosophy and the battles of minds as a background to RFT/ACT.
Catania, C. (1992). Learning. Prentice Hall.
Hayes, S. C. (Ed.). (1989/2004). Rule Governed behavior: Cognition, contingencies, and instructional control. New York: Plenum / reprinted in 2004 by Context Press.
- One of the first full-length presentations of the ACT / RFT model is in three chapters in this book on the topic.
Skinner, B.F. (1965). Science and Human Behavior. Free Press.

Community February 17, 2010 - 10:46pm

ACT Books in 20+ Languages

Click here for a list of ACT and RFT Books Translated in 20+ Languages

Community December 1, 2021 - 1:59pm

General Purpose Books on Contextual Behavioral Science

General Purpose Books on Contextual Behavioral Science

McHugh, L., Stewart, I., & Almada, P. (2019). A Contextual Behavioral Guide to the Self: Theory and Practice. Oakland, CA: New Harbinger.
Wilson, D.S., Hayes, S.C. (2018) Evolution and Contextual Behavioral Science: An Integrated Framework for Understanding, Predicting, and Influencing Human Behavior. Context Press.
Zettle, R. D., Hayes, S.C., Barnes-Holmes, D., Biglan, A. (2016) The Wiley Handbook of Contextual Behavioral Science (Wiley Clinical Psychology Handbooks) Wiley-Blackwell.
Ramnero, J., & Torneke, N. (March 2008). ABCs of human behavior: Behavioral principles for the practicing clinician. Oakland, CA: Context Press / New Harbinger.
It's a basic behavior analysis book for clinicians/ M.D.s/ psychiatrists/ etc. who haven't had training in BA. Goes all the way up to RFT. Nice.
Woods, D. W., & Kanter, J. W. (Eds.). (2007). Understanding behavior disorders: A contemporary behavioral perspective. Oakland, CA: Context Press/New Harbinger.
This volume presents a contemporary behavioral model of behavior disorders that incorporates the findings of current RFT and ACT research. Rich in possibilities for clinical work, this view of disordered behavior is an important milestone in clinical psychotherapy - an opportunity for behavioral clinicians to reintegrate their clinical practice with an experimental analysis of behavior.
Biglan, A. (1995). Changing cultural practices: A contextualistic framework for intervention research. Oakland, CA: Context Press/New Harbinger.
This is begins to show how you might scale these issues to the level of cultural practices. If the ACT model is correct, we either alter the prevalence of psychological inflexibility or we fail to help the human condition. You can do that one at a time, or in formal prevention efforts, but either way it is the same bottom line. No change in prevalence = failure. So we need to think about how to measure this and approach this wisely throughout the work we are doing.
Hayes, S. C., Hayes, L. J., Reese, H. W., & Sarbin, T. R. (Eds.). (1993). Varieties of scientific contextualism. Oakland, CA: Context Press/New Harbinger.
If you get interested in the philosophical foundations of ACT, this will help you understand them.
Leigland, S. (1992). Radical behaviorism: Willard Day on psychology and philosophy. Oakland, CA: Context Press/New Harbinger.
Puts Skinner's work in context; links history/philosophy and the battles of minds as a background to RFT/ACT.
Hayes, S. C. (Ed.). (1989/2004). Rule Governed behavior: Cognition, contingencies, and instructional control. New York: Plenum / reprinted in 2004 by Context Press and currently sold by Oakland, CA: Context Press/New Harbinger..
One of the first full-length presentations of the ACT / RFT model is in three chapters in this book on the topic. This book is now available in paperback from Context Press.

admin May 11, 2009 - 8:54pm

FAP and CFT Books

FAP Books

Gareth Holman PhD, Jonathan Kanter PhD, Mavis Tsai PhD, Robert Kohlenberg PhD, Steven C. Hayes (2017) Functional Analytic Psychotherapy Made Simple.
Mavis Tsai, Robert J. Kohlenberg, Jonathan W. Kanter, Gareth I. Holman, Mary Plummer Loudon (2012) Functional Analytic Psychotherapy (CBT Distinctive Features)
Mavis Tsai, Robert J. Kohlenberg, Jonathan W. Kanter, Barbara Kohlenberg, William C. Follette, Glenn M. Callaghan. (2008) The Practice of Functional Analytic Psychotherapy.
Mavis Tsai, Robert J. Kohlenberg, Jonathan W. Kanter, Barbara Kohlenberg, William C. Follette, Glenn M. Callaghan (2008) A Guide to Functional Analytic Psychotherapy: Awareness, Courage, Love, and Behaviorism.
Mavis Tsai, Robert J. Kohlenberg. (2007) Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships. (Published in 1991 and republished in 2007)

Translations of FAP Books

Italian: Tsai, M. Kohlenberg, R., Kanter, J. W., Holman, G., Plummer Loudon, M. (2013). La psicoterapia analitico-funzionale (FAP). Caratteristiche distintive. (Ed. C. Orsini) Franco Angeli Edizioni.
Portuguese: Holman, G., Kanter, J. W., Tsai, M., & Kohlenberg, R. (2022). Psicoterapia Analítica Funcional Descomplicada: Guia Prático Para Relações Terapêuticas (Rolim de Moura, P., Bastos Oshiro, C. K., & Villas-Bôas, A., Trans). Sinopsys Editora.
Spanish: Kanter, J. W., Tsai, M., & Kohlenberg, R. J. (2021). La práctica de la psicoterapia analítico-funcional. (Ed J. Virues-Ortega) ABA Espanay.
Spanish: Kohlenberg, R. J. & Tsai, M. (2021). FAP. Psicoterapia Analítico Funcional: Creación de relaciones terapéuticas intensas y curativas. Editociones Psara

Compassion Focused Therapy Books for Therapists

Gilbert, P. & Simos, G. (Editors) (2022). Compassion Focused Therapy: Clinical Practice and Applications. Routledge.
Kolts, R.L., Bell, T., Bennett-Levy, J., Irons, C. (2018) Experiencing Compassion Focused Therapy from the Inside Out.
Kolts, R.L. (2016) CFT Made Simple - An excellent and very readable introduction to compassion-focused therapy, with a fantastic chapter showing how to use chair-work with highly self-critical clients.
Tirch, D., Schoendorff, B., Silberstein, L.R. (2014) The ACT Practitioner's Guide to the Science of Compassion - This is the first book on the market to provide an in-depth discussion of compassion in the context of ACT and other behavioral sciences. It offers case conceptualization, assessments, and direct clinical applications that integrate ACT, functional analytic psychotherapy, and compassion focused therapy to enhance your clinical practice.
Gilbert, P. (2010) Compassion-Focused Therapy: Distinctive Features - A key reference source for learning compassion-focused therapy. It's concise, filled with clinical wisdom, and a handy reference for thinking through how to work with shame and self-criticism.
Gilbert, P. (2009). The Compassionate Mind. London: Constable.

Books based on Compassion-Focused Therapy for Clients

How to Be Nice to Yourself: The Everyday Guide to Self Compassion by Laura Silberstein-Tirch (2019)
The Mindful Self-Compassion Workbook: A Proven Way to Accept Yourself, Build Inner Strength, and Thrive by Kristin Neff and Christopher Germer (2018)
Self-Compassion: The Proven Power of Being Kind to Yourself by Kristin Neff
Compassion Focused Therapy for Dummies - From the publisher: Compassion Focused Therapy For Dummies is a wonderful resource if you are seeing—or thinking about seeing—a therapist who utilizes compassion techniques, or if you would like to leverage the principles of compassion focused therapy to manage your own wellbeing.
Mindful Compassion: How the Science of Compassion Can Help You Understand Your Emotions, Live in the Present, and Connect Deeply with Others. This book by Paul Gilbert (creator of compassion-focused therapy) and Choden (a Buddhist monk) presents the principles of compassion-focused therapy in an accessible manner. A great book for people wanting to develop a kinder, more compassionate way of related to themselves and others.
The Power of Self-Compassion: Using Compassion-Focused Therapy to End Self-Criticism and Build Self-Confidence by Welford and Gilbert. This book uses tools from Compassion-Focused Therapy to guide increased self-compassion and self-confidence.
An Open-Hearted Life: Transformative Methods for Compassionate Living from a Clinical Psychologist and a Buddhist Nun is written in short chapters that make it easy to consume. Each chapter can be read in one sitting, each has a brief exercise to put to use the concepts therein, and each covers one topic that is important to living a more compassionate life.
The Compassionate Mind Guide to Overcoming Anxiety - This book is written primarily from the perspective of compassion-focused therapy, but also integrates techniques from acceptance and commitment therapy. This might be a particularly relevant book for people who are both anxious and highly self-critical.
The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions. By C.K. Germer
The Compassionate-Mind Guide to Managing Your Anger – A book based on compassion-focused therapy on how to bring compassion to the pain of anger and feeling threatened.
The Compassionate-Mind Guide to Recovering from Trauma and PTSD - A book based on compassion-focused therapy on how to bring compassion to people who have survived trauma and abuse.
The Compassionate-Mind Guide to Ending Overeating - A book based on compassion-focused therapy for people who binge or suffer from disordered eating.
The Compassionate-Mind Guide to Building Social Confidence - A book based on compassion-focused therapy for people who are shy or suffer from social anxiety.

Mindfulness and other Third Generation Books

Jonathan Feiner (2020). Mindfulness: A Jewish Approach. Mosaica Press.
Christopher Germer, Ronald D. Siegel, and Paul R. Fulton, Editors (2016) Mindfulness and Psychotherapy, Second Edition.
Ann F. Haynos, Evan Forman, Meghan Butryn, and Jason Lillis, Editors (2016) Mindfulness and Acceptance for Treating Eating Disorders and Weight Concerns: Evidence-Based Interventions
Matthew D. Skinta and Aisling Curtin (2016) Mindfulness and Acceptance for Gender and Sexual Minorities: A Clinician's Guide to Fostering Compassion, Connection, and Equality Using Contextual Strategies
Dennis Tirch, Laura R. Silberstein-Tirch, Russell L. Kolts (2015) Buddhist Psychology and Cognitive-Behavioral Therapy: A Clinician's Guide
Paul Gilbert and Choden. (2014). Mindful Compassion: How the Science of Compassion Can Help You Understand Your Emotions, Live in the Present, and Connect Deeply with Others.
Matthew S. Boone, Editor (2014) Mindfulness and Acceptance in Social Work: Evidence-Based Interventions and Emerging Applications
Jason M. Stewart, Editor (2014) Mindfulness, Acceptance, and the Psychodynamic Evolution: Bringing Values into Treatment Planning and Enhancing Psychodynamic Work
Jacqueline Pistorello, Editor (2013) Mindfulness and Acceptance for Counseling College Students: Theory and Practical Applications for Intervention, Prevention, and Outreach
Todd B. Kashdan and Joseph Ciarrochi, Editors (2013) Mindfulness, Acceptance, and Positive Psychology: The Seven Foundations of Well-Being
Steven C. Hayes and Michael Levin, Editors (2012) Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions
Lance McCracken (2011) Mindfulness and Acceptance in Behavioral Medicine: Current Theory and Practice
Steven C. Hayes, Victoria M. Follette, and Marsha M. Linehan, Editors (2011) Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition
Richard W. Sears, Dennis D. Tirch, Robert B. Denton (2011) Mindfulness in Clinical Practice
Lizabeth Roemer and Susan M. Orsillo (2010) Mindfulness- and Acceptance-Based Behavioral Therapies in Practice (Guides to Individualized Evidence-Based Treatment)
Ruth Baer, Editor (2010) Assessing Mindfulness and Acceptance Processes in Clients: Illuminating the Theory and Practice of Change
Kelly G. Wilson PhD and Troy DuFrene (2009) Mindfulness for Two: An Acceptance and Commitment Therapy Approach to Mindfulness in Psychotherapy
Kashdan, T. (2009). Curious? Discover the missing ingredient to a fulfilling life. New York, NY: Harper Collins.
Flowers, S.H. (2009). The Mindful Path Through Shyness: How Mindfulness and Compassion Can Free You From Social Anxiety, Fear, and Avoidance. Oakland, CA: New Harbinger.
Vieten, C. (2009). Mindful Motherhood: Practical Tools for Staying Sane During Pregnancy and Your Child’s First Year. Oakland, CA: New Harbinger.
Greco, L., & Hayes, S. C. (Eds.). (2008). Acceptance and mindfulness treatments for children and adolescents: A practitioner's guide. Oakland, CA: New Harbinger. Shows how the work in acceptance and mindfulness is impacting the treatment of children and adolescents. Several ACT chapters; also includes DBT, MBCT, MBSR etc
Baer, R. A. (Ed.). (2005). Mindfulness-based treatment approaches: Clinician's guide to evidence base and applications. New York: Academic Press. This book discusses the conceptual foundation, implementation, and evidence base for the four best-researched mindfulness treatments: mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT). All chapters were written by researchers with extensive clinical experience. Each chapter includes the conceptual rationale for using a mindfulness-based treatment and a review of the relevant evidence base.
Orsillo, S. M., & Roemer, L. (Eds). (2005). Acceptance and mindfulness-based approaches to anxiety: New directions in conceptualization and treatment. New York: Kluwer Academic/Plenum. Includes conceptual and practical applications of ACT and other third-wave therapies to the anxiety disorders, with chapters covering ACT, DBT skills, and MBSR, as well as specific anxiety disorders, anxiety in children and basic research in anxiety and acceptance.
Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.). (2004). Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition. New York: Guilford Press. Meet most of the major approaches in the third wave. Shows that ACT is not alone. Lots of good ideas for expanding your clinical work inside a third wave model. More theoretical though than immediately practical.
Dougher, M. J. (Ed.). (2000). Clinical Behavior Analysis. Oakland, CA: Context Press/NewHarbinger. Situates ACT, Behavioral Activation, and other approaches in clinical behavior analysis. That is the tradition where this work comes from.
Hayes, S. C., Jacobson, N. S., Follette, V. M., & Dougher, M. J. (Eds.). (1994). Acceptance and change: Content and context in psychotherapy. Oakland, CA: Context Press/New Harbinger. The first comprehensive third wave book. It carved out the domain we are now busy filling. Still relevant, despite its age.

admin May 11, 2009 - 8:56pm

Books (Archives)

Books (Archives) Community March 1, 2024 - 1:38pm

ACT Study Group for Beginners

How This Came About

In February 2004 several beginners, interested but little experienced with ACT, found themselves on the ACT listserve. The idea arose for launching an on-line study group for beginners. Very soon 30 or more folks signed in, and the “ACT study group for beginners” was born.

Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.

We began reading the book chapter by chapter, and discussing it on the listserve. The first, theoretical part was tough. Kate Partridge raised the idea of starting each discussion with a summary of a section of the book. The summarizing began on 04/13/04, when we reached the clinical part of the book.

What you find below is a uncensured, uncorrected collection of the summaries. They’re meant for discussion, not for teaching purposes per se, but we are allowing them to become part of this website simply because we hope they might be useful to other beginners. People from 7 countries did parts of it: Australia, Belgium, Canada, Netherlands, Spain, United Kingdom, and the USA. (More countries participated in the discussion: Germany, Israel, Sweden, …) It was fun to participate, and very inspiring, … but sometimes hard too: we chose a fixed schedule of weekly reading, discussing, and sometimes summarizing … but we were willing and committed.

Part of the value in doing this probably cannot be achieved just by reading these products. This way we structured it beginners, hesitatant to take part in discussions between more experienced ACT-ors, had unique learning opportunities by taking part in the beginners’ discussion. The “masters” could watch us and interfered when helpful, which also was stimulating. I can recommend the formula to other beginners and hesitating “lurkers”. It might be worth while to start a second round. But that’s up to others. Meanwhile, here are our written products.

Thanks to all beginners who participated, and to the listserve for the opportunity!

Francis De Groot July 2, 2005 - 4:35pm

ACT Book Summary: Pages 81-86

Contributed by: Francis De Groot Part II: The clinical methods of ACT Chapters 3 to 9 present the ACT concepts and strategies. ACT = Acceptance and Commitment Therapy = Accept, Choose and Take action Goal: to move in the direction of chosen values, and accept the automatic effects of life's difficulties. Barriers: experiential avoidance & cognitive fusion Source of these barriers: verbal Act stages focus on shift from content of experience to context of experience Why?: to enable clients to pursue valued goals in life. During treatment metaphors, paradoxes, and experiential exercises are frequently used to undermine the traps of literal language and pliance. Metaphors:

are not specific & proscriptive (less pliance)
are more like pictures (more experiential)
are easily remembered

Therapeutic paradox:

not the classic therapeutic paradox to eliminate certain sympoms: e.g. "don't obey me". They rely on pliance
= inherent paradox: functional contradictions between literal and functional properties of a verbal event: e.g. "try to be spontaneous"

Experiential exercises: To help contact potentially troublesome thoughts, feelings, memories, ...

experience in a different context
allows experience to be observed & studied experientially
superior to discussing

Summary: More:

pursuing of valued goals
direct experience
acceptance of negative experiences (thoughts, feelings, memories, bodily sensations, ...)

Less:

literal language
pliance

Use of: less "literalizing" verbal modalities: metaphors, paradoxes, experiential exercises Focus on: WHAT DOES YOUR EXPERIENCE TELL YOU? This also goes for therapists? Let's go for some tracking, not for pliance!

Francis De Groot May 1, 2005 - 1:13pm

ACT Book Summary: Pages 87 - 91

Contributed by Kate Partridge Creative Hopelessness: Challenging the Normal Change Agenda [Comments in square brackets are from me. I know this summary is almost as long as the section itself, but doing it has really helped me understand it. Kate] Theoretical Focus Resistance to Change: Clients enter therapy because they have already struggled for a long time with "the problem", in many different ways (contemplation, planning, discussion, praying, reading, tapes, etc.) In spite of so much effort having been exerted, no solution to the problem has arisen. In this sense, the client is resistant to change. There are [at least] two reasons for this: 1) The client has not found the right way to fix the problem. 2) There is a fundamental flaw in the model for change, which is based on culturally sanctioned, language-based rules for solving problems. Culturally Sanctioned [Unconscious] Problem-Solving Rules:

Psychological problems = the presence of unpleasant inner experiences (feelings, thoughts, sensations, etc.). The presence of these unpleasant experiences signal that "something is wrong and must be changed".
"Healthy living" = the absence of these negative experiences.
These experiences need to be eliminated by the correction of inner deficits (e.g., lack of confidence), through the understanding or modification of their causes (e.g., overcritical parents).

The underlying metaconcept is: "The problem is one of bad content; change the content and the problem will go away." ACT Assumption [Message of Hope and Liberation]: The Change Agenda Is Not Workable: The culturally sanctioned problem solving rules are like water to fish - they are taken so much for granted that to challenge them seems nonsensical. The ACT therapist works to undermine the sense of normality surrounding these rules, by showing that efforts based on these rules can actually be the source of problems, not their solution. The therapist asks: • "Which will you believe, your 'mind' or your actual experience of the unworkability of these rules?" [Not expressed in these words, naturally.] The therapist takes apart for the client the underlying logical assumption: 1) Identify the problem: "bad" thoughts and feelings. 2) Eliminate the problem: " " " " 3) Life will then improve. By drawing out multiple examples from the client's own history, the client can become experientially connected to what is often a long series of unsuccessful attempts to use this strategy. This can be quite painful. The therapist aims to organize most of the client's solutions into a general class of events that can be described as: "Control of private experience = Successful living." The client is (gently) encouraged to confront the reality of their multiple experiences of the unworkability of this assumption. This leaves the client often not knowing what to do next, in a state of "creative hopelessness". The state is "creative" because entirely new strategies can be developed with being overwhelmed by the old and previously unconscious rule system. Clinical Focus In this phase of ACT, the therapist focuses on the following issues:

Client has tried everything, but the problem remains.
The problem is not one of motivation, nor of specific tactics. The client is not to blame for being stuck.
There is a paradox here: Working hard to solve the problem makes the problem seem worse. The solution is part of the problem. [I need some concrete examples here of how the solution makes things worse - KAP]
The logic of the problem-solving system is flawed. A more valid and reliable source of problem-solving is the client's own direct experience and their feedback from life.

TABLE 4.1: ACT Goals, Strategies, and Interventions Regarding Creative Hopelessness. [There is no point in summarizing this useful table. It is on Page 91]. Informed Consent ACT interventions can be intense, and the client must be prepared for this by being provided with:

general descriptions of operating principles [How general?]
frank discussion of areas of ambiguity [What does this mean?]
alternative forms of therapy that could be followed instead of ACT

Treatment involves the client in having to face previously avoided experiences. When this occurs, the client can start to question his/her commitment to treatment. Therefore, the client should be committed to meeting for a certain number of sessions, to expect ups and downs, and to hang in until a progress review occurs at a specified session. In this way, the client is guided away from impulsively dropping out of treatment.

Eric Fox May 1, 2005 - 1:18pm

ACT Book Summary: Pages 92 - 98

Drawing out the system-developing the idea with the client that the process of trying to solve the problem-verbalized as actions taken by the mind or as "language", creates a logical trap that if directly described presents its own paradox of being linear, literal and analytical-the very process we are attempting to discredit. A less direct approach: What do you want? Outcome goals: Love others, have children, be content...Process goals: A technique (I think) that leads to outcomes. Example-Outcome goal: living well, Process goal: changing bad feelings. Linking these two by a technique such as drinking is an unworkable system. I'm confused about this. "Process" seems dynamic while "Outcome" seems static. Aren't "drinking" and "changing bad feelings" both processes? In other words, isn't "changing bad feelings" a strategy while drinking is a tactic (subset)? Anyway then-What has the client tried? This is where you identify with the client and follow along with his historic plan of solving his problems, clarifying with examples the process of attempts, and agreeing on their relative success of lack thereof(there should be lack thereof or the person wouldn't be here, right?). How has it worked? Using the "mind" metaphor to reify the process of producing inflexible and unworkable verbal rules that persist as technique in spite of experiential feedback that they aren't working. Also pointing out the false solution of "trying harder" when confronted with this reality. This (1) focuses on verbal understanding and (2) helps client look at mental reactions rather than through them. The essence of this section is creating the dichotomy of what your mind tells you versus what experience is telling you.

Eric Fox May 2, 2005 - 10:53pm

ACT Book Summary: Pages 98 - 105

Confronting the System: Creative Hopelessness (this is a little long, but wanted to make sure I covered everthing adequately)

Begins by noting that engendering creative hopelessness is the first ACT intervention (following thorough assessment of the client's 'presenting problem', change agenda, and strategies that have been tried to resolve it.
Also notes (or warns) that doing this inevitably involves the use of human language, which is part of the trap the client is in anyway - the conundrum of attempting to side- step the trap of language, but needing to use language to deliver interventions. The therapist is thus just as susceptible as the client to the trap of literal language, and must be careful about too strongly believing or becoming fixed on the logic of words.
This highlights the equality of therapist and client, with the therapist's only advantage that of having an outside perspective (the client would also have this advantage were the therapist's problems the topic of discussion).
The therapist confronts the system by working outside it, using language only to meet certain ends, not to change beliefs or model more "rational" beliefs and thoughts. If those ends are not met, then the words are not true, no matter how logical. So this takes us from the typical reliance on logic to relying on workability - this become our metric. The question for both clients and therapists is "does that work for you?".

Workability and Creative Hopelessness

In the beginning of this section, the authors provide a caveat that it is written with severely affected clients in mind (although the tools are still useful in less severe circumstances).
The work starts with confrontation, although of a different sort than typically thought. The confrontation is between the client's change agenda and the client's experience of the workability of that system. The message of the therapist and client being in the same boat as far as confronting this system (i.e. the therapist is not some expert who has all the answers) can be powerfully conveyed by the therapist sitting next to the client, with the system imagined as out in front, being confronted by both people together.
The therapist is armed at this point with information related to strategies the client has tried in the past that haven't worked.
Unworkability is gently suggested - the therapist highlights how hard the client has been thinking and working at the change agenda, and that consulting a therapist is another attempt to find a solution. Another powerful intervention here is to highlight that usually when we work this hard, things get accomplished, but that this situation seems different. All this effort has not resolved the issue.(this is a subtle way to highlight the role of the client's experience)
This moves into a discussion of the notion that perhaps looking for solutions is part of the problem. That the client is stuck, and it's not because they are not clever enough to figure it out or are not trying. Perhaps it is because it can't work. The authors suggest that a way to make this more tangible to the client is to suggest that the client doesn't actually believe there is a solution - that anything offered by the therapist would likely just be refuted by the client based on the client' s experience that it would not work. So here, the idea that experience and mind tell the client different things, and that experience is more accurate is brought to the discussion.
The authors break from the therapeutic dialogue here to discuss the importance of framing creative hopelessness as a positive thing. Being careful not to suggest that the client is hopeless or to engender hopeless feelings. But rather to introduce this idea as a starting point for giving up unworkable strategies and opening up for new possibilities to emerge.
Several metaphors are provided, including the Man in the Hole metaphor, p. 101, to side-step the trap of language. This metaphor is flexible and can be used to address many issues a client might raise, such as:
- giving up
- belief in the need to delve into the past
- responsibility
- blame
- continuing to look for solutions - this one actually seems really important and I think best highlights the goals of this part of therapy. The therapist really seems to stay away from promising solutions, but takes on a role of saying "I don't know". The goal at this point is batter down the tendency toward sense-making and to stay with the importance of the client giving up unworkable strategies, even without any promise of what will come next. This is a leap of faith and should be noted as such, since clients (like the rest of us) are definitely not used to not trying to make sense of things when there are problems in our lives.
- illustrating the opportunity suffering presents for us to learn to disentangle ourselves from our own minds.
The goal of this dialogue and the highlighting of what experience tells us, then, is to break apart the control-private-events-to-control-life-quality believe system. It is also to make contact with the client's knowledge of how the world works (rather than systems of logical language and rules that govern behavior). The authors highlight the importance of being mindful of this goal through this discussion.

Eric Fox May 2, 2005 - 10:54pm

ACT Book Summary: Pages 105 - 110

Chinese Handcuffs Metaphor illustrates that sometimes the counterintuitive solution is the one that works. Brief; can be used to reinforce the message of the more extended Man in the Hole metaphor or to introduce the therapy as part of an informed consent procedure. Understanding: Belief versus Experiential Wisdom Expressions of belief or disbelief on the part of the client are irrelevant and probably signify that the old control agenda is trying to claim any new territory opened up by metaphorical talk. The dimension of belief and disbelief is toward the nonexperiencing, derived stimulus functions end of the experiencing-nonexperiencing continuum. This includes the therapist's beliefs as well as the client's. Persuasion is not an ACT move; consulting one's experience is. Confusing No Hope with Creative Hopelessness 2 possible errors: confusing creative hopelessness with hopelessness as a negative feeling state or with hopelessness as a belief. Creative hopelessness is an action or a behavioral posture that results from experiencing the uselessness of deliberate control over unwanted thoughts and feelings, because this control cannot deliver the promised rewards. The over expansive track that maintains the control agenda is undermined. This prepares the way for a fundamentally new approach. However, talking about hopelessness is a sign of persuasion efforts on the part of the therapist. Hopelessness the feeling is often used as a move to coerce someone (God, a spouse, the therapist, oneself) to rescue the client from despair. Hopelessness the belief tends to be over expansive, in the sense that the person sees him or her self or life or situation as hopeless, rather than the more circumscribed control agenda. Barriers to Giving Up the Unworkable System It can be hard for clients to give up unworkable control strategies because previously avoided material quickly shows up in consciousness and there's no clear alternative. Metaphors that can be useful here include: Feedback Screech Metaphor, which illustrates how control moves amplify the inherent discomfort in living and make "tiptoeing around the stage" seem like a good solution; and Sports and Activities Metaphors, in which practice makes better, you have to "step up to the plate" or "get in the water," and overthinking interferes with the process. Letting Go of the Struggle as an Alternative Tug of War with a Monster Metaphor illustrates that letting go of the struggle with unwanted private experiences can be a more workable strategy than trying to win the struggle. Clients may want to know how to "let go of the rope" and describing the process would be a bit like describing how to swim or hit a baseball or drive a car: better learned by experience.

Eric Fox May 2, 2005 - 10:58pm

ACT Book Summary: Pages 110 - 114

The chapter on creative hopelessness ends with a few therapeutic do's and dont's. I took the freedom to add some do's and don'ts from the list and one of my own 1. Am I hurting or helping the client seems to be a question that's often asked in workshops. Kelly Wilson suggests on this list (April 15th) that this is about the therapists' own experiential avoidance when sitting with the patients' pain. Empirical findings show that you don't have to be afraid that your patients will quit therapy, get deeply depressed or even kill themselves when they discover the futility of their struggle. In other words the message is essentially a hopeful one, and patients may feel relieved. CR may be the first step towards an increase of degrees of freedom of the patients' respondent behavior. 2. I suggest that as a therapist you have to face your own creative hopelessness in order to be able to sit with the patient when he or she is testing his rule sytem against experience. 3. Don't expect anything to change (yet), because any change can be linked to the intentional change agenda, and so become just another avoidance strategy. This is paradoxical. As I try to grasp it right now, experiential avoidance seems to be an escape reaction triggered (or conditioned) by a certain class of stimuli (Sd, like for instance the possibility of being criticized), and thus it's under antecedent control (see also Kelly Wilson's note on this). Each time I face this type of situation I feel stressed or aroused (CER), want to escape or avoid by procrastination, let's say (CAR). This is reinforced by nicely elaborated verbal rules (COV)(and each time I think I'm right is a reinforcement, a +S+). Moreover, i feel relieved in the short run because the criticism is avoided (-S-). If I try to change this chain of behavior without loosening the conditioned response, I may just get entangled in a more complex conditioned avoidance response. In terms of 'Mary had a little .... ' I will get even more 'lamb' connections on the dots. I guess the idea is that behavior change will result spontaneously when the link between the situation and your avoidance reactions will be weakened, for instance by an increase of awareness of the unworkability. And isn't hope just the same as finding more and new opportunities to achieve your goals? Just like the two Swedish colleagues I 'd like to try to describe these processes in behavior analytic terms, but feel very insecure about it. It seems to me very helpful in the process of understanding ACT, and also in grasping the patient's struggle. So who wants to join or help in this enterprise? 4. Give homework to help people become aware of how they struggle, and what situations trigger it. Just do self monitoring, and not behavior change (see above) 5. The book (and the discussion on the list as well) seems to suggest that there should be a fixed order in therapy with CH as the starting point. I'd like to cite Kelly Wilson (April 15th) on this: " No you absolutely don't need to do CH like it says in the book. If it needs to be done, you will end up doing it. why? Well as you pursue values, it will appear as an obstacle--then you will do defusion of hopelessness, and the emergence of what we like to call creative hopelessness." 6. A very important do was formulated yesterday by Joanne Steinwachs. I'll just cite her contribution, can't do it better, as she's also including a beautiful metaphor. "I find it useful to begin the questioning with 'beginner's mind'. Perhaps what they tried did work out, in some way for them. Of course, if they're stuck in a framework of unworkable rules, then in the larger picture, it doesn't work, but sometimes talking to people about what they do and how it works in their idiosyncratic rule system illuminates the rule system both for them and for me. If I start with the agenda of discovering unworkability, then I can miss a lot of the nuances of trappedness, both for them and for me, and I feel like I move into a place of expert rather than co-explorer. I also feel that using "discovering unworkability" as my guide, respect and curiosity are harder to maintain as my base feelings towards the client. I can't do this if I've got the agenda of discovering unworkability. I have to hold the idea that the system DOES work for the client as a possibility. Usually, in my experience, clients have worked hard and creatively, their shtick does work in some way and it's often an elegant and creative adaptation to some crazy rule. I talk to people about the pre-Copernican world, and how astronomers were trying to describe the path of the planets, starting from the wrong assumption that the earth was the center of the universe. They came up with elegant and complex theories that sometimes could predict the position of the planet. Men spent their entire lives on these theories. To let them go took enormous courage and great pain. That conversation comes after I and the client understand the complex rules that govern their "planetary movement" and we've paid tribute to the fact that the rules can in some ways predict and control their experiences." Perhaps techniques as interviewing for solutions (De Shazer) can be useful here. Progress to the next phase can be seen when clients express doubts about their system of coping and avoidance. Personal work for the clinician is building on the work on page 80. Somehow this questioning is a bit too abstract for me-as-a-client. Me-as-a-client needs a bit more encouragement and support as to what is a problem, how can I analyze it in ACT terms, what level of detail is required to gain awareness or insight. I like to be as concrete and detailed as possible, and I try to find out what exactly is is what a client did (does), thought (thinks) and felt (feels) when using his or her strategies. Underneath abstract descriptions of an apparent intelligent strategy can hide a completely invalid schema (can I use such a term here?).

Eric Fox May 2, 2005 - 11:01pm

ACT Book Summary: Pages 115 - 118

Control Is the Problem In ACT, attempts at controlling private events are thought of as part of the system that have brought the client into therapy. Four factors are identified that most clients bring into therapy (and, that have been wrestled with at various times in this forum):

"Deliberate control works well for me in the external world."
"I was taught it should work with personal experiences (e.g., 'Don't be afraid...')."
"It seems to work for other people around me (e.g., 'Daddy never seemed scared...')."
"It even appears to work with certain experiences I've struggled with (e.g., relaxation works for a while to reduce my anxiety symptoms)." It is emphasized that the examination of control strategies is based entirely on the clients experience, with workability as the unit of analysis, and that the therapist needs to be extremely careful not to dictate or demand that the client evaluate their control strategies as unworkable. Therapist techniques that are mentioned include using metaphors and experiential exercises to help the client develop increasing sensitivity to directly experienced contingencies. Also, the authors mention that asking questions rather than stating conclusions can be helpful in reducing pliance on the part of the client.

Eric Fox May 2, 2005 - 11:03pm

ACT Book Summary: Pages 119 - 125

Giving the struggle a name - control is the problem Continuing to explore unworkable strategies (i.e., "digging" in the man in the hole metaphor) without interpretation. The goal here is to explore the form and function (immediate goals) of client's behaviors and hold these up against the change agenda. At this point in time there is no need to do any more than just touch and clarify these behaviors and their functions. Eventually the goal is to lump these responses into a single class "emotional control" The rule of private events The key lesson here is that purposeful control works in the successful manipulation of external events but that the same strategies do not work in controlling private events as these are governed by historical and automatic factors. The rule "if bad events are removed, then bad outcomes can be avoided" is not effective with regards to private events. On pages 120-122 is a good transcript showing a therapist bringing out the paradox of control:

If I'm not willing to have it (e.g., anxiety), I have it
If I don't get so uptight about being anxious, I will be less anxious
If I am willing to have it in order to get rid of it, I am not willing to have it and I will have it again

Polygraph metaphor (page 123) is a core intervention in this stage of therapy - particularly useful for anxiety or mood disordered clients. In short the metaphor describes being hooked up to the most sensitive and accurate lie detector ever built. The task is simple, STAY RELAXED. An extra incentive is given, "stay relaxed or I’ll shoot you". Not surprisingly, any hint of anxiety would escalate ("Oh my god, I’m getting anxious.") and BAM!, it’s all over. There are three elements that can be drawn from this metaphor:

contrast between controllable behaviors (i.e., paint the wall or I will shoot you) versus behavior that is not regulated successfully by verbal rules (relax or I'll shoot you)
People carry their own polygraph with them all the time (their nervous system) and their own gun (self-esteem, self-worth). They are constantly monitoring for symptoms (e.g., anxiety) and firing the gun at themselves
How seemingly successful attempts to make situation work, don't work in the long term. For example, taking valium may help you relax initially but what about when it wears off?

Chocolate cake exercise (124) - particularly effective with clients struggling with obsessive thoughts or ruminations In short, don't think about delicious warm chocolate cake with icing and cream! (yum) Two things here:

either it is particularly difficult not to think about it (me included in this group)
or attempts to not think about it (e.g., "I thought about something else") actually require you to think about chocolate cake (you have to know what you are not thinking about)

Similar idea can be applied to physical reactions (e.g., salivation) "The key lesson here is for the client to make direct contact with the ineffectiveness of conscious purposeful control in these domains" (my own personal comments: I really like these ideas, and regularly use similar concepts no matter what therapeutic style I am incorporating. I think a lot of these ideas have filtered into the CBT framework, whereby automatic thoughts are treated more as uncontrollable private events and B (behavior change) is emphasized. The only trouble I have with some of this stuff is picking those clients that respond well to discussing these kinds of issues. This is totally my personal opinion, but I think many therapies suffer from some kind of intellectual bias, that is, techniques developed by well-educated, trained minds. I have trouble breaking down psych concepts to layman concepts. This is not a big issue at this stage, because the use of metaphors breaks down that barrier, but when it comes later to exploring the traps of language, I think this is so.

Eric Fox May 2, 2005 - 11:06pm

ACT Book Summary: Pages 125 - 132

How Emotional Control Is Learned At this point in therapy, the client is coming to the realization that "control doesn't work". In the recovery business this is the same as "taking" the first step (12 step approach) where the client comes to the realization that they are "powerless." This can be a frightening step. As the book points out, the "thought that repeatedly applying a seemingly unworkable strategy proves there is something wrong with the client 'deep down inside.'" and this can be quite troubling. Again, in recovery we would say, that this is like "doing the same thing and expecting a different result." It is like the guy that thought he had figured out how to fly with a wing like contraption attached to his arms. He got up on his roof and ran straight off the end and flapped his arms like crazy. But, as you would expect, he landed with a thud and broke several bones in his body. After healing he thought, well I don't think I jumped high enough, or flapped my arms fast enough. That's what I have to do, jump higher and flap faster. I don't think I need to tell you what happened. Getting back to my assignment, at this point it would be easy for the client to blame them self for the predicament that they have gotten themselves into, however, as the book points out, all of the conditioning that got them here is actually very random. The trick now is how do we "come to believe"(step 2) this. The book suggests, "Experiential exercises are particularly useful for demonstrating how easy it is to condition a irrelevant and nonfunctional private response." The "'What Are The Numbers?" exercise is a good intervention at this point. In this exercise the book demonstrates the arbitrariness of reactions, thus hopefully helping the client see that ""I'm bad" is no more meaningful than "one, two, three."" The therapist would than help the client move into examining the apparent success of a control agenda. Which brings us to, Examine The Apparent Success Of Control At this point it is suggested that we help the client explore the "cost of using this change agenda in the wrong places." The therapist is helping the client "establish discrimination." Which always makes me think of the serenity prayer, God grant me the serenity to accept the thing I can not change (or control), the courage (or willingness) to change (or control) the things I can, and the wisdom to know the difference ("establish discrimination"). I see this step as helping the client become more aware of when this control (change) agenda works and when it doesn't. The book gives a good dialogue of walking a client through this process. But as the client begins to get a sense of the unworkability of this control agenda, they can feel naked and vulnerable to the world, and desperately looking for someway to cover up. At this point all we want to do is help the client recognize what thoughts and feelings are showing up. This is not an easy task. The therapist needs to continually undermine the clients need to avoid the distressing thoughts and feelings and to help the client become more "willing" to experience these things in the here and now. All of this leads the client to "the alternative to control: willingness" which is next weeks homework. However, it brings me back to the serenity prayer, and how I see willingness (or courage), "to change the things that I can."

Eric Fox May 2, 2005 - 11:11pm

ACT Book Summary: Pages 132 - 135

The Alternative to Control and the Two Scales Metaphor The objective here is to point to an alternative to the control agenda. Use willingness instead of acceptance-because it is often confused with resignation or tolerance/defeat. Two Scales Metaphor

designed to look at concept of control and its relationship to distress
Should be linked to clients' experience of their own futile effort to control distress, can link it to more mundane or less meaningful examples for the client (for example, trying to sleep during a bout of insomnia. The harder you try to fall asleep the less sleep you get. In supervision, we often use the Chinese finger trap example-the harder you try to get out of it, the less out of it you are- you get stuck.)
Want to undermine the client's confidence in the control strategy and depathologize the struggle over control
Not crazy, just using the wrong strategy

Metaphor Two scales--anxiety (or whatever fits for the client here) and willingness. Willingness has been low, anxiety has been high. Client came in with the goal of getting anxiety to be low. But what if there's this other scale that we haven't been using, haven't even seen, called willingness. Make a promise about what will happen if willingness is set high-anxiety will be low except when it is high and then it will be high. If you move willingness up, then anxiety is free to move around. Seems like the goal here is not describing acceptance or distinguishing acceptance/resignation, but merely providing an alternative to their endless, futile struggle Can distinguish between mind/experience here. Mind tells you that if you demand anxiety to go down, then it will. However, experience says that this doesn't work "Suppose life is giving you this choice: You can choose to try to control what you feel and lose control over your life, or let go of control over discomfort and get control over your life" (p.135) Willingness is one thing that only you have control over. I can influence you feeling anxiety for example, but I cannot control how willing you are to have that anxiety. Comment: This was a perfect reading for me this week! I recently used ACT in my abnormal psychology class in the service of changing the stigma of the mentally ill and making a difference in my students' lives. I provided an alternative to their control agenda, but I spent a lot of time distinguishing between acceptance and resignation. I had one student in particular who would not "accept" the thing he hated most about himself (which was what I used in exposure and defusion exercises) because he refused to "just get over it and move on". I like using willingness instead of acceptance because it frames the whole concept in a different way. There's no question about what willingness is, acceptance can have different connotations. Another thing: When first reading this section, I thought "how can you describe willingness", "willingness to what...?" I think that my class would have benefited from my using the willingness to experience as opposed to acceptance. This seems much clearer to me.

Eric Fox May 2, 2005 - 11:12pm

ACT Book Summary: Pages 136 - 141

The Cost of Unwillingness CLEAN DISCOMFORT: discomfort that comes and goes as a result of just living your life (= primary discomfort?) ------------- cannot be controlled DIRTY DISCOMFORT: emotional discomfort & disturbing thoughts created by efforts to control feelings = discomfort over discomfort (= secondary discomfort?) ------------- disappears when willingness is high and control is low ---------------> clean discomfort stays when dirty discomfort disappears Box full of stuff metaphor: p. 136. Shows the additive nature of history; nothing is subtracted! You can only add to life. You can fill it up with things you want to avoid until you can't move anymore. Various reactions are put into the box = deliteralizing: treated as objects, dispassionate observation of reactions. WATCH OUT! Client's worldview can be put upside down! Clients can insist on using old strategies. This has to be supported. DON'T START LECTURING DON'T START INTELLECTUALIZING (& do all the talking; it's no question of trying to convince) DON'T START EXPLAINING & DISCUSSING CONTROL STRATEGIES (this keeps you within the existing language paradigm) DON'T FEEL PRESSURED TO MOVE INTO SUBSEQUENT STAGES with multiproblem clients (they need more time) DO ENCOURAGE CLIENTS TO NOTICE THE COMING AND GOING OF DISTRESS (when they cling to control strategies) DO STAY ON THE EXPERIENTIAL TRACK DO STAY WITH THE CLIENT's EXPERIENCE OF THE WORKABILITY OF CONTROL STRATEGIES Clients may be ready for the next stage when:

willingness is appearing spontaneously in situations that used to elicit control
clients report spontaneous examples of feeling feelings differently

Eric Fox May 2, 2005 - 11:15pm

ACT Book Summary: Pages 141 - 147

Chapter 5 finishes with:

personal work for the clinician
a clinical vignette
appendices containing daily experiences diary, identifying programming exercise, feeling good exercise, rules of the game exercise and clean versus dirty discomfort diary. I'll deal with each of these in turn:

Personal work for the clinician Having identified a problem in your own life, explore the strategies that you have used or are currently using to solve this problem a) consider each strategy and designate it as either an acceptance or control strategy b) examine the distribution of control and acceptance strategies. Is there a trend? c) For each control strategy, identify what it was that you hoped (hope) to control, avoid, manipulate, change or eliminate Clinical Vignette The clinical vignette describes a 45yo male with severe anxiety attacks at work and more recently at home. There is stress at work (high stress job), a recent move and relationship difficulties. The client uses deep breathing, distraction, hypervigilance to physical symptoms, avoidance of work and tranquilizers to cope with the anxiety. The question(s) for clinicians are: a) how would you conceptualize the client's major coping strategies and assumed goals? b) How would you discuss these solutions with the client? c) What would your goal(s) be in doing so The answers are as follows: a) strategies are primarily to reduce or control anxiety and appear not to work (long term) b) is anxiety serving another function? Are there areas in your life that you legitimately have reason to be anxious about c) Goal is to separate clean versus dirty anxiety (legitimate stressors versus the struggle, fusion) Appendices Daily experiences diary Client records uncomfortable moments, including feelings, thoughts and bodily sensations as well as efforts to handle these things Client and therapist can explore the use of acceptance versus control strategies. Therapist can reinforce strategies that reflect acceptance. Willingness diary Client provides a global rating for each day (e.g., emotion rating from 1-10). Client records the amount of effort put in to getting this to go away (rating 1-10) Client records how workable the day was (rating 1-10) Client and therapist explore the relationships between the struggle to controland the workability of the day. Identifying programming exercise Clients are encouraged to explore how a significant childhood event (or events) shaped or programmed who they are now to demonstrate how dysfunctional coping strategies are passed on. This is to demonstrate the arbitrary nature of learning events. Feeling good exercise Clients fill out a questionnaire tapping into a number of specific language rules that act as self-instructions (e.g., "the way to be healthy is to learn better and better ways to control and eliminate negative emotions") Rules of the game exercise Clients are asked to generate their favorite life sayings (e.g., no pain, no gain). Client and therapist can then explore sayings with reference to acceptance versus control strategies or on the basis of a number of other dimensions (e.g., black/white thinking, severity of consequence, good versus bad) Clean versus Dirty discomfort diary Client is encouraged to explore particular "high risk" situations in terms of clean discomfort (what immediately showed up in the way of thoughts, feelings etc) versus dirty discomfort (what emerged as a result of the struggle with these initial feelings)

Eric Fox May 2, 2005 - 11:17pm

ACT Book Summary: Pages 148 - 154

Building Acceptance by Defusing Language

Here are some nuts and bolts followed by questions and critiques:

1. The distinction between process and content: language is a learned set of derived stimulus relations, while languaging is the action of deriving those relations.

2. Humans (therapists, clients, etc.) often don't make this distinction and often relate on (and become connected to) the content level. Taking these contents at "face value" (i.e., literally, tangibly) in turn, leads to powerful and predictable behavior patterns (that are often destructive) on the part of the client.

3. One of the main paradoxes in ACT is that language cannot be weakened by more language; however the essence of deliteralization is to take advantage of loopholes in the way language functions (by teaching the client to see that thoughts and feelings are just that-thoughts and feelings).

4. Page 152 contains a table (6.1) of ACT goals, strategies, and interventions to use regarding deliteralization.

5. One of the ways to begin addressing the paradox and function of language is to demonstrate to the client the limits of language in deciphering human experience (and to elicit their own examples). For example, there are two metaphors (found on page 153) that communicate how describing something is different from experiencing it. One metaphor is "finding a place to sit," which essentially describes how talking about a chair (its features, uses) does not help when one wants to actually sit down. In other words, one cannot "sit" in a description of a chair. One can only sit IN an actual chair. A corollary of this metaphor is that one can describe the experience of swimming (how the water feels moving through it, its temperature, etc.). However, one cannot learn to swim in or by a description.

6. There is an assumption in ACT that "your mind is not your friend." Extrapolating from pre-human experience, one can see that the (human) mind was not developed to make humans or "prehumans" feel good. It was developed to keep humans from danger and was mostly comprised of negative content. Explain to clients the paradox "your mind is not your friend AND you cannot live without it."

7. Another assumption is that language is arbitrary and that once it is learned, it becomes relatively independent of immediate environmental support. This reminds me of my nanny's (successful) efforts to train my 20 month-old son to say "bling-bling" when he sees jewelry-now without her having to label it.

8. There is a provocative quote related to the usefulness of nonverbal (experiential?) knowledge at the end of this section on page 154: "If we suddenly had all nonverbal knowledge removed from our repertoires-we would fall to the floor quite helpless."

Comments/questions:

9. It has been my experience that, while clients appear "fused" to a lot of different ideas/contents, a great share of them come to my office without having specific terms/language to describe their experience. In fact they come ONLY with experience, which they have a difficult time describing in words. For example, an extremely anxious patient I had (with Posttraumatic Stress Disorder) wouldn't ever label himself as "anxious," rather he just knows he feels bad.

10. I don't know if behavior patterns follow from the premise that one does not make a distinction between the process of thinking and actual thought, and becomes fused with actual thought content, thereby leading directly to ingrained behavior patterns. I suppose one could explain this as troublesome behavior patterns becoming automatic due to conditioning (i.e., not being aware of the interaction pattern itself); however, I'm not sure if this is because one is fused to a verbal event.

11. Have any of these hypotheses been evaluated using individuals with various types of brain injuries (resulting in apraxia, aphasia, acquired deficits in language versus acquired deficits in motor ability, etc.)?

Eric Fox May 2, 2005 - 11:21pm

ACT Book Summary: Pages 154 - 158

Deliteralizing Language Several exercises are described to help people improve their skill of looking at the process of language instead of looking from language.

Thoughts are used to structure our perception of the world. We don't even notice that we look at the world from our thoughts, because we believe them in literal way. To look at the process of language involves focusing attention on language as language, cryptic as this may sound. A bit of defusion from literal 'understanding' can be achieved by watching the direct stimulus functions of language like sound, the feeling of your muscles, the sight, etc.
An elegant way to watch your attention switch from the symbolic function of a word to some of its direct stimulus functions is by repeating a word over and over again for one or two minutes. This is the classic milk, milk, milk exercise (Titchener, 1916). Present it as an experiment or experiential exercise and help the client notice how the literal meaning of the word disappears and one can see the word as an instant of the language process.
I like the notion of skill learning here. Deliteralization is a skill you can practice, it's not another rule to follow. One can play with direct stimulus properties and thereby loosen the 'grand illusion of language' by realizing that the symbolized thing is not there at all. The only thing that's there is sound, movement, breathing and so on. And this is not a fact, but a skill, something you do.

Another skill that helps to defuse from nasty or frightening thoughts is practiced in the passengers on the bus exercise. In this exercise the relation between a person and his or her thoughts (or avoided inner experiences) is reframed. These are the elements of the metaphor:

You, the driver of the bus. You want to go places and do your job.
The passengers are your thoughts and all kinds of inner states. Some are nice, some ugly, scary, nasty.
The scary ones threat you and want to come up front where you'll see them.
You take this very serious and stop the bus (you don't go anywhere anymore) and try to make a deal with them: they'll keep quiet in the back of the bus, only when you do exactly what they tell you.
This means your route plan is greatly impaired and you're always on the watch inside the bus.
What happens is that you let these passengers control the whereabouts of the bus. You, the driver, are not in control at all.
Even though these passengers look scary, nasty, threatening etc. they can't take control (unless you let them). They can't make you do something against your will.

Eric Fox May 4, 2005 - 5:31pm

ACT Book Summary: Pages 158 - 168

Summary: We are in Chapter 6, Building Acceptance by Defusing Language. Page 158 begins the section titled "Don't Buy Thoughts". The subject is the deliterization of language. The explanations, exercises and metaphors are designed to enable the client to become aware of and "assume" self as perspective and to focus that perspective on thoughts and feelings themselves as they are experienced. Comment: The ease or difficulty of this and degree of success may vary greatly from person to person, but those who find it most difficult may also reap the greatest benefits. The shift to looking at literal meaning from looking through literal meaning is subtle. "Having a thought" may be distinguished from "buying a thought" or "buying in". A common example is the shift from "I am a bad person" to "I am having the thought that I am a bad person". The idea is to expose the process of thinking often hidden behind the content of thinking. Mindfulness exercises include Zen-like meditation, Soldiers in the Parade Exercise, Leaves in the Stream Exercise, Contents on the Card Exercise, and Taking Your Mind for a Walk Exercise. The client/therapist dialogue (pgs. 159-161) illustrates a therapy situation using the Soldiers in the Parade. Note how you have to get the client to try this and then give you feedback as to what they are experiencing. The client is specifically reminded that thoughts like "This isn't working" or "I can't do this" should be placed on the soldiers' placards (along with "This therapist must be one of those nutty Gestalt guys I've heard about."). The therapist sort of anthropomorphizes the mind and speaks of it trying to "hook" the client on literal meaning. He also points out how the parade stops when the client "buys" or is "hooked" by a thought. I additionally had the thought in this section that while "Contents on Cards" and "Taking Your Mind for A Walk" may seem gamey or contrived, these might be necessary and effective with certain clients who experience very emotional fusions such as cluster B type folks(or the more politically correct "multi problem client"). Undermining Reasons as Causes A troublesome class of thoughts, reasons tend to disguise themselves as deterministic statements with a cause-effect function which they really may not have. Reasons often actually function as language community justifications. Personal history is often cited as a reason things can't change. This has always been a real pain for psychodynamic therapists (I speak from personal experience). Statements focusing on functional utility rather than literal truth are suggested as helpers, such as, "And what is this story in the service of"(Ouch! They may get angry!), "If God told you that your explanation is 100% correct, how would this help you?", etc. Another dialogue (pgs. 164-166) illustrates how reasons may be deliteralized to the clients' advantage without loosing their true function. An additional "tips" section is Disrupting Troublesome Language Practices (pgs. 166-168). A discussion of the etymology of the word "but", for example, reveals how it can be a psychologically limiting verbal behavior that may be changed to "and". "I want to go, but I am angry" could be "I want to go and I am angry" leading to behavior which may not be controlled by the language conceptualization of it. The "And/Be Out Convention" inset describes how this might be communicated to a client. I had the thought that this requires some careful listening to insert this timely intervention when it can be most useful to the client. I will only comment that this is an extremely important section, drawn from RFT research and Zen and Gestalt traditions which are nuclear to ACT. It strikes me as needing a great deal of experience and/or training to be handy with it. I suspect that psychodynamically trained therapists, such as myself, have a harder time with it because we have to unlearn and learn at the same time.

Eric Fox May 4, 2005 - 5:34pm

ACT Book Summary: Pages 168 - 174

Evaluation versus Description Evaluations masquerade as descriptions of things and events because language makes little distinction between them. Descriptions may be thought of as primary properties of things and events while evaluations are secondary properties, reactions to things and events. The authors point out that most clients bring negative self-referential evaluative self-talk directed toward themselves ("I'm a despicable human being") to therapy that would be difficult to accept if it described the essence of a person. The Bad Cup Metaphor illustrates this principle by pointing out the difference between essential properties of a cup (such as that it is made of metal or ceramic or whatever) and our evaluations of the cup (good cup/bad cup). As an aside, my husband, who is not a therapist, really related to the question of "If all the humans on earth died tomorrow, would this still be a good (or just, or moral, etc.) ____?" as a way of identifying evaluations. A second strategy for highlighting the kind of thought or speech someone is engaged in is to have them label each thought or sentence as a description, an evaluation, a feeling, a thought, a physical sensation, a memory, etc (Cubby Holing). Although this is awkward, it can be very effective at promoting defusion with private events. Willingness: The Goal of Deliteralization The goal of deliteralization is to decrease the role of evaluation and strengthen the client's ability to take a non-judgmental, observer perspective so that they can begin to observe their own disturbing private events with less struggle and more willingness. Two exercises that give the client live experience with willingness are the Physicalizing Exercise and the Tin Can Monster Exercise. The Physicalizing Exercise has the client treat their unwanted content (depression, anxiety, addiction, etc) as an object, by describing its physical attributes (size, weight, color, density, etc). Then the client sets it aside and describes reactions to the "object" they described; they repeat the exercise with the reaction. They then go back and look at the first "object"; often it is less intense in some attributes (smaller, lighter, etc). The Tin Can Monster Exercise helps the client get in touch with their "observer you," then uses that perspective to explore several domains (physical sensations, thoughts, feelings, memories) associated with the problem area. The focus is on staying with the uncomfortable, unwanted content while letting go of the struggle to make it go away.

Eric Fox May 4, 2005 - 5:35pm

ACT Book Summary: Pages 174 - 179

Therapeutic do's and don'ts The goal of deliteralization is a hefty one. Chapter Six offers a dazzling array of ACT metaphors and exercises: confronting nasty passengers on the bus, endlessly saying milk, milk, milk, soldiers wandering around in a parade amongst the recesses of the mind, taking your mind for a walk, reasons as causes, avoid use of those 'buts," and practicing awareness of your experience, to name just a few. Deliteralization is an essential step in the ACT process, and yet its filled with perilous pitfalls for our heroic ACT therapist. First, there is the challenging task of entering the client's language system The therapist seeks to realize that it is a language system, while at the same time avoid the many opportunities presented to "fuse" with the system. This challenge occurs because we are using language to point out the dangers of language in an effort to convince a person to avoid being taken in by the power of their own words. Encouraging willingness and deliteralization by using words alone may result in an overuse of logic. Hence, words are always connected to metaphor (and hopefully experience) as a way of avoiding this pitfall. On the other hand, the use of metaphors presents another challenge in that the therapist may get totally caught up in the process of painting pictures. Telling stories and doing exercises keeps everyone awake, but the goal of willingness and deliteralization may get lost in the mix. Focusing on one metaphor per session at most (and any given metaphor may be useful for more than one session) is the best remedy. Most important, metaphors are adapted to fit a client's particular form of fusion. Context always is combined with content in the client's experience for the proper and judicious use of metaphor. Next -- How to determine when its time to get out of Dodge City and move on to the next stage of ACT? First, we know there's progress when a person does not automatically respond to every troublesome thought (or emotion) with the same overwhelming and automatic connection. They cease to automatically fuse with their language system and instead are able to "wake up" and be aware of non-workable reactions, sometimes in the very midst of the process. Second, from this evolving stance of observer to their reactions, a person demonstrates an increased capacity for a willingness to experience content that would have previously brought automatic fusion. In other words, they do not always and automatically respond with well worn methods of control and avoidance. ACT would argue that this occurs when a person ceases to fuse and there is a "weakening of social/verbal context of control." The client is able to have more difficult experiences and demonstrates a willingness to set aside moves of experiential avoidance. From this point, the clinician is then advised to observe thyself in an exercise which eventually encourages one to "release" attachment to cherished notions of self, whether they be the best of things or the worst of things that you think about who you are. How difficult is it to release our attachment to these statements about self as "literal" realities of who we are? Perhaps this will develop an empathy for the challenges faced by our clients. Then we are presented with a clinical vignette about a 31 year old man with panic attacks whose life has become constricted because he avoids situations that produce feelings of anxiety and panic. How to conceptualize this situation? What strategies are we to use here? An ACT perspective would suggest that the client is confusing content with context by treating any appearance of a dreaded symptom of anxiety and panic as a harbinger of absolute danger ahead. An effective strategy would seek to use deliteralization exercises (e.g. Milk, Milk or Tin Can Monster) that encourage the person to step back and avoid the automatic literal response (disaster is here), and instead see these experiences as experiences -- nothing more and nothing less. Can the client allow these symptoms to occur without fusing? Then these symptoms can take their "natural course" without the rollercoaster wrought by cognitive fusion. Finally, the chapter concludes with two exercises for client homework The first seeks to analyze the extent to which reason giving pervades experiences outside the session. This will hopefully make the client more aware of how they use reason giving and to see reasons as merely content to be considered as useful only when they meet the criteria of workability. The second exercise is an awareness exercise which encourages a mindfulness and acceptance of present moment experience that helps one practice being in the role of observer. A useful and life long task indeed.

Eric Fox May 4, 2005 - 5:36pm

ACT Book Summary: Pages 180 - 187

This is all open to feedback, of course, as I am never sure I have this stuff quite right. But then again, it's only a bunch of thoughts, so don't believe me anyway. Somehow this self stuff reminded me of a recent interview with Clint Eastwood (paraphrased from memory) --

Int: So, we've talked a lot about what your critics think of you and your work, what your wife and ex-wives and children think. I have to ask, what do you think about Clint Eastwood?
CE: I tend not to think about him very much.

ACT (181): In order to face one's monsters head-on, it is necessary to find a place where this is possible. I believe there is a Zen story (don't recall where I heard or read this) of a man who is alone in his house trying to eliminate all of his demon's. One after one, he faces them down, and they all disappear as he sees them for what they are -- except one. This is the largest demon of all, and as hard as the master-to-be tries, he cannot eliminate this demon. He cannot avoid the monster, he cannot talk the demon into going away, he cannot make a deal with the chimera. Finally, after he thinks he has attempted everything he could possibly do, he jumps right into the mouth of the demon, and it disappears. ACT- Three Senses of Self Conceptualized Self -- The me who I think I am Clients come into therapy, counseling, etc with varying goals regarding this self -- to defend the self, to fix the self, to find the self, to avoid the self ACT View for Success Regarding the CS -- to have the client voluntarily experience conceptual self suicide expurgate the boundaries of the self and (my thought) broaden the psychological world of the client to make room for all history and experience - to bring the clients to where they began and to see it again for the first time (I can't remember where I stole that one, either). Self as concept might make a statement like "I am a person who ....." and this statement is taken literally with many predicates, even predicates which do not work. Examples "I am a person who breathes" compared to "I am a person who is sad, happy, " This universality can cause mucho problems. (Here's a reach) If I am a person who is sad, I may not notice the times when I am happy- they don't fit my self concept. On the other hand, if I am a person who is happy, what does it mean on an afternoon - when it is cold and wet and rainy in Minnesota, and it is June, and dammit, isn't supposed to warm and sunny now - when I am sad? With this concept we, and the community around us becomes very invested in my maintaining my "image" of being a certain kind of person; or

When I am x and I and my community do much better when I am x, I am pretty invested in remaining x, because if I act as Y there are consequences
Our history has taught us to see and maintain patterns.
We have equivalency statements that may not be equivalent "I am 5'10" (maybe 9") becomes the same as "I am alcoholic."
If I try to act outside of "who I think I am," it seems almost life (or self?) threatening. Note: I wonder about this with the "guys" I work with. Many are domestic violence offenders, and even though their physicality is usually not threatened, many lash out when their sense of "self" is threatened, the "manly man syndrome." OR "Eliminate conceptualization = eliminate me."

The self can be "maintained more easily simply by distorting or reinterpreting events if they are inconsistent with our conceptualized self." I am concurrently (as my bathroom bibliotherapy) reading a book - The Tao of Zen - there is a quote there that I somehow want to fit into this chapter. You decide - " For all Chinese philosophy is essentially the study of how [people] can best be helped to live together in harmony and good order ... [There is] nothing more dangerous than that theories and doctrines which belong to the world of language should be mistaken for truths concerning the world of fact." Our conditioned responses to and with language create the prison which many people go into therapy to theoretically escape, and get there and work hard to build stronger walls. Page 183 - "To escape a prison it is first necessary to see the prison itself." Most therapy to date has been designed to paint the walls of the prison with different thoughts and/or emotions, whereas ACT's design is for the client to see the prison from both the inside and the outside. Ongoing Self Awareness While the conceptualized self is a verbal trap, it is still necessary to have an idea of who you are and how you are when you are there. Without getting attached to the content, there still has to be a verbal self knowledge of life to engage with it. In this sense, it seems it is more like a surfer riding the waves, than a swimmer battling the water, or maybe, better yet, than a non-swimmer flailing in the waves. The surfer knows the water (language, words, content) is there, but does not get caught up in the depth, the swirls and eddies that come along moment to moment. A thought is just a thought, a feeling is just a feeling. The client is encouraged to engage some of these things descriptively, rather than evaluatively - to look at a thought, rather than through it. The Observer Self The "I" is a place, a locus, a perspective. It came about and is used to differentiate my experience from the experience of others? "I" am looking at my computer screen. "You" are not. The "I" sets up the context for description. ( I think I have this right, or at least am making sense of it.) Spirit/Matter distinction which has emerged in all cultures. Spirit - a private event that cannot be experiences as a thing or object. Sense of self-as-perspective has same properties as spirit. This is important because we/I/You as context is the one place any of us can stand that is enduring. Even though we are constantly changing, we always have that sense of "being there," of seeing all that is in our life from behind these eyes. This important in the change process because there is something grounding about there being one part of us that will go through all of "this" unscathed, at least for the time we are aware of. With all of the threatening things that happen in therapy, life, etc, there is that sense of I that will remain. ( I think) In ACT, it is important that the I/you-as- context will always be there, at night, in the clouds, through sleet and hail and thunder, wherever I am, whatever happens, there I go. Page 187 - "The trick lies in teaching the client how to be aware of content, to be aware of the awareness of content, and yet not be so preoccupied with content or attached to it as a matter of personal identity ... without objectifying these events or mistaking them for" the real me. Be careful not to pay too much "attention to that little man behind the curtain."

Eric Fox May 4, 2005 - 5:37pm

ACT Book Summary: Pages 187 - 192

We're looking at the first part of the 'Clinical Focus' section of chapter 7 'Discovering Self, Defusing self'.

As will have been outlined earlier, this is an important part of ACT. The section begins with a brief outline of the core perspectives that are introduced here. Table 7.1 (p.188) provides the ACT goals, strategies and interventions regarding self.

Initially, it is helpful to 'Undermine Attachment to a Conceptualized Self'. Clients may vary in readiness to work on this area. The timeless struggle between content and context is presenting itself here. ACT promotes the idea that the problem may lie in attachment to beliefs, rather than in the beliefs themselves. This may be seen as a reversal of some views in which self-conceptualization and performance are linked. The 'Mental Polarity Exercise' can be used here to demonstrate the effects of attachment to evaluative thoughts. The description of the exercise also describes the etymology of the word 'perfect'. This is also a powerful and important point, that, in my view is worthy of detailed attention.

Next we have a section on 'Building Awareness of the Observing Self', that aims to help the client notice the process of consciousness and sense of perspective. A 'central ACT intervention', the Chessboard Metaphor, is then described in detail, and a helpful brief therapist/client transcript provided. The Chessboard metaphor can be physically acted out in therapy. Issues such as willingness can be demonstrated through observing how little effort it takes for the board to hold the pieces. An important phrase - " The point is that thoughts, feelings, sensations, memories etc are pieces on the board, they are not you" (p.192).

A couple of notes from a beginner: As p.189 notes, 'therapists and clients are in this language stew together'. It is therefore as important for therapists to work on attachment to their own conceptualized self(-ves), as for the client (a theme of the book). I especially like the brief paragraph on perfect (p.190). In this sense, who is not 'thoroughly made'? This perspective may also carry over to the judgments and evaluations we make of others.

The Chessboard Metaphor is very useful - although I have had one or two clients wanting to sweep all of the pieces from the board (wipe the slate clean). John Billing gave us alternative metaphor on 16.06.04 (or 06.16.04, depending on which side of the pond you're on)

Eric Fox May 4, 2005 - 5:40pm

ACT Book Summary: Pages 192 - 198

Experiential Exercise with the Observer Self Observer Self exercise: This is a "key" lengthy exercise that brings the person to the place where they are observing the changes that have occurred in their life from a perspective that seemingly does not change. Phase1: The exercise begins with general focusing and by noticing bodily sensations. From there it moves onto observing sensations of a recent memory; then to observing a further away memory, then lastly it moves to observing sensations of a distant memory. The main focus is on being aware of the self that was present at those past moments is the same self that is presently noticing; the observer self is a sort of common denominator; it's the soul prospective. It is also practice in "seeing seeing" where seeing is defined as what we feel, think, and sense. Phase2: Is similar to what occurred in Phase1, just the content has changed. The client is guided through observing the roles they play and the emotions and thoughts that they have; roles, thoughts, and emotions change, come and go but there is a you that is having them and has stayed the same while they have changed. The perspective of Observer Self is one where a person can more easily observe themselves engaging in the behaviors of thinking and sensing. Paraphrasing Skinner, "a person who is aware of his own behavior is in a better position to [influence] his behavior." Pick an identity: This is an exercise where a few semi-random statements about a self are picked from a box, randomly, and then the client uses these statements to take on that personality, with the help of some guidance. This equates to the client's real life experience of picking a few statements about themselves and becoming that person. This is an experience in flexibility where being flexible has not been utilized (much). Faking it: is a good example of how our minds' can give us the opposite experience of what we actually experience. "I feel like a fake because I am having a good time but I am not a person who has a good time; I'm depressed! Therefore I must be having a good time just to make other's feel like I am having a good time (which of-course I couldn't be). Since I am a fraud this really sucks." The benefits of being able to observe these thoughts as thoughts and not truths should be obvious. Buying these thoughts will lead to one experience where the experience itself yields or is a much different experience.

Eric Fox May 4, 2005 - 5:41pm

ACT Book Summary: Pages 198 - 203

Here is my attempt at the next couple of section called "Therapeutic Do's and Don'ts", "Progress To The Next Phase", "Personal Work For The Clinician: Is Your Self Getting In The Way?", and "Clinical Vignette". In the fist section "Therapeutic Do's and Don'ts", the authors caution clinicians about a couple of things. First "Reinforcing the Problem", in this section we a cautioned about joining in with the client's language, which will show "itself in the development of an excessive amount of logical, rational talk about why the client can't trust his or her thoughts, the lack of self-confidence, and so on." I usually see this rearing it ugly head when I realize that I am talking way to much, and at times trying to convince the client of something. At these moments the authors suggest we return the focus to "experiential exercises and metaphorical talk." We should also "Reaffirm for clients that there is no secret formula that delivers happiness in any consistent way." Because, inevitably we want to take our new found tools for living and turn them into shovels and start digging new holes. Next "Spirituality As An Experience, Not A Religion", warns of the dangers of seeing ACT as a religion. This is a pitfall that we have seen since the beginning of AA, where they warned of being swept up in a religious zeal. These new ways of living daily can bring with it a new found spiritual awakening, and as the book says "that is gravy." As therapist, we need to "emphasize the concept of workability for the client, not a belief system." Next "The Multiproblem Client And Self-Obliteration", in this section the authors deal briefly with the topic of more seriously dysfunctional individuals. I see this section as boiling down to two sentences from the section. One, "The destructive effects of trauma lie less in the event per se than in the escape and avoidance maneuvers used to compensate for the event.", and Two, "ACT strongly promotes the use of experiential and metaphorical exercises that undermine the need for avoidance with such clients." And isn't that the lesson to learn? This reminds me of a poem I once wrote; "Lost and Found I lost what I was looking for Because I was looking for what I hadn't found. I hope I find what I'm Looking for Before I've lost what I find that I found." Next "Progress To The Next Phase", how do we know when it is time to move on to the next stage? When clients start to speak of "looking at, rather than being caught up in, private experiences." The authors also state "Another critical sign at this stage is the ability to laugh at oneself in earnest." In my own life it shows when I spontaneously think of how I "dig my holes" and can laugh to myself as I say "Mark, step awayyyyyy from the shovel." Next "Personal Work For The Clinician: Is Your Self Getting In The Way?", this is where you break out your pad and pen, and get a chance to play along at home. In this section we are suppose to look at the "monsters" we have been avoiding in our own lives. This is not for the squeamish, but it can be truly freeing. I will share one of my "Monsters", but I suggest you use your own. "Remember to save your work." (My "Monster" is the internal circus that happens every time I am called Doctor.) 1. What emotion does this problem present that is most difficult for you to deal with? (When this happens, fear rushes through me, and I think someone is going to expect me to be something.) 2. What thought(s) does this problem present that is most difficult for you to deal with? (That I am unworthy, and inadequate) 3. What memory or personal history does this problem present that is difficult? (I have many memories of being told in High School that I wasn't college material, and that the best I could hope for was maybe getting in the military.) 4. Is there anything in these private experiences that, considered on their own terms, you cannot have and still live a vital life? If you can't have them or a part of them, just notice you are not having that part. (I don't think this issue for me rises to this level, however, there are times that it gets in the way of me making my opinion known.) 5. Are you willing to get into contact with these emotions, thoughts, memories right now? If so, practice having them in a new context. For example, if there is a horrible thought, say the thought out loud 50 times as fast as you can. If it's painful feeling, hold the feeling in your mind and mentally describe its shape, color, texture, temperature, or smell. Try to see it as a feeling and see yourself feeling it. If it's a painful memory, consider holding it in mind and separating out the physical sensations first, then put them "out there," then move on to the emotions and put them out there, then the images and put them out there. (I have found that when separating out the sensations, emotions, and images that I can move in to the present without the negative effects of these past experiences.) 6. As you consider each of these content areas, notice also that a conscious person is considering them. Review items 1 to 5, but this time see whether you can also be aware of the person "behind the eyes" who is aware of what you are aware of. (Wow, that was a trip. You may need to be in a quiet place to try this, but it seemed as if I was invading my own body.) Finally "Clinical Vignette", here you are asked to "conceptualize the client's dilemma from an ACT viewpoint." This is a good exercise that folks can check out in the book starting on page 202.

Eric Fox May 4, 2005 - 5:42pm

ACT Book Summary: Pages 205 - 212

What are values? 1. Values represent "verbally constructed global desired life consequences", different from goals in that they specify a more general direction and hence can not ultimately be satisfied, completed or achieved. For example the goal of completing this summary serves a larger goal of learning about ACT, that is consistent with my life value of continuing to learn as much as I can about psychology and its disciplines. Values typically elicit a number of goals, that is, values are "a verbal glue that holds sets of goals together". 2. Values are an action, not a feeling. Values are followed through behaviour, not through it necessarily "feeling right". 3. Values are a more stable form of "verbal rules" re-aligning a client in the present to a valued direction. Thoughts and feelings can be contradictory and inconsistent. 4. The main goal of ACT is help clients develop a "behavioural trajectory" that is vital and valued. 5. All of the techniques in ACT feed this main goal. Techniques such as defusion and acceptance are only useful in so far that they provide a means for a client to achieve a valued end. Are values innate or learned? 6. All clients have the capacity to define their life direction (i.e. develop values) 7. Verbal fusion and experiential avoidance are common barriers to following these values 8. Developing values is linked more to removing barriers (e.g., verbal fusion) rather than needing to teach valuing skills. 9. A lack of values in a client may reflect a chaotic, unpredictable environment, where the development of values/goals has met with frequently painful or disappointing consequences. 10. The social/verbal community requires that we have explanations or justification for our actions. Citing values may not appease this community, hence they are not always socially reinforced. Why have them? 11. People's behaviour is shaped by consequences, both experienced and verbally constructed. While learning histories provide a means of shaping behaviour over the short term, language provides the means by which behaviour can be shaped over longer periods (i.e., knowing that I will receive my degree at the end of 4 years keeps me studying, even though short term consequences can be somewhat aversive). 12. Values are part of this language process, specifying long term consequences for current behaviour. They can coordinate current actions over long time frames and since they are global, they require a person to do this on a day-to-day basis, different from specific goals in that they are not achievable per se. Stance of the ACT therapist with regards to values: 13. ACT therapists are asking clients a number of questions with regards to values: 1) What are your values (this will be explored with other people's summaries) 2) Can you act in a way that is consistent with your values, even when your thoughts or feelings tell you otherwise?" 3) What stands in the way of you acting in accordance with your values? 4) In pursuing a valued life direction, are you willing to have what emerges, what you encounter along the way? 5) Is there a difference between feeling a belief and acting on a belief? How will others know? (The "argyle socks exercise" is a useful way of addressing some of these questions)

Eric Fox May 4, 2005 - 5:43pm

ACT Book Summary: Pages 212 - 219

This is a section I find very compelling and challenging. It has parts I can put into words but don't understand. It has other parts I understand, but can't put into words (Should the "buts" be "ands"?). At least it seems that way to me. I can put into words the difference between judgments and choices but can't seem to differentiate in practical examples. I have, for example, a vague feeling for where I want to go with the organization I manage. This feels like a value. I want everyone to be relatively happy and do a good job. That seems like a goal. What's my value here? I begin with "Choice" on page 212. Choice is distinguished from judgment-almost as a residual category (defined by what it isn't) of behavioral processes with certain characteristics that are used to select among alternatives. A selection among alternatives based on reasons is a judgment. Reasons are verbal formulations of cause and effect which answer the question "why?". The formulations serve as a justification of sorts which may make reference to societal or personal outcomes or use quasi scientific historically based deterministic assertions. For example, "I eat fruits and vegetables because they clean out my system". A choice is a selection among alternatives that may be made with reasons but not for reasons. The live demonstrative exercise is to offer your fists and say, "Choose!". The client points to one. When ask "Why?", he may or may not formulate a reason; but most persons will realize that the reason is formulated after the act of choosing and therefore not functioning causally in the selection process. In a judgment, the weighing of pros and cons actually influences the outcome of the selection process. For example, "I was going to hire Mr. Smith because of his job skills. I decided not to hire him when I considered his poor health." Is it a judgment because my awareness of Mr. Smith's health problems precede my selection of Mr. Jones? Would it have been a choice if I met them both, wanted to hire Mr. Jones but didn't do so until I found out about Mr. Smith's health? Then there's this business on 213 and 214 about asking why a reason is true as a way undermining the causal relationship between the reason and the selection(in the mind of the client, that is). Or asking why a food is chosen and then when they say it tastes good you say you asked the person to choose and not their taste buds. Maybe this is over my head. The authors acknowledge that there is no "free choice" in a scientific sense. Is this then a question of creating the subjective illusion of "free choice" by impeachment of reason(or reason giving)? This seems to be the point of the paragraph at the end of this section. I can't quite grasp this. Help me Francis or Patty or Hank or someone. Valuing is always occurring as a behavior. The dialogue between Therapist and Client on page 215 is to show how choices are always being made and purposes fulfilled. The point here does not seem to be to elucidate how these selections among alternatives are choices rather than judgments even though the word "choice" is used. Perhaps this follows in some logical way from the previous section. Still the implication is that clients are not conscious of the selection among alternatives process being "choice making" and this dialogue will make them so. What do you want your life to stand for? The dialogue is with an independently wealthy client presumably because such an unfortunate is stripped of the illusion that working for a living guides life, I guess. Anyway, they do the exercise about attending the client's funeral and what he wishes everyone would say. The therapist comments that he doesn't expect them to say "...he was no fluke." I think this is to make the point that avoiding negatives is out as a value in the sense that we're after here(File it. Along with judgments and stuff determined by reasons). They're mainly trying to distinguish values, whatever they are, from the clients current real life actions. This section ends with Albert Schweitzer as an example of someone known by what he stood for rather than specific accomplishments and it recommends the values assessment homework assignment (pages 224-225). We'll get to that shortly. I wish I could've gone to Dr. Wilson's ABA workshop on this; but I chose Prof. Barnes-Holmes' RFT workshop (or was it a judgment? Does it matter how I think I arrived at the selection among alternatives?). Choice and Commitment. If actions are based on reasons and reasons change, then "true commitments" are better done as choices than as judgments. The heart of the ACT life strategy seems to be to develop a life direction in the behavioral sense relatively independent of thoughts and impulses of the moment. The marriage commitment is given as an example of a commitment that is undermined 50% of the time by divorce. The authors see the "cause" of divorce as the persons involved not knowing how to make commitments and marrying on the basis of judgments, decisions, and reasons-therefore not having made a commitment at all by our definition (right?). Is this logic circular? Does it follow that divorce can have no other cause? Maybe so-for our purposes. Anyway, the experience (private event?) of falling in and out of love is rather unpredictable compared to the "choice" quality of commitment. This frames things in a way that life can be lived differently for some than those who "believe" in love feelings as a guideline for action taking. They conclude that commitments are choices free of reasons and changeable verbal cover and suggest the Chessboard Metaphor and Gardening Metaphor as ways to illustrate conceptually.

Eric Fox May 4, 2005 - 5:45pm

ACT Book Summary: Pages 219 - 229

These pages concern how to differentiate goals from values, methods to clarify values, ways to elicit actions related to values and how to evaluate barriers to valued action.

Outcome is the Process through which Process Becomes the Outcome

This section relates how needing to attain goals creates motivation and direction for action, but does not provide vitality in life. Attaining goals does not equal happiness or life satisfaction, as one is forced to live in a constant state of deprivation (interestingly, it is pointed out that the etymology of the word "want" is "missing").

The Gardening Metaphor describes how to stick it out with an initial choice (i.e., value) to see what happens (without believing that the "grass is greener on the other side," no pun intended). Another "goal" in this phase of therapy is to help clients see that the process of living equals the outcome of interest. The Skiing Metaphor describes this well. Your stated "goal" may be to get down to the lodge and you are planning to ski there. If someone whisks you off in a helicopter to bring you to the lodge, that would make you mad. It is the process of getting to the lodge (i.e., skiing) that is what is to be enjoyed.

Finally, process cannot be measured from moment to moment like goals. If one continually monitors progress toward specific goals, they may miss the " big picture" (i.e., what they have accomplished to date). Here the Path up the Mountain Metaphor comes into play. It highlights what is wrong with monitoring only "snapshots" of life. If you are hiking up a mountain, you may notice twists and turns, circling around (perhaps even going down the path in parts) ultimately to get up the mountain. You may think at any given time: "I'm doing well" (for instance on an up-path) or conversely: "I'm doing poorly" (on a down-path). Yet, an observer with binoculars across the way (looking down at the hikers) may notice steady, continuous progress toward the overall goal.

Values Clarification: Setting the Compass Heading

In this section, values work is further elaborated. The authors point out that doing values work can be an intimate experience between therapist and client, as oftentimes values are not something the client has ever articulate before to someone else. One of the "values" of "values work" is in the fact that values may help point out to clients what IS working in their lives (i.e., they may be leading valued lives in certain areas they hadn't even recognized). There are some values worksheets on page 224. There are three forms, including a values narrative form, values assessment rating form, and goals, actions, barriers form you can use with clients. The goal is to review the worksheets together and build on them. Values work may be a helpful assessment tool as well. In doing the values work, therapists can uncover possible "ulterior motives" for certain values. The authors give three examples:

when values statements are controlled by the presence of the therapist, the consequence can be therapist approval or lack of disapproval.
when values statements are controlled the presence of the culture more generally, the consequence can be the absence of cultural sanctions, broad social approval, or prestige.
when values statements are controlled by stated or assumed values of the client's parents, the consequence can be parental approval

This is not to say that these factors don't affect EVERYONE'S values, but the extent to which the client takes ownership of their values is important to assess. When a client is wedded to the consequences mentioned above, the therapist can ask the client what would happen if the stated consequences were not there (i.e., "What if your parents did not know you received a Ph.D.?"). Another point the authors make is that it is not uncommon for values to change in valence over the course of therapy. Sometimes (oftentimes) clients may leave certain (or many) domains completely empty. In this situation it can be helpful for the therapist to ask the client what values he/she held earlier in life.

Assessing Goals and Actions

After values work is underway, the focus is on developing goals and specifying the actions that can be taken to achieve those goals. A goal is define as a specific achievement, accomplished in the service of a particular value. Clients do homework in acting according to values either as a one-time deal or from a commitment to repeated and regular acts in the service of a given value. The therapist and client monitor for a close connection between action, goal, and value and try to "accumulate small positives." The authors assert that little steps consistently taken are more useful than heroic steps taken inconsistently. What to do about barriers? The authors mention that engaging in valued action almost always provokes a psychological reaction (often in the form of barriers). At these times, clients may get stuck because they avoid taking values actions as a means of avoiding painful emotional barriers. The therapist then helps the client examine:

the type of barrier
ask if the barrier is something they can make room for and still act
find out what aspect of the barrier may actually help reducing your willingness to have it without defense
assess whether barriers are a form of emotional control or avoidance

Question

Although I am a big proponent of values work (or I wouldn't be doing this therapy), I am still struck by the similarity of values homework to "monitoring progress toward a goal," not noticing the process itself. In other words, the question "How well did you move toward this goal this week by these actions" seems like the very "snapshot" that is proposed as problematic in the initial part of this section. Any reactions?

Eric Fox May 4, 2005 - 5:46pm

ACT Book Summary: Pages 229 - 234

Willingness to have barriers and barriers to willingness: willingness is a value-based action, a choice: see the "Bubble in the road" metaphor p. 230. Therapeutic do's and don'ts:

coercive use of choice: conflicts are possible between the therapist's and the client's values. Take care not to use "choice" as a way to blame the client.
confusing values and goals: "I want to be happy" is not a value. It's no direction. It's something you can have or not have, like an object. Values cannot be achieved and maintained. Helping question: "What would you be able to do if that was accomplished?" Values are no means to an end.

Eric Fox May 4, 2005 - 5:49pm

ACT Book Summary: Pages 235 - 238

Willingness and commitment: putting ACT into action ACT is not only about defusing and defining life values. Essentially ACT is all about living, action. This chapter focuses on the commitment part of ACT: "getting the client engage in valued actions while making room for their intended or unintended consequences". Theoretical focus Willingness & behavioral commitment = actively engaging in actions that may invite the presence of negative evaluated thoughts, emotions, and bodily states. This induces a confrontation with the unworkable aspects of old rule systems. Verbal and nonverbal aspects are important here. Verbal: formulating valued ends & intermediate goals Nonverbal: through action, actual movement, behavior can actual contingencies be met. Nonverbal behavior is necessary to find out what actually works. The difference with systematic exposure and behavior change lies in the focus on overt situations + on private events. The emergence of the old rule systems is helpful in the defusion process. Goal of this phase = to elicit behavior & to support the client's commitment to sustaining such change. Comments: - ultimately ACT is no talk therapy, it's behavior therapy. No behavior therapy without action. The proof of the pudding is in the eating. -old rule systems can be very though. Is it possible to change them in old people, with problem histories of tens of years?

Eric Fox May 4, 2005 - 5:50pm

ACT Book Summary: Pages 238 - 244

Willingness and Commitment chapter Clinical Focus 1. The goal of clinical work in this section is to elicit behavior change and support the client's commitment to sustaining this change. 2. Therapeutic topics center around willingness and committed action. 3. There is a chart with goals, strategies, and interventions related to willingness and commitment on page 239. My comments: 4. The authors note that committed action is "funded by valuing." I find that description very helpful! Experiential Qualities of Applied Willingness 5. The experiential piece of willingness relates to increasing the client's ability to detect internal struggles and abandon them-even in the midst of the most difficult moments. 6. The authors differentiate willingness from wanting in that often clients feel that they have to want something to do it. They also often feel that if they withhold willingness to have X, X will go away (yet they experience just the opposite). 7. Joe the Bum metaphor (page 24) is used to illustrate willingness. * This metaphor underscores two characteristics of the fantasy of unwillingness: 1) If only invited and wanted guests came to the party, life would be grand. 2) Withholding willingness to welcome the unwanted guest will somehow promote peace of mind. My comments: 8. I am struck by how often we expect life to be rosy and don't want anything to happen to upset the applecart, when that's just a frightening way to live! Willingness Has an All-or-nothing Quality 9. There is an old Zen saying: "You cannot jump a canyon in two steps." The authors provide an experiential exercise on page 241 related to the simile: "willingness is like jumping." They discuss how the quality of jumping is the same whether one chooses to jump off of a book on the floor, off of a chair onto the floor, and off of a building to the ground. It is merely the context that changes and limits willingness. When you try to change the quality of willingness (for example, by trying to reach your toe to the ground from the book or chair), you destroy it altogether. My comments: 10. Maybe someday I'll be gutsy enough to jump off a chair in my office in the service of illustrating this point to a client-I'll have to commit to that J Reconnecting with Values, Goals, and Actions 11. At this stage, the therapist reviews the client's contemplated actions in each life domain. 12. While some domains may not be filled in, it is important to develop at least one high priority target and to keep the focus on willingness, not barriers. 13. A couple of therapist statements to illustrate the above are: "What stands in the way of you setting your willingness on high right now?" (the therapist noting the barriers the client cites) and "Has being unwilling worked to protect you over the long haul from those reactions?" Committed Action as a Process 14. It is not unusual for clients to avoid making a commitment because of the fear of failure to keep it. 15. There is a therapist-client dialogue on pages 243-244 demonstrating the difference between process and outcome (and how to help the client see this difference). My comments: 16. I think it's crucial in any behavior change undertaken by humans to realize (intellectually and experientially) that it is a process, and one will inevitably "fall off the wagon." I attribute this to "stress inoculation" or the Zen meditative notion of guiding one's wandering mind back to task.

Eric Fox May 4, 2005 - 5:52pm

ACT Book Summary: Pages 244 - 249

The section titled "Committed Action Invites Obstacles" begins with the idea that once we have a value-guided game plan, it is time to act. The Eye Contact Exercise is a live demonstration of action and a way to begin to behaviorally confront a common avoidance behavior. This exercise may elicit the reactions described. My experience has been also that many of the client's friends, relatives and acquaintances may perceive a change in the client as eye contact improves. Sometimes it gives them "the creeps". An action oriented, surprisingly powerful intervention. The FEAR and ACT algorithms are introduced as help aids in identifying barriers to willingness(Fusion with thoughts, Evaluation of experiences, Avoidance of experiences, and Reason giving for behavior) and maintaining focus on the game plan(Accept your reactions and be present, Choose a valued direction, and Take action). These can be printed on cards and carried. Live confrontational exercises in the therapy hour are suggested and the "Looking for Mr. Discomfort Exercise" is described on page 247. There's the business of renegotiating the clients relationship with "Mr. Discomfort" and possible use of earlier references to the Passengers on the Bus Metaphor. "Culprits" or likely suspects in failure to complete committed action sited in the book are actions not connected to client's valued ends(direction?) with possible influence by wishes of others, being hooked on literality bolstered by destructive reason giving, or taking a step that is too large or with insufficient preparation. There is also the tip in exposure exercises of identifying component experiences(bodily sensations, memories, emotions, thoughts) and being willing to have them rather than what it says it is or may become. There is also the technical tip of reminding awareness of external environment while encountering negative private experiences. This is helpful when the client "can't stand it" and resorts to devaluing the valued end(direction?). The authors' use of "valued end" in this section bothers me as it seems to raise the specter of goals rather than the previously emphasized compass direction. The Swamp Metaphor on page 248 helps illustrate the idea of walking "through pain the service of taking a valued direction". The Expanding Balloon Metaphor considers the edge of the balloon as a growth zone where the question is asked: "Are you big enough to have this?" You may respond to each issue with a yes or no. Yes, you get bigger. No, you get smaller. No matter how big you get, there's always more "big" to get. It does not get easier (very important) as each issue may seem relatively as difficult. It may become habitual, however, which begins to provide a source of strength and confidence in the process. Figure 9.1 illustrates how avoided issues cause one to distort life around the issue until it is faced. The Take Your Keys with You Metaphor additionally helps deal with the relationship between avoidance and action. The keys represent difficult emotions, thoughts, reactions, sensations, etc. The client may pick up and carry the keys without them preventing the action and the keys may open doors(an illusion to insight?) The metaphor is given on page 250 and its use creates a tangible for the client to use in his outside therapy life. I'm surprised at how few comments there are on the summaries. These metaphors can restructure a persons' cognitive experience of life and facilitate behavior change. Is it a form of insight? Is that an important question? Is anyone else bothered by the "valued end" versus "valued direction" thing? Is it important? Why or why not? The idea that willingness never gets easier and can't be done piecemeal strikes me as important. I take an exercise class that seems to have this characteristic. It involves recurrent unpleasant private experiences, but doesn't seem to harm or traumatize me. The instructor reminds us, "If this was easy, everyone would be in here doing this." Is this an example of acceptance in service of health as a valued direction? I can tell you, it never gets easier. Do the FEAR and ACT algorithms que rule directed behavior? Could they have a down side?

Eric Fox May 4, 2005 - 5:54pm

ACT Book Summary: Pages 249 - 254

Primary barriers to committed action:

When a client resists committed action, often the client is struggling with how the action will alter his (or her) personal history; how the client has created in his own mind his place in his world. The client may also be grappling with the impact this history has had on his conceptualized self. The client has constructed a self perception of who he is. If he has been subjected to an abusive or otherwise harmful environment, his self perception embraces how he has been victimized by others.

Not surprisingly, the client is threatened with the possibility of positive change. This threat challenges both the client's self perception and the hope that an abuser may someday validate the client's self perception and make amends. For example, a client was physically abused as a child. He now perceives himself as a victim of physical abuse; the perception is intertwined with his identity. If he makes positive change, he may no longer appear as a victim to himself or his abuser. He loses his self perceived identity (as a victim).

Clients with history of painful events (especially in childhood) may have learned that life can be unpredictable and punitive. By limiting their exposure to painful thoughts, they mistakenly believe they can curb their sense of trauma. The opposite is often true. Psychological pain hurts but does not damage; whereas psychological trauma is pain without the willingness to experience the pain. This unwilling causes damage; the effect of the pain persist.

An exercise to teach the difference between psychological pain and trauma:

Ask the client to describe past painful and traumatic events in detail.

- distinguish between the original pain and,

- the client's reaction to the events.

2. Inventory the area of responses (i.e. physical reactions, emotional reactions, memories, thoughts, etc.)

3. Note the sense of trauma

4. As the client becomes aware of the reaction, ask the client to let go of the struggle with the reaction.

The client's willingness will shift the context of the events; this change will often reduce the client's tension related to the event. As a consequence, the client will be begin to distinguish between trauma and pain. The pain will remain; the trauma will disappear; positive change may occur. A client's reluctance and resistance can be expected. If so, the clinician should:

point out to the client the burdened caused by resisting the avoided content
have the client notice physical, emotional and cognitive responses that attach to the unwillingness
prompt the client to let go of the struggle with unwillingness and be willing to be unwilling
if the client is able to do this, ask the client to notice the difference between struggle and letting go
encourage the client to continue the process of letting go and bringing up avoided material.

Things to remember:

The therapist must identify the functional connection between failing to be "right" about being a victim and remaining a victim who demands redress.
If the client believes he must remain "broken" in order to prove someone else wrong, the client is stuck, not broken.
Intervention is delicate.
The events in question are not being disputed.
What is being disputed is the necessity of living in a self defeating life in the service of waiting for the recognition and redress that seldom, if ever, comes.

Eric Fox May 4, 2005 - 5:55pm

ACT Book Summary: Pages 254 - 259

Guilt and Self-loathing (not in Las Vegas, not Hunter Thompson) Guilt = "I'm bad" is a stance that weakens the client's valuing ability. It is connected to past, dead behavior, and, when functionally connected to such a chimera, prevents the client from living in the present, in real time, and moving ahead with life.. In the example shown, the client implies that guilt/shame regarding past behavior is making a visit with a brother an extraordinarily stressful event. The client holds on to contradictory concepts, "I want to be close to my brother, so I cannot tell him the truth." The client is feeling numerous emotions, and seems to get that he is trying to bargain with them, and get them to the back of the bus. When he sees the cognitive dissonance (?), he appears to be able to also see the disconnect, which scares him. Therapist asks what is between him and honesty with his brother -- answer: fear, He can bring that to the front of the bus as well and is still able to drive. Forgiveness Clients often think fear is a change in stance where once they 'knew' someone was wrong, bad, untrustworthy, and to forgive is to say they are no longer these things, they are right, good, etc. The client has, in essence, changed their mind. It can also appear to be emotional avoidance -- excusing, denying, forgetting old angers. It is actually a gift to oneself, to give the self that which came before. It gives the for-giver the ability to regain the grace under which they can neutralize the injustices -within themselves. To paraphrase "the injustices of others can only be made permanent by the victim, not the perpetrator," or pain is unavoidable, but suffering is optional. Example used is the Gestalt "empty chair" exercise. It may be best to allow the client work on the pivotal, profoundly personal issue of forgiveness outside of the session, where the necessary privacy and time for self-reflection is available. Behavior When the client is nearing the end of the willingness and commitment phase, ACT begins to resemble other Behavior Therapy, while maintaining an ACT flavor. Skill building, couples work, role-playing et al, are used from an ACT perspective. Termination Termination comes when the client has reached a point where valued behavior change has been actualized for him or her. Therapy is not designed to be permanent -- Woody Allen "I have been in Analysis for twenty years. I think I will give it another ten and if that doesn't work, I will call it quits." It is to help the client get unstuck. When a client shows openness to change, a rating scale may be used to gauge further commitment to same. Termination may be tapered off, shorter for the functional client, and longer for the multiple problem client. This phase is used to bolster key ACT principles (Oh how quickly we forget) and for relapse prevention. This, thinking of diClemente's stages of change, is the maintenance and transition stage. During this period, if the need to reenter therapy arises, the therapist will be aware of it during these phasing out visits.

Eric Fox May 4, 2005 - 5:58pm

ACT Book Summary: Pages 259 - 264

THERAPEUTIC DO'S AND DON'TS Even in Relapse, Values are Permanent When client is experiencing a relapse, the first thing therapist and client must know is if there's a change in client's values. Most of the times, there's not a change in values but on client's confidence to achieve them. When client experiences a relapse, there's probably inner conflictive talk about different rules and memories. If the therapist confirms that the client's values are the same, he can use a metaphor to say that even though obstacles may show up in the way, the way to arrive to the committed goal is the same. omments: What if the client's approach to his value allows him to foresee a "danger" (such as the non accomplishment of other values). On the other hand, the client might answer that if one is tired to drive to San Francisco it is not recommendable to do it, or that if he knows the road is blocked because of an accident, he should wait till another day or month. My comment might be silly but since my short therapeutic experience, clients are very good at refuting and turning over all kind of metaphors adjusting them to their immediate needs. The Client Owns Committed Action In this section, the authors emphasize the importance that the client follows his own values and not the ones that might be a non intentional influence of the therapist. Noncompliance is not Failure When client's behavior doesn't change, therapists use to think it's a failure, and when this happen, therapist pushes the client to act according to his own values (the ones of the client). That strategy doesn't lead to a good outcome, and client's behavior gets resistant or definitely avoidant. The best way to cope with that situation is to accept the client's struggle and non-action from the point of view of the client. Comments: It's interesting to me that in this situation the main problem is not the client's resistance, but the therapist resistance to accept the client's behavior. PERSONAL WORK FOR THE CLINICIAN: COMMITTED ACTION In this exercise, the therapist takes one value and establishes goals, actions and obstacles according to it. Then, the therapist thinks about which private events would show up once committed action begins and if he is decided to make room for them. Comments: it's very interesting to me the difference between ACT approach and CBT. In my clinical experience as a CBT I remember that after the assessment and before treatment, we had to write down together the client's goals, but most of the times, even though classifying them in different areas and making a hierarchy, there was a lack of certain "structure", not only in the result but also in the process of "outcoming" goals, so the goal sessions used to be quite unsatisfactory. CLINICAL VIGNETTE In this section, the authors expose an example of how a client can mislead committed action as a process, and as an outcome. The client relates "drinking again" to not to be a "loving and emotionally available husband", so he experiences negative private events. But he should consider "drinking again" as an obstacle which is part of the whole process, and not the outcome. The other point of the example to stand out is that the client misleads blame and responsibility. But considering "drinking again" as part of a process and not as an outcome, he would understand that he is able to choose again from now on. Three metaphors are provided. APPENDIX: CLIENT HOMEWORK Accepting Yourself on Faith Exercise The therapist differentiates between conclusion and assumption, and defines assumption (something we use to do other work). Then, after checking that the client validates himself making a conclusion, impels the client to choose the assumption that he is acceptable and valid. That's called Faith Exercise. When the client chooses to be acceptable, some contents such as self-doubt depend on the previous assumption and so they loose their meaning. Comments: I understand that assumptions are so frequent and necessary as breathing, and also, that approaching the problem of self acceptance might be easier and quicker that way. But I think that self validity can be approached from a filogenetical point of view. What we are is the outcome of millions of years of environmental and social selection. That has a great value per se, and is not an assumption. If we have being selected is that we are good. But on the other hand I understand that sometimes that's something difficult and maybe long to explain. What do you all think about it?

Eric Fox May 4, 2005 - 6:00pm

ACT Book Summary: Pages 267 - 271

The Effective ACT Therapeutic Relationship The chapter begins with the statement that the therapist stance towards the client and therapy is an important variable, and as a result therapy becomes an intense experience for both, client and therapist. Then, the problem of language traps is introduced as a process in which the therapist may fall down itself. The beginning of the chapter also announces the possibilities and limitations of all therapeutic relationships, their lights and shadows. Comments: the last passage of this page makes me think that in a therapeutic relationship, due to the fact that there's a short history of contingencies between client and therapist, words in that context have a great amount of relations, and so, the range of meanings is wide. For example, when talking to an old and close friend, some words, sentences or non verbal behaviors have an unique meaning. Usually it happens the opposite in therapy. Positive leverage points in ACT As a main feature of ACT stance it is presented its sensitivity: its open, accepting and coherent stance towards client. But the paradox of using rule governed behavior to direct and influence the therapist behavior is presented in a quick and clearly way. Comments: I ask myself which are the historical antecedents and conditions that lead to a sensitive therapist. Understanding the word "sensitivity" as a track to therapists is important, but I think that every kind of human relationship called therapy, shares (regarding other psychological models) the fact that therapy is an art, and art is a practice. And in that sense I think that the beginnings of all kind of therapy are mechanical, not only because of the model but mainly because of the lack of experience. ACT in a functional sense Then, the authors present an example of a therapist being caught up by the literal meaning of an internal event and the possible consequences of it. The point referred is not how to "resolve the problem" but how to accept the fact of experiencing this kind of thoughts. The therapist itself must become a living flesh example of individual being stuck by a rule ("Good therapists would know what to do in that case") that accepts its own inner events and commits to therapy goals. Comments: I like the fact that the possible interventions of therapist are not a memorizeable standardized list of sentences, just contingencied, spontaneous responses. Otherwise, I like the impel to consider therapy as a struggle DURING therapy and not a previously manufactured "solution". Observer Perspective Another of the positive leverages of ACT is an observer perspective that takes an extremely care in not rationalizing and justifying through verbal behavior our private events. The ACT model emphasizes the importance of the acquisition of this skill by the therapist, arguing that the way the therapist behaves during therapy regarding internal events is important to influence the way the client will behave itself. Comments: following the argument I agree that personal growing and maturity of the therapist is a fundamental variable in therapy Wisdom is Gained by Approach, Not Avoidance And as an end to my summary, the authors explain the difference between achieving goals and values and the stance of coping them despite of "secondary effects" hung on them. They say that therapist should show this stance during therapy, and furthermore, that they should have experienced such a coping stance. An effective ACT therapist is the outcome of that condition. Comments: I appreciate the difference between merely achieving goals and to live while achieving goals. I always thought that a goal oriented stance was not enough.

Eric Fox May 5, 2005 - 12:35am

ACT Book Summary: Pages 271 -275

Contradiction and uncertainty: the willingness to entertain contradictory themes of uncertainties without feeling compelled to use verbal behavior or verbal reasoning to resolve them. Two things come to mind: The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function. One should, for example, be able to see that things are hopeless and yet be determined to make them otherwise. - F. Scott Fitzgerald And "Alice laughed: "There's no use trying," she said; "one can't believe impossible things." "I daresay you haven't had much practice," said the Queen. "When I was younger, I always did it for half an hour a day. Why, sometimes I've believed as many as six impossible things before breakfast." The phrase "field of play" seems apt to me. When I am in ACT mode with a client, it does feel like play, even if we're working on heavy painful stuff. Field of possibility is another way I think of it. No guarantees, no warranties-just living. My clients and I have a bus metaphor when we talk about the impermanence of life. Years ago, when I was making another appointment with a client, he told me he planned to be there, but as John Lennon said, "Life is what happens when you're busy making plans," and that either of us could be hit by a bus. He was right and I try to remember it. It seems to me that this awareness leads right into values work. If you have no guarantee that you will survive the day, how does that affect what you're doing right now? Tolerate paradox, ambiguity, confusion and irony. I suppose you'd have to be a fan of Monty Python, then, hey? I still find the rescuing bit hard not to buy. Getting older helps. I'm beginning to realize on a gut level that I have no idea what happens next. Some days that's really hard. One woman and I were discussing the whole uncertainty thing and I got rescue-y. I suggested to her that it was like being a trapeze artist, and you just let go of one trapeze, fly through the air for a while and grab then next. She replied, "Right. Except for a few things: you've never seen a trapeze before, you're blind, all of your enemies are watching, your hair's on fire and you're naked." Point taken. Identification with the client: "We are not cut from different cloth, but from the same cloth." This, to me, is perhaps the most precious thing about doing ACT. Being trained in the psychodynamic camp, I always felt like a fraud. I knew that I wasn't necessarily stronger or more psychologically healthy, but the work seemed to need me to put on my therapist suit and pretend that I was. So the client would be wearing their client suit and I'd be wearing my therapist suit and we'd sit in the room and pretend not to notice when the suits slipped. Not as much fun as you might imagine. Normal reassurance vs. soft reassurance. How I make this distinction is this-normal reassurance has the flavor of the tense pat on the back and the underlying desire for them to stop talking. "It will be all right," is usually for me. I can feel the tenseness in my face when I'm being normally reassuring, and I can find myself wandering, thinking about grocery shopping and whatnot. When I'm doing soft reassurance, I'm often more uncomfortable, tending to see how close their suffering is to mine and I'm riveted. I can't hold anything else, just the awareness of how hard it is sometimes to be human. Often, I get teary, especially when I get in touch with the amazing courage it takes for some of my clients to just get out of bed in the morning. Self-disclosure: An essential aspect of developing a human relationship. Where I still struggle is with the workability of the self- disclosure. If I'm having a terrible day, I think the client can tell, but they're paying me to be present for them, although some of them would love to caretake me in the session, if only to avoid their stuff. It's messy, this edge, and I like precision. But I think the messiness is where the life is. Perhaps. Therapeutic Use of Spirituality. "A view of the world that recognizes a transcendent quality to human experience, acknowledges the universal aspects of the human condition, and respects the client's values and choices. " Stepping back from a personal struggle and examining it openly and non-defensively. Easier said than done. This is where the observer exercise comes in, for me. I've had the experience of transcendence with this exercise, and clients had described the same. When they can dip into that open hearted space and observe themselves from there, their faces and bodies soften. It's really wonderful to watch. This observer position is the most fluid position I can take in the session as well. That being said, it takes repeated effort and intention to come to this place. But when someone--myself or client--has had the experience of this observer self, they know that it's possible. There's a “there there” for them, if you will. Until the experience happens, there's no there for them to go to. At least as I see it. Radical respect: "There is no right of wrong way to live one's life. There are only consequences that follow from specific human behaviors." Another quote I've stolen from a client. "So the way I look at it, there's six billion and counting humans on the planet. There's probably not one right way to be a human being, so my job is to find the way I want to be a human being and choose things that get me there." In my experience, this defining of valued direction tends to evolve over time. Not many of the people I work with can immediately describe what matters to them. We tend to do successive approximation, and look for a non-verbal response, sort of an aha experience. Values work is the part of ACT I struggle with the most. Clinical use of humor and irreverence: "The therapist's irreverence comes from an appreciation of the craziness and verbal entanglements that surround human living." It seems to me that this can backfire if I'm not in radical respect. Radical respect seems to infuse all of the work with a client from the ACT perspective. RR for their values, RR for their history, RR for their choices. RR for how they show up in the room. Is RR the same as acceptance? It's great when the client begins using humor and irreverence with their stuff. Another steal: Client's doing a lot of reason giving, catches themselves and says, "Anyway, that's my story and I'm sticking with it." Then laughs. Very cool stuff.

Eric Fox May 5, 2005 - 12:37am

ACT Book Summary: Pages 275 - 288

Negative leverage points in ACT ACT is not an intellectual exercise Overemphasizing verbal content and trying to convince clients is the antithesis of an effective ACT relationship. Better: - be "compassionately confrontational" - no more than 20% of the session involving explaining ACT principles - use metaphors and exercises Modeling a lack of acceptance This is especially difficult with more disturbed clients (suicidality, self-mutilation, bizarre behaviors,...) Ways of nonacceptance: - selective reinforcement of socially desirable thoughts & behavior, while ignoring or disputing negatively evaluated experiences - using the language of choice in a socially coercive way: "It's your choice, and you're not making it!" - "Where did you learn that way of thinking?" Heavy emphasis on history & reason giving Solution: acknowledge it & let go of it. Excessive focus on emotional processing Misconception: clients should "get in touch with their feelings". This is true only insofar as avoidance blocks them taking a committed direction in life. No emotional rediscovery for it's own sake. This is the most seductive error. Solution: come back to active exercises linked to values and behavior change. Countertransference There will be issues that are as salient for the therapist as for the client. Resulting in: topic avoidance, advice giving, excessive reliance on personal experience. Solution: self-acceptance for the therapist • The therapeutic relationship: strong, open accepting, mutual, respectful, loving. It's not an end purpose per se. • ACT in context - Don't "believe" a word in this book - Important (different from many other clinical traditions): link with experimental research - "Are we using language or is language using us?" - It's our job to try to establish & support cultural practices inside & outside psychotherapy that ameliorate these destructive processes in a socially broader way (e.g. acceptance & cognitive defusion). Psychotherapy sometimes undermines valuable existing traditions (spiritual & non-rigid, non-punitive religious traditions). THE END Comments:

some useful rules are given (esp. for beginners): no more than 20% explanation, back to exercise, ...
excessive focus on emotional processing: I was exactly doing this the very moment I read this piece. Back to values and behavior!
remaining questions: what about clients not seeking help, but needing it (involuntary treatment); how to integrate RFT with other problems (not having to do with avoidance): impulsivity, aggression, ...

Eric Fox May 5, 2005 - 12:40am

Book Translations (Archives)

Book Translations (Archives) Community December 2, 2021 - 6:07pm

Translated ACT and RFT Books

This list is no longer being updated. Please click here for a list of ACT Books in 20+ Languages.

Translated ACT Books Organized by Language Community
(see below for list by English title)

Chinese

Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Chinese translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2016). 接纳承诺疗法（ACT）--正念改变之道 (Translators: Zhu Zhuzhuohong, Zhang Qi). Bejing: 知识产权出版社 (Intellectual Property Press).
Hayes, S. C., & Lillis, J. (2012). Acceptance and Commitment Therapy. Washington, DC: American Psychological Association.
- Chinese translation: Hayes, S. C., & Lillis, J. (2016). 接纳承诺疗法（ACT). Translators: Zhu zhuohong, Cao Jing, & Wang Shujuan. Chongqing: 重庆大学出版社 (Chongqing University Press)
Hayes, S. C., Follette, V. M., & Linehan, M. M. (2004) (Eds.). Mindfulness and acceptance: Expanding the cognitive behavioral tradition. New York: Guilford Press.
- Chinese translation: Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.). (2005.) Mindfulness and acceptance: Expanding the cognitive behavioral tradition. Shanghi: Ewen Publishers. [2011]
Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA: Trumpeter.
- Chinese translation: 羅斯．哈里斯（2009）。快樂是一種陷阱。台北：張老師文化。
Bach, P., & Moran, D. (2008). ACT in practice: Case conceptualization in Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Chinese translation: 帕特里夏·A.巴赫（Patricia A.Bach）、（美國）丹尼爾·J.莫蘭（2011）。接受與實現療法：理論與實務。重慶：重慶大學出版社。
John P. Forsyth, & Georg H. Eifert. (2008). The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free from Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Chinese translation: 約翰．福賽思（John.P.Forsyth）、格奧爾格．艾弗特（Georg H.Eifert）（2010）。晚安，我的不安：緩解焦慮自助手冊。四川：四川人民出版社。
Patricia J. Robinson, & Kirk D. Strosahl. (2008). The Mindfulness and Acceptance Workbook for Depression. Oakland, CA: New Harbinger.
- Chinese translation: 科尔克．斯特尔萨拉，派翠西娅．罗宾逊（2010)。抑郁的自我疗法：用接受与实现疗法走出抑郁。华东：华东师范大学出版社。
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Chinese translation: Hayes, S. C., & Smith, S. (2010). Zǒuchū nǐ de tàidù, zài nǐ de shēnghuó: Xīn Acceptance and Commitment Therapy. Chongqing, China: Chongqing University Press.

Danish

Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Danish translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2013). Acceptance en Commitment Therapy: Psykologisk fleksibilitet og mindfulnessprocessor (2nd edition). Translator: Bjorn Nake. Copenhagen, Denmark: Hans Reitzel Publishers).
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Danish translation: Hayes, S. C., & Smith, S. (2008). Slip tanketyrraniet – tag fat på livet. (Trans. T. Bøgeskov). Copenhagen: Dansk Psykologisk Forlag.

Dutch

Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Dutch translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2012). Acceptance en Commitment Therapie: Veranderingen door mindfulness, het process en de praktijk. (2nd edition). Amsterdam: Pearson Education Publishers.
Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An Acceptance & Commitment Therapy Skills-Training Manual for Therapists. Oakland, CA: New Harbinger & Reno, NV: Context Press.
- Dutch translation: Luoma, J., Hayes, S. C., & Walser, R. (2009). Leer ACT. Vaardigheden voor therapeuten (Trans. L. Berkhuizen, P. van der Kaaij, & J. A-Tjak). Houten, The Netherlands: Bohn Stafleu van Loghum.
Hayes, S. C., Strosahl, K. & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.
- Dutch translation: Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2006). ACT. Een experiëntiële weg naar gedragsverandering. Nederlandse bewerking (trans. By Ando Rokx). ISBN 90 265 1758 0 Verschijnt zomer 2006 Prijs: C.a. € 50, -
Hayes, S. C., Follette, V. M., & Linehan, M. M. (2004) (Eds.). Mindfulness and acceptance: Expanding the cognitive behavioral tradition. New York: Guilford Press.
- Dutch translation: Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.). (2006). Mindfullnes en acceptatie. De derde generatie gedragstherapie . (Trans. By Ando Rokx). Nederlandse bewerking. ISBN 90 265 1759 9 Verschijnt zomer 2006 Prijs: C.a. € 50, -
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Dutch translation: Hayes, S. C., Smith, S. (2006). Uit je hoofd, in het leven. Een werkboek voor een waardevol leven met mindfulness en Acceptatie en Commitment Therapie. (Trans. A. Rokx). Amsterdam: Uitgeverij Nieuwezijds.
Eifert, G. H., McKay, M., & Forsyth, J. P. (2006). Act on life not on anger: The new Acceptance and Commitment Therapy guide to problem anger. Oakland, CA: New Harbinger.
- Dutch translation: Eifert, G. H., Forsyth, J., & McKay, M. (2006). Boosheid de bass: ACT: een nieuwe methode om ergernis en frustratie in de hand te houden. The Netherlands: Thema.
Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA: Trumpeter.
- Dutch translation: (2010): De valstrik van het geluk. Bohn Stafleu van Loghum.

Finnish

Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Finnish translation: Hayes, S. C., & Smith, S. (2008). Vapaudu mielesi vallasta ja ala elää. (Trans. Päivi and Raimo Lappalainen). Tampere, Finland: Suomen Käyttäytymistieteellinen.

French

Polk, K. L., Schoendorff, B., Webster, M., & Olaz, F. O. (2016). The essential guide to the ACT matrix: A step-by-step approach to Using the ACT matrix model in clinical practice. Oakland, CA: New Harbinger Publications.
- French translation: Polk, K. L., Schoendorff, B., Webster, M., & Olaz, F. O. (2017) Guide de la matrice ACT. De Boeck Sup.
Villatte, M., Villatte, J., & Hayes, S. C. (2015). Mastering the clinical conversation: Language as intervention. New York: Guilford.
- French translation: Villatte, M., Villatte, J., & Hayes, S. C. (2019). Maîtriser la conversation clinique: Le langage en therapie. Malakoff: Dunod Editeur.
Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA: Trumpeter.
- French translation (2009): Le piège du bonheur. Montréal : Éditions de l’Homme.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- French translations: Hayes, S. C., & Smith, S. (2013). Penser moins pour etre heureux: Ici et maintenant, accepter so passé, ses peurs et sa tristesse. Paris, France: Groupe Eyrolles.
- Hayes, S. C., & Smith, S. (2019). Penser moins pour etre heureux: Vicure pleinement, ici et mainenant. Paris, France: Editions Eyrolles.

German

Hayes, S. C. (2019). A liberated mind: How to pivot toward what matters. New York: Penguin/Avery.
- German translation: Hayes, S. C. (2020). Kurswechsel im Kopf: Von der Kunst anzunehmen, was ist, und innerlich frei zu werden. Beltz Verlag
Villatte, M., Villatte, J., & Hayes, S. C. (2015). Mastering the clinical conversation: Language as intervention. New York: Guilford.
- German translation: Villatte, M., Villatte, J., & Hayes, S. C. (2020). Beherrschung der klinischen Konversation: Sprache als Intervention. Stuttgart: W. Kohlhammer GmbH.
Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- German translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2014). Akzeptanz & Commitment Therapie: Achtsamkeitsbasierte Veranderungen in Theorie und Praxis (2nd edition). Paderborn, Germany: Junfermann Verlag
Greco, L., & Hayes, S. C. (Eds.). (2008). Acceptance and mindfulness treatments for children and adolescents: A practitioner’s guide. Oakland, CA: New Harbinger.
- German translation: Greco, L., & Hayes, S. C. (Eds.). (2011). Akzeptanz und achtsamkeit in der kinder - und jugendlichenpsychotherapie. Wienheim, Germany: Beltz Verlag.
Hayes, S. C., Strosahl, K. & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.
- German translation: Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2004). Akzeptanz- und Commitment-Therapie: Ein erlebnisorientierter Ansatz zur Verhaltensänderung. München: CIP-Medien. (transl. by Rainer F. Sonntag & Danielle Tittelbach)
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- German translation: Hayes, S. C., & Smith, S. (2007). In abstand zur inneren wortmaschine: Ein selbsthilfe- und therapiebegleitbuch aud der grundlage der Akzeptanz- und Commitment-Therapie. (Trans. G. Kluger). Tübingen, Germany: dgvt-Verlag.
Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An Acceptance & Commitment Therapy Skills-Training Manual for Therapists. Oakland, CA: New Harbinger & Reno, NV: Context Press.
- German translation (2009): ACT-Training. Reihe Fachbuch, ACT für die klinische Praxis; Acceptance & Commitment Therapie: ein Handbuch. Ein Lernprogramm in zehn Schritten. Translators:Theo Kierdorf, Hildegard Höhr. (ISBN: 978-3-873877-00-9).

Hebrew

Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Hebrew translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2014). תרפיית קבלה ומחויבות: תהליך ועבודה מעשית ליצירת שינוי קשוב (2nd edition). Haifa, Israel: Ach Publishers.

Italian

Luoma, J., Hayes, S. C., & Walser, R. (2017). Learning ACT: An Acceptance & Commitment Therapy skills-training manual for therapists (2nd ed). Oakland, CA: Context Press / New Harbinger Publications.
- Italian translation: Luoma, J., Hayes, S. C., & Walser, R. (2019). Il manuale del terapeuta ACT: Apprendere e allenare le abilita dell’ Acceptance & Commitment Therapy (2nd ed). Rome, Italy: Giovanni Fioriti Editore.
Villatte, M., Villatte, J., & Hayes, S. C. (2015). Mastering the clinical conversation: Language as intervention. New York: Guilford.
- Italian translation: Villatte, M., Villatte, J., & Hayes, S. C. (2020). Il dialogo clinic: Funzione, valore e centralita del linguaggio in psicoterapia. Milan: Franco Angeli.
Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Italian translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2013). Teoria e pratica del l'Acceptance and Commitment Therapy. (2nd edition). Translation edited by Cesare Maffei. Translators: Nidia Morra and Nicolò Gaj. Milan, Italy: Rafaello Cortina Editore.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Italian translation (2010): Hayes, S. C., & Smith, S. (2010). Smetti di Soffrire, Inizia a Vivere. (ed. IT P. Moderato trans. ACT-Italia) Milano: Franco-Angeli. Visit the ACT-Italia site for information on how to purchase this book. Translators: Ilaria Balasini, Sara Borelli, Katia Covati Katia Manduchi, Giovambattista Presti, Anna Bianca Prevedini, Elisa Rabitti, Massimo Ronchei, Francesca Scaglia, Giovanni Zucchi, Silverio Zucchi, Giovanni Miselli.

Japanese

Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Japanese translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2014). Juyō to komittomentoserapī. Suginami City, Japan: Seiwa Shoten.
Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA: Trumpeter.
- Japanese translation:幸福になりたいなら幸福になろうとしてはいけない: マインドフルネスから生まれた心理療法ACT入門 (単行本) (Japanese) Tankobon Hardcover – December 17, 2015
Greco, L., & Hayes, S. C. (Eds.). (2008). Acceptance and mindfulness treatments for children and adolescents: A practitioner’s guide. Oakland, CA: New Harbinger.
- Japanese translation: Greco, L., & Hayes, S. C. (Eds.). (2013). Shōni oyobi seinen no tame no ukeire to maindofurunesu ryōhō: jitsumu sha no tame no gaido (Translation Supervisor: T. Muto). Tokyo, Japan: Akashi Shoten.
Bach, P., & Moran, D. (2008). ACT in practice: Case conceptualization in Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Japanese translation (2009): ACT wo jissenn-suru. (Trans. T. Muto, M. Yoshioka, K. Ishikawa, & A. Kumano) Tokyo: Seiwa-shoten. www.seiwa-pb.co.jp/
Ramnero, J., & Torneke, N. (2008). ABCs of human behavior: Behavioral principles for the practicing clinician. Oakland, CA: Context Press / New Harbinger.
- Japanese translation (2009): Rinshou-koudou-bunnseki no ABC. (Trans. T. Muto, N. Yoneyama, & J. Tanaka-Matsumi) Tokyo: Nihon-Hyoron-sha. www.nippyo.co.jp
Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An Acceptance & Commitment Therapy Skills-Training Manual for Therapists. Oakland, CA: New Harbinger & Reno, NV: Context Press.
- Japanese translation (2009): ACT wo manabu. (Trans. H. Kumano, F. Takahashi, & T. Muto) Tokyo: Seiwa-shoten. www.seiwa-pb.co.jp
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Japanese translation (2008): Anata no Jinsei wo Hajimeru tameno Workbook: Kokoro tono Atarashii Tsukiai kata, Acceptance and Commitment (Trans. T. Muto, H. Harai, M. Yoshioka, & M. Okajima). Tokyo: Brain Shuppan.
Hayes, S. C., Follette, V. M., & Linehan, M. M. (2004) (Eds.). Mindfulness and acceptance: Expanding the cognitive behavioral tradition. New York: Guilford Press.
- Japanese translation (2005): Maindofurunesu ando akuseputansu; Ninchikodo-ryoho no shinjigen. (Trans. by Y. Haruki, T. Muto, Y. Ito, & Y. Sugiura). Tokyo: Brain-shuppan.

Korean

Villatte, M., Villatte, J., & Hayes, S. C. (2015). Mastering the clinical conversation: Language as intervention. New York: Guilford.
- Korean translation: Villatte, M., Villatte, J., & Hayes, S. C. (in press). Imsang daehwa maseuteohagi : Gaeib-euloseoui eon-eo. Seoul: Life and Knowledge Publishing
Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Korean translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2018). Acceptance and Commitment Therapy: The process and practice of mindful change. Soule, Korea: Sigma Press.
Greco, L., & Hayes, S. C. (Eds.). (2008). Acceptance and mindfulness treatments for children and adolescents: A practitioner’s guide. Oakland, CA: New Harbinger.
- Korean translation: Greco, L., & Hayes, S. C. (Eds.). (2012). Eo-ri-ni-wa cheong-so-nyeo-neu-rwi-han su-yong mit mindfulness teu-ri-teu. Soule, Korea: Sigma Press.
Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An Acceptance & Commitment Therapy Skills-Training Manual for Therapists. Oakland, CA: New Harbinger & Reno, NV: Context Press.
- Korean translation: Luoma, J., Hayes, S. C., & Walser, R. (2012). Bae-u-gi ACT. Soule, Korea: Hakjisa Publishers.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Korean translation: Hayes, S. C., & Smith, S. (2010). 마음에서 빠져나와 삶 속으로 들어가라 새 수용전념치료. Seoul: Hakjisa Publishers.
Hayes, S. C., Strosahl, K. & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.
- Korean translation: Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2009). 수용과 참여의 심리치료. Sigmapress (translated by Moon, S-W & Kim, E.). Click here to buy this book.
Hayes, S. C., & Strosahl, K. D. (2004) (Eds.). A practical guide to Acceptance and Commitment Therapy. New York: Springer-Verlag.
- There is a Korean translation in press from Hakjisa Publisher
McCurry, C. (2011). Parenting your anxious child with mindfulness. Oakland, CA: New Harbinger.
- Korean translation: McCurry, C. (2011). 불안한 아이 수용과 마음챙김으로 키우기. Sigmapress (translated by Lee, S.).
Forsyth, J. P. & Eifert, G. H. (2008). The Mindfulness and Acceptance Workbook for Anxiety Workbook: A guide to breaking free from anxiety, phobias, & worry using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Korean translation: Forsyth, J. P. & Eifert, G. H. (2008). 마음챙김과 수용중심 불안장애 치료의 실제. Sigmapress (translated by Lee, S., Han, H., Jung, E.).
Törneke, N. (2010). Learning RFT: An Introduction to Relational Frame Theory and Its Clinical Application. Reno, NV: Context Press.
- Korean translation: Törneke, N. (2019). Learning RFT: An Introduction to Relational Frame Theory and Its Clinical Application. Hakjisa (translated by Lee, S.).

Norwegian

Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Norwegian Translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2018) Aksept og verdibasert adferdsterapi (ACT) Mindfull endring - prosess og praksis. Oslo: Arneberg Forlag.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Norwegian translation: Hayes, S. C., & Smith, S. (2015). Slutt å gruble begynn å leve. Oslo: Arneberg Forlag.

Persian

Vowles, K. E., & Sorrell, J. T. (2008). Life with chronic pain: an acceptance-based approach (therapist guide and patient workbook).
- Persian translation: Vowles, K. E., & Sorrell, J. T. (2008). زندگی با درد مزمن: رویکرد مبتنی بر پذیرش. zendegi ba darde mozmen: roykarde mobtani bar paziresh (rahnamaye darmangar va ketabe kare bimar). translated by F. Mesgarian. Tehran: Arjmand.

Polish

Hayes, S. C. (2019). A liberated mind: How to pivot toward what matters. New York: Penguin/Avery.
- Polish translation: Hayes S. C. (2020). Umysł Wyzwolony. Zakończ wewnętrzną walkę i żyj w zgodzie ze sobą. Sopot: Gdańskie Wydawnictwo Psychologiczne.
Hayes, L. L., & Ciarrochi, J. (2015). The Thriving Adolescent: Using Acceptance and Commitment Therapy and Positive Psychology to Help Teens Manage Emotions, Achieve Goals, and Build Connection. Oakland, CA: New Harbinger.
- Polish translation: Hayes, L., Ciarrochi, J. (2019). TRUDNY CZAS DOJRZEWANIA. Jak pomóc nastolatkom radzić sobie z emocjami, osiągać cele i budować więzi, stosując terapię akceptacji i zaangażowania oraz psychologię pozytywną. Gdańsk: GWP.
Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Polish translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2015). Terapia akceptacji i zaangażowania (2nd edition). Krakow, Poland: Jagiellonian University Press.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Polish translation: Hayes, S. C., & Smith, S. (2014). W pulapce mysli: Jak skutecznie poradzic sobie z depresja, stresem I lekiem. Gdansk: Gdanskie Wydawnictwo Psychologizne.

Portuguese

Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Portuguese translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2021). Terapia de aceitacao e compromisso: a processo e a practica da mundanca consciente (2a editcao). Translation edited by Sandra Maria Mallmann da Rosa. Porto Alegre, Brazil: Artmed.

Romanian

Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Romanian translation: Hayes, S. C., & Smith, S. (2013). Ieși din scenariile minții și trăiește-ți viața. (Trans. K. Szabo). Lași, Romania: Editura Poliram.

Russian

Hayes, S. C. (2019). A liberated mind: How to pivot toward what matters. New York: Penguin/Avery.
- Russian translation: Hayes S. C. (2021). Освобождённый разум. Moscow: Бомбора (Bombora).

Serbian / Bosnian / Croatian / Montenegrin

Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Serbian / Bosnian / Croatian / Montenegrin translation: Hayes, S. C., & Smith, S. (2017). Centar za Kongnitivno-Bohejvioralnu Terapiju. Banja Luka, Bosnia Hercegovina: My Books / Centar za kognitivno-bihejvioralnu terapiju.

Spanish

Villatte, M., Villatte, J., & Hayes, S. C. (2015). Mastering the clinical conversation: Language as intervention. New York: Guilford.
- Spanish translation: Villatte, M., Villatte, J., & Hayes, S. C. (2019). Gerente la conversación clínica: El lenguaje como intervención. Madrid: Madrid Institute of Contextual Psychology.
Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Spanish translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2014). Terapia de aceptacion y compromise: Proceso y practica del cambio (2nd edition). Translation edited by Ramiro Alvarez. Bilbao, Spain: Desclee de Brouwer.
Twohig, M., & Hayes, S. C. (2008). ACT verbatim: Depression and Anxiety. Oakland, CA: New Harbinger; Reno, NV: Context Press.
- Spanish translation: Twohig, M., & Hayes, S. C. (2019). ACT en la practica clinica para le depression y la ansiedad. Bilbao, Spain: Desclee de Brouwer.
Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA: Trumpeter.
- Spanish translation (2008): Las Trampas De La Felicidad. Grupo Editorial Patria.
Harris, R. (2011). The Confidence Gap. Boston, MA: Trumpeter.
- Spanish translation (2012): Cuestión de Confianza. Santander. Sal Terrae.
Hayes, S.C. (2005). Get Out of Your Mind and Into Your Life. Oakland, CA: New Harbinger Publications.
- Spanish translation (May 2013): Sal de tu mente, entra en tu vida. Bilbao. Desclée de Brouwer.
Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Spanish translation (2014) Terapia de aceptacion y compromise: Proceso y practica del cambio (2nd edition). Translation edited by Ramiro Alvarez. Bilbao, Spain: Desclee de Brouwer.

Swedish

Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition). New York: The Guilford Press.
- Swedish translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2014). ACT – Acceptance and Commitment Therapy i teori och tillamping: Vagen till psykologisk flexibilitet (2nd edition). Stockholm, Sweden: Natur Och Kulture.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
- Swedish translation: Hayes, S. C., & Smith, S. (2007). Sluta grubbla Borja leva. (Trans. A. Ghaderi). Stockholm: Natur och Kultur.
Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA: Trumpeter.
- Swedish translation: (2009): Lykofallan. Stockholm, Sweden.

Translated ACT Books by English Title

Translations of Hayes, S. C. (2019). A liberated mind: How to pivot toward what matters. New York: Penguin/Avery.

German Translation: Hayes, S. C. (2020). Kurswechsel im Kopf: Von der Kunst anzunehmen, was ist, und innerlich frei zu werden. Beltz Verlag.
Polish Translation: Hayes S. C. (2020). Umysł Wyzwolony. Zakończ wewnętrzną walkę i żyj w zgodzie ze sobą. Sopot: Gdańskie Wydawnictwo Psychologiczne.
Russian Translation: Hayes S. C. (2021). Освобождённый разум. Moscow: Бомбора (Bombora).

Translations of Luoma, J., Hayes, S. C., & Walser, R. (2017). Learning ACT: An Acceptance & Commitment Therapy skills-training manual for therapists (2nd ed). Oakland, CA: Context Press / New Harbinger Publications.

Italian translation: Luoma, J., Hayes, S. C., & Walser, R. (2019). Il manuale del terapeuta ACT: Apprendere e allenare le abilita dell’ Acceptance & Commitment Therapy (2nd ed). Rome, Italy: Giovanni Fioriti Editore.

Translations of Polk, K. L., Schoendorff, B., Webster, M., & Olaz, F. O. (2016). The essential guide to the ACT matrix: A step-by-step approach to Using the ACT matrix model in clinical practice. Oakland, CA: New Harbinger Publications.

French translation: Polk, K. L., Schoendorff, B., Webster, M., & Olaz, F. O. (2017) Guide de la matrice ACT. De Boeck Sup.

Translations Villatte, M., Villatte, J., & Hayes, S. C. (2015). Mastering the clinical conversation: Language as intervention. New York: Guilford.

French translation: Villatte, M., Villatte, J., & Hayes, S. C. (2019). Maîtriser la conversation clinique: Le langage en therapie. Malakoff: Dunod Editeur.
German translation: Villatte, M., Villatte, J., & Hayes, S. C. (2020). Beherrschung der klinischen Konversation: Sprache als Intervention. Stuttgart: W. Kohlhammer GmbH.
Italian translation: Villatte, M., Villatte, J., & Hayes, S. C. (2020). Il dialogo clinic: Funzione, valore e centralita del linguaggio in psicoterapia. Milan: Franco Angeli.
Korean translation: Villatte, M., Villatte, J., & Hayes, S. C. (in press). Imsang daehwa maseuteohagi : Gaeib-euloseoui eon-eo. Seoul: Life and Knowledge Publishing.
Spanish translation: Villatte, M., Villatte, J., & Hayes, S. C. (2019). Gerente la conversación clínica: El lenguaje como intervención. Madrid: Madrid Institute of Contextual Psychology.

Translations of Hayes, L. L., & Ciarrochi, J. (2015). The Thriving Adolescent: Using Acceptance and Commitment Therapy and Positive Psychology to Help Teens Manage Emotions, Achieve Goals, and Build Connection. Oakland, CA: New Harbinger.

Polish translation: Hayes, L., Ciarrochi, J. (2019). TRUDNY CZAS DOJRZEWANIA. Jak pomóc nastolatkom radzić sobie z emocjami, osiągać cele i budować więzi, stosując terapię akceptacji i zaangażowania oraz psychologię pozytywną. Gdańsk: GWP.

Translations of Hayes, S. C., Strosahl, K., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The process and practice of mindful change (2nd edition). New York: Guilford Press.

Dutch translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2012). Acceptance en Commitment Therapie: Veranderingen door mindfulness, het process en de praktijk. (2nd edition). Amsterdam: Pearson Education Publishers.
Danish translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2013). Acceptance en Commitment Therapy: Psykologisk fleksibilitet og mindfulnessprocessor (2nd edition). Translator: Bjorn Nake. Copenhagen, Denmark: Hans Reitzel Publishers).
Italian translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2013). Teoria e pratica del l'Acceptance and Commitment Therapy. (2nd edition). Translation edited by Cesare Maffei. Translators: Nidia Morra and Nicolò Gaj. Milan, Italy: Rafaello Cortina Editore.
Spanish translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2014). Terapia de aceptacion y compromise: Proceso y practica del cambio (2nd edition). Translation edited by Ramiro Alvarez. Bilbao, Spain: Desclee de Brouwer.
Swedish translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2014). ACT – Acceptance and Commitment Therapy i teori och tillamping: Vagen till psykologisk flexibilitet (2nd edition). Stockholm, Sweden: Natur Och Kulture.
German translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2014). Akzeptanz & Commitment Therapie: Achtsamkeitsbasierte Veranderungen in Theorie und Praxis (2nd edition). Paderborn, Germany: Junfermann Verlag;
Norwegian translation: Hayes, S. C., Strosahl, K., & Wilson, K. G. (2018) Aksept og verdibasert adferdsterapi (ACT) Mindfull endring - prosess og praksis. Oslo: Arneberg Forlag.
Japanese translation: (Suginami City, Japan: Seiwa Shoten
Chinese translation
Polish translation: (Krakow, Poland: Jagiellonian University Press)
Hebrew translation: (Haifa, Israel: Ach Publishers)
Korean translation: (Soule, Korea: Sigma Press)
Portuguese translation: (Porto Alegre, Brazil: Artmed)

Translations of Hayes, S. C., Strosahl, K. & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.

German translation: Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2004). Akzeptanz- und Commitment-Therapie: Ein erlebnisorientierter Ansatz zur Verhaltensänderung. München: CIP-Medien. (transl. by Rainer F. Sonntag & Danielle Tittelbach)
Dutch translation: Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2006). ACT. Een experiëntiële weg naar gedragsverandering. Nederlandse bewerking (trans. By Ando Rokx). ISBN 90 265 1758 0 Verschijnt zomer 2006 Prijs: C.a. € 50, -
Korean translation: Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2009). 수용과 참여의 심리치료. Sigmapress (translated by Moon, S-W & Kim, E.). Click here to buy this book.

Translations of Hayes, S. C., & Strosahl, K. D. (2004) (Eds.). A practical guide to Acceptance and Commitment Therapy. New York: Springer-Verlag.

There is a Korean translation in press from Hakjisa Publisher
Japanese translation (in press). Akashi Shoten Co.

Translations of Hayes, S. C., Follette, V. M., & Linehan, M. M. (2004) (Eds.). Mindfulness and acceptance: Expanding the cognitive behavioral tradition. New York: Guilford Press.

Dutch translation: Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.). (2006). Mindfullnes en acceptatie. De derde generatie gedragstherapie . (Trans. By Ando Rokx). Nederlandse bewerking. ISBN 90 265 1759 9 Verschijnt zomer 2006 Prijs: C.a. € 50, -
Japanese translation: Hayes, S. C., Follette, V. M., & Linehan, M. M. (2005.) Maindofurunesu ando akuseputansu; Ninchikodo-ryoho no shinjigen. (Trans. by Y. Haruki, T. Muto, Y. Ito, & Y. Sugiura). Tokyo: Brain-shuppan.
Korean translation: Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.). (2005.) Mindfulness and acceptance: Expanding the cognitive behavioral tradition. Seoul: Meditation Counseling Research Institute. [2009]
Chinese translation: Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.). (2005.) Mindfulness and acceptance: Expanding the cognitive behavioral tradition. Shanghi: Ewen Publishers. [2011]

Translations of Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger. (Winner of the Association for Behavioral and Cognitive Therapies Self-Help Book of Merit Award, 2010)

Danish translation: Hayes, S. C., & Smith, S. (2008). Slip tanketyrraniet – tag fat på livet. (Trans. T. Bøgeskov). Copenhagen: Dansk Psykologisk Forlag.
Dutch translation: Hayes, S. C., Smith, S. (2006). Uit je hoofd, in het leven. Een werkboek voor een waardevol leven met mindfulness en Acceptatie en Commitment Therapie. (Trans. A. Rokx). Amsterdam: Uitgeverij Nieuwezijds.
Finnish translation: Hayes, S. C., & Smith, S. (2008). Vapaudu mielesi vallasta ja ala elää. (Trans. Päivi and Raimo Lappalainen). Tampere, Finland: Suomen Käyttäytymistieteellinen.
German translation: Hayes, S. C., & Smith, S. (2007). In abstand zur inneren wortmaschine: Ein selbsthilfe- und therapiebegleitbuch aud der grundlage der Akzeptanz- und Commitment-Therapie. (Trans. G. Kluger). Tübingen, Germany: dgvt-Verlag.
Italian translation (2010): Hayes, S. C., & Smith, S. (2010). Smetti di Soffrire, Inizia a Vivere. (ed. IT P. Moderato trans. ACT-Italia) Milano: Franco-Angeli. www.act-italia.org
French translation: Hayes, S. C., & Smith, S. (2013). Penser Moins pour etre heureux: Ici et maintenant, accepter so passé, ses peurs et sa tristesse. Paris, France: Groupe Ayrolles.
Chinese translation: Hayes, S. C., & Smith, S. (2010). Zǒuchū nǐ de tàidù, zài nǐ de shēnghuó: Xīn Acceptance and Commitment Therapy. Chongqing, China: Chongqing University Press.
Korean translation: Hayes, S. C., & Smith, S. (2010). 마음에서 빠져나와 삶 속으로 들어가라 새 수용전념치료. Seoul: Hakjisa Publishers.
Japanese translation: Hayes, S. C., & Smith, S. (2008). Anata no Jinsei wo Hajimeru tameno Workbook: Kokoro tono Atarashii Tsukiai kata, Acceptance and Commitment (Trans. T. Muto, H. Harai, M. Yoshioka, & M. Okajima). Tokyo: Brain Shuppan.
Second Japanese translation: Hayes, S. C., & Smith, S. (2010). Anata no Jinsei wo Hajimeru tameno Workbook: Kokoro tono Atarashii Tsukiai kata, Acceptance and Commitment (Trans. T. Muto, H. Harai, M. Yoshioka, & M. Okajima). Tokyo: Seiwa Shoten Publishers.
Swedish translation: Hayes, S. C., & Smith, S. (2007). Sluta grubbla Borja leva. (Trans. A. Ghaderi). Stockholm: Natur och Kultur.
Romanian translation: Hayes, S. C., & Smith, S. (2013). Ieși din scenariile minții și trăiește-ți viața. (Trans. K. Szabo). Lași, Romania: Editura Poliram.
Bosnian translation: Hayes, S. C., & Smith, S. (in press). Centar za Kongnitivno-Bohejvioralnu Terapiju.
Croatian translation: Hayes, S. C., & Smith, S. (in press). Centar za Kongnitivno-Bohejvioralnu Terapiju.
Montenegrin translation: Hayes, S. C., & Smith, S. (in press). Centar za Kongnitivno-Bohejvioralnu Terapiju.
Serbian translation: Hayes, S. C., & Smith, S. (in press). Centar za Kongnitivno-Bohejvioralnu Terapiju.
Polish translation: Hayes, S. C., & Smith, S. (n press). Gdansk: Gdanskie Wydawnictwo Psychologizne.
Spanish translation: Hayes, S. C., & Smith, S. (2013). Sal de tu mente entra en tu vida: La nueva Terapia de Aceptación y Compromiso. Bilbao, Spain: Editorial Desclée De Brouwer.
For the visually impaired (or just those who like audio books) there is an Audio book version: New York: Tantor Audio (2012)

Translation of Eifert, G. H., McKay, M., & Forsyth, J. P. (2006). Act on life not on anger: The new Acceptance and Commitment Therapy guide to problem anger. Oakland, CA: New Harbinger.

Dutch translation: Eifert, G. H., Forsyth, J., & McKay, M. (2006). Boosheid de bass: ACT: een nieuwe methode om ergernis en frustratie in de hand te houden. The Netherlands: Thema.

Translation of Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Boston, MA: Trumpeter.

Spanish translation (2008): Las Trampas De La Felicidad. Grupo Editorial Patria.
Chinese translation: 羅斯．哈里斯（2009）。快樂是一種陷阱。台北：張老師文化。
French translation: (2009): Le piège du bonheur. Montréal : Éditions de l’Homme.
Japanese translation: 幸福になりたいなら幸福になろうとしてはいけない: マインドフルネスから生まれた心理療法ACT入門 (単行本) (Japanese) Tankobon Hardcover – December 17, 2015
Dutch translation: (2010): De valstrik van het geluk. Bohn Stafleu van Loghum.
Swedish translation: (2009): Lykofallan. Stockholm, Sweden.

Translation of Harris, R. (2011). The Confidence Gap. Boston, MA: Trumpeter.

Spanish translation (2012): Cuestión de Confianza. Santander. Sal Terrae.

Translations of Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An Acceptance & Commitment Therapy Skills-Training Manual for Therapists. Oakland, CA: New Harbinger & Reno, NV: Context Press.

German translation (2009): ACT-Training. Reihe Fachbuch, ACT für die klinische Praxis; Acceptance & Commitment Therapie: ein Handbuch. Ein Lernprogramm in zehn Schritten. Translators:Theo Kierdorf, Hildegard Höhr. (ISBN: 978-3-873877-00-9).
Japanese translation (2009): ACT wo manabu. (Trans. H. Kumano, F. Takahashi, & T. Muto) Tokyo: Seiwa-shoten. www.seiwa-pb.co.jp
Dutch translation: Luoma, J., Hayes, S. C., & Walser, R. (2009). Leer ACT. Vaardigheden voor therapeuten (Trans. L. Berkhuizen, P. van der Kaaij, & J. A-Tjak). Houten, The Netherlands: Bohn Stafleu van Loghum.
Korean translation: Luoma, J., Hayes, S. C., & Walser, R. (20012). Bae-u-gi ACT. Soule, Korea: Hakjisa Publishers.

Translations of Bach, P., & Moran, D. (2008). ACT in practice: Case conceptualization in Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

Japanese translation (2009): ACT wo jissenn-suru. (Trans. T. Muto, M. Yoshioka, K. Ishikawa, & A. Kumano) Tokyo: Seiwa-shoten. www.seiwa-pb.co.jp
Chinese translation: 帕特里夏·A.巴赫（Patricia A.Bach）、（美國）丹尼爾·J.莫蘭（2011）。接受與實現療法：理論與實務。重慶：重慶大學出版社

Translation of Ramnero, J., & Torneke, N. (2008). ABCs of human behavior: Behavioral principles for the practicing clinician. Oakland, CA: Context Press / New Harbinger.

Japanese translation (2009): Rinshou-koudou-bunnseki no ABC. (Trans. T. Muto, N. Yoneyama, & J. Tanaka-Matsumi) Tokyo: Nihon-Hyoron-sha. www.nippyo.co.jp

Translations of Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001). Relational Frame Theory: A Post-Skinnerian account of human language and cognition. New York: Plenum Press.

Japanese translation: Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2009). Relational Frame Theory: A Post-Skinnerian account of human language and cognition. Tokyo: Seiwa Shoten.

Translation of Forsyth, J. P. & Eifert, G. H. (2008). The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free from Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

Chinese translation: 約翰．福賽思（John.P.Forsyth）、格奧爾格．艾弗特（Georg H.Eifert）（2010）。晚安，我的不安：緩解焦慮自助手冊。四川：四川人民出版社。

Translation of Robinson, P. J. & Strosahl, K. D. (2008). The Mindfulness and Acceptance Workbook for Depression. Oakland, CA: New Harbinger.

Chinese translation: 科尔克．斯特尔萨拉，派翠西娅．罗宾逊（2010)。抑郁的自我疗法：用接受与实现疗法走出抑郁。华东：华东师范大学出版社。

Jen Plumb October 14, 2009 - 5:34am

Examples of Books on ACT and RFT

This is a partial list as of 2014

General ACT Books: Professionals

Luoma, J., Hayes, S. C. & Walser, R. (2007). Learning ACT. Oakland, CA: New Harbinger. [A step by step learning companion for the main ACT book below. Very practical and helpful]

Hayes, S. C., Strosahl, K., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The process and practice of mindful change (2nd edition). New York: Guilford Press. [This is still the heart of the ACT literature. It is where it started]

Wilson, K. G. & Dufrene, T. (2009). Mindfulness for two: An Acceptance and Commitment Therapy approach to mindfulness in psychotherapy. Oakland, CA: New Harbinger. [A book on ACT that emphasizes mindfulness and the therapeutic relationship]

Hayes, S. C. & Strosahl, K. D. (2005). A Practical Guide to Acceptance and Commitment Therapy. New York: Springer-Verlag. [Shows how to do ACT with a variety of populations]

Twohig, M., & Hayes, S. C. (2008). ACT verbatim: Depression and Anxiety. Oakland, CA: New Harbinger; Reno, NV: Context Press. [Good example of ACT in actual practice]

Chantry, D. (2007). Talking ACT: Notes and conversations on Acceptance and Commitment Therapy. Reno, NV: Context Press. [This is an edited version of the ACT listserv from July 2002 through August 2005 compiled by a therapist, for therapists. Functions as a quick reference on a wide range of ACT topics (acceptance, anxiety, behavior analysis, choice, clinical resources, contextualism, etc)]

Ciarrochi, J. V. & Bailey, A. (2008). A CBT practitioner’s guide to ACT. Oakland, CA: New Harbinger. [Does what the title says it does]

Batten, S. (2011). Essentials of Acceptance and Commitment Therapy. London: Sage. [Broad introduction to ACT]

Harris, R. (2009). ACT made simple. Oakland, CA: New Harbinger. [Easy place to start with ACT]

Hayes, S. C. & Lillis, J. (2012). Introduction to Acceptance and Commitment Therapy. Washington, DC: American Psychological Association. [Books specifically for students learning about ACT]

General ACT Books: Clients

Hayes, S. C. & Smith, S. (2005). Get out of your mind and into your life. Oakland, CA: New Harbinger. [A general purpose ACT workbook. RCTs show that it works as an aid to ACT or on its own, but it will also keep new ACT therapists well oriented]

Harris, R. (2008). The happiness trap. New York: Shambala. [Very accessible ACT book for the public]

Trauma: Professional book

Walser, R., & Westrup, D. (2007). Acceptance & Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder & Trauma-Related Problems: A Practitioner's Guide to Using Mindfulness & Acceptance Strategies. Oakland, CA: New Harbinger. [A very practical and accessible approach to using ACT to treat post-traumatic stress disorder (PTSD) and acute trauma-related symptoms.]

Trauma: Client book

Follette, V. M., & Pistorello, J. (2007). Finding Life Beyond Trauma: Using Acceptance and Commitment Therapy to Heal from Post-Traumatic Stress and Trauma-Related Problems. Oakland, CA: New Harbinger. [Applies the principles of ACT to help readers cope with the after effects of traumatic experience. Straightforward, practical, and useful]

Depression: Professional book

Zettle, R. (2007). ACT for Depression: A Clinician's Guide to Using Acceptance & Commitment Therapy in Treating Depression. Oakland, CA: New Harbinger. [An solid book from one of the founders of ACT on one of the most pervasive problems human beings face.]

Depression: Client book

Strosahl, K. & Robinson, P. J. (2008). The Mindfulness & Acceptance Workbook for Depression: Using Acceptance & Commitment Therapy to Move Through Depression & Create a Life Worth Living. Oakland: New Harbinger. [Great workbook on ACT for depression]

Anxiety: Professional book

Eifert, G. & Forsyth, J. (2005). Acceptance and Commitment Therapy for anxiety disorders. Oakland: New Harbinger. [Good book with a protocol that shows how to mix ACT processes into a brief therapy for anxiety disorders].

Anxiety: Client book

Forsyth, J., & Eifert, G. (2007). The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free from Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy. Oakland: New Harbinger. [Solid workbook for anxiety]

Worry: Client book

Lejeune, C. (2007). The Worry Trap: How to Free Yourself from Worry & Anxiety using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger. [A guide to the application of ACT to worry and generalized anxiety.]

Chronic pain: Professional books

Dahl, J., Wilson, K. G., Luciano, C., & Hayes, S. C. (2005). Acceptance and Commitment Therapy for Chronic Pain. Reno, NV: Context Press. [Describes an ACT approach to chronic pain. Very accessible and readable. One of the better clinical expositions on how to do ACT values work.]

McCracken, L. M. (2005). Contextual Cognitive-Behavioral Therapy for chronic pain. Seattle, WA: International Association for the Study of Pain. [[Describes an interdisciplinary ACT-based approach to chronic pain

Chronic pain: Client book

Dahl, J. C., & Lundgren, T. L. (2006). Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain. Oakland, CA: New Harbinger. [Uses ACT principles to help those suffering from pain transcend the experience by reconnecting with other, more valued aspects of their lives.]

Anger: Client book

Eifert, G. H., McKay, M., & Forsyth, J. P. (2006). ACT on life not on anger: The new Acceptance and Commitment Therapy guide to problem anger. Oakland, CA: New Harbinger. [The first book to adapt ACT principles to dealing with anger. It teaches readers how to change their relationship to anger by accepting rather than resisting angry feelings and learning to make values-based responses to provocation. Has been tested successfully in a small randomized trial.]

Caregivers: Client book

McCurry, S. M. (2006). When a family member has dementia: Steps to becoming a resilient caregiver. Westport, CT: Praeger Publishers. [Although not directly on ACT or mindfulness, this book for caregivers does include a significant emphasis on acceptance, as might make sense given that the author is on of the early ACT therapists from UNR.]

Eating disorders: Client book

Heffner, M., & Eifert, G. H. (2004). The anorexia workbook: How to accept yourself, heal suffering, and reclaim your life. Oakland, CA: New Harbinger. [An eating disorders patient workbook on ACT.]

Diabetes management: Client book

Gregg, J., Callaghan, G., & Hayes, S. C. (2007). The diabetes lifestyle book: Facing your fears and making changes for a long and healthy life. Oakland, CA: New Harbinger. [You cannot tell from the title but this is a book applying ACT to diabetes management.]

Organizational issues: Professional book

Hayes, S. C., Bond, F. W., Barnes-Holmes, D., & Austin, J. (2007). Acceptance and Mindfulness at Work: Applying Acceptance and Commitment Therapy and Relational Frame Theory to Organizational Behavioral Management. Binghamton, NY: Haworth Press. [This was a special issue of the Journal of Organizational Behavior Management that was bound into book form. Don't buy it expecting a smooth presentation of the applicability of ACT and RFT to organizational issues -- it is a collection of journal articles gather into a book. But it is still worthwhile if I/O is your area and you are wondering how ACT and RFT might apply.]

Human performance: Professional book

Gardner, F.L., & Moore, Z.E. (2007). The psychology of enhancing human performance: The Mindfulness-Acceptance-Commitment (MAC) approach. New York: Springer.
[This book provides theory and empirical background, and a structured step-by-step, protocol for the assessment, conceptualization, and enhancement of human performance with a variety of high-performing clientele including executives, athletes, artists, and emergency/military personnel].

Trichotillomania: Professional book

Woods, D. W., & Twohig, M. P. (2008). Trichotillomania: An ACT-enhanced Behavior Therapy Approach Therapist Guide. New York: Oxford University Press.

Trichotillomania: Client book

Woods, D. W., & Twohig, M. P. (2008). Trichotillomania: An ACT-enhanced Behavior Therapy Approach Workbook. New York: Oxford University Press.

Behavioral Medicine: Professional book

McCracken, L. (2011). Mindfulness and Acceptance in Behavioral Medicine. Oakland, CA: New Harbinger.

Assessment: Professional book

Baer, R. (2010). Assessing Mindfulness & Acceptance Processes in Clients: Illuminating the Theory & Practice of Change. Oakland, CA: New Harbinger.

Primary care settings: Professional book

Robinson, P. J., Gould, D. A., & Strosahl, K. D. (2011). Real behavior change in primary care. Oakland, CA: New Harbinger.

Irritable Bowel Syndrome: Client book

Ferreira, N. B. & Gillanders, D. T (2012) Better Living with IBS: A step-by-step program to managing your symptoms so you can enjoy life to the full! Exsile Publishing, New South Wales.

Psychosis: Professional book

Morris, E. M. J., Johns, L. C., & Oliver, J. E. (2013) (Eds). Acceptance and Commitment Therapy and mindfulness for psychosis. London: Wiley-Blackwell. ISBN: 978-1-1199-5079-0

Sleep: Client book

Meadows, G. (2014). The sleep book: How to sleep well every night. London, UK: Orion.

Steven Hayes March 31, 2014 - 11:34am

Persian

This list is no longer being updated. Please click here for a list of ACT Books in 20+ Languages.

Vowles, K. E., & Sorrell, J. T. (2008). Life with chronic pain: an acceptance-based approach (therapist guide and patient workbook).

Persian translation: Vowles, K. E., & Sorrell, J. T. (2008). زندگی با درد مزمن: رویکرد مبتنی بر پذیرش. translated by F. Mesgarian. Tehran: Arjmand.

fatemeh April 20, 2013 - 12:57pm

Original Non-English ACT Books

This list is no longer being updated. Please click here for a list of ACT Books in 20+ Languages.

Original Non-English ACT Books

Danish (Dansk)

Grønlund, C. & Møller Rasmussen, S. (2015). Rundt om ACT : muligheder og metode i acceptance and commitment therapy. Frydenlund.
- This first Danish-written anthology on ACT (Acceptance and Commitment Therapy) goes in depth with the method's many application possibilities - seen through the eyes of Danish therapists.
Ramussen, S. & Taggaard Nielsen, O. (2010). Introduktion til ACT. Copenhagen: Dansk Psykologisk Forlag.

Dutch (Nederlandstalig)

A-Tjak, J., & De Groot, F. (Eds.). (2008) . Acceptance and commitment therapy: Een inleiding voor hulpverleners. Houten: Bohn Stafleu van Loghum. (ISBN 978 90 313 5894 6. NUR 777)
- An original edited volume about ACT.
Jansen, G. (2006). Denk wat I wilt doe wat I droomt: op weg naar waardevol leven. Amsterdam: Uitgeverij Nieuwezijds.
- An ACT-related book in Dutch. Some discussion between ACT and Cognitive Therapy in this book, but it is not possible to make such discrimination out of a language community. The book definitely puts a number of ACT concepts forward for consideration.

Finnish (Suomi)

Lappalainen, R., Lehtonen, T., Hayes, SC, Batten, S., Gifford, E., Wilson, K.G., Afari, N., & McCurry, S.M. (2004). Hyväksymis- ja omistautumisterapia käytännön terapiatyössä (Applying Acceptance and Commitment Therapy (ACT): A Clinical Manual). Tampere, Finland: Suomen Käyttäytymistieteellinen Tutkimuslaitos (The Finnish Institute for Behavioral Science).
- An ACT clinical manual in Finnish.

French (Français)

Dionne, F., & Veillette, J. (2021). Apprivoiser la douleur chronique avec ACT: un guide de pratique en 10 modules. Paris, France : Dunod.
- La douleur chronique constitue un enjeu de santé publique important et pose plusieurs défis cliniques et personnels pour le praticien. La thérapie d’acceptation et d’engagement (ACT, Acceptance and Commitment Therapy) propose des stratégies thérapeutiques originales et efficaces pour améliorer la qualité de vie des gens souffrant de cette problématique.
- Son objectif n’est pas de modifier les symptômes, mais de faire évoluer le rapport du patient à leur égard, de la lutte vers l’acceptation active de la douleur, et l’engagement dans des activités en cohérence avec ses valeurs personnelles.
Monestès, J. L. (2010). Changer grâce à Darwin. La théorie de votre évolution. Paris: Odile Jacob.
- Darwin nous a appris comment l’évolution avait façonné notre espèce. Mais sa théorie peut aussi être utile à chacun d’entre nous au quotidien !
- Cet ouvrage explique comment les mécanismes naturels qui ont fait leur preuve pour l’espèce humaine peuvent aider chacun de nous à évoluer dans sa vie : nous pouvons favoriser une sélection de nos comportements, et ne plus laisser le hasard gérer notre destin.
- Il propose de nombreux outils pratiques fondés sur la thérapie d’acceptation et d’engagement et les thérapies cognitives et comportementales : dépasser les obstacles au changement, créer de la variation, développer sa curiosité au monde, mais aussi, quand il le faut, accepter les choses comme elles viennent, ne rien changer, cesser de vouloir contrôler l’incontrôlable….
- Un « darwinisme personnel » pour faciliter votre propre évolution !
- This book presents a selectionist approach of behaviors. It proposes advice and tools to commit in direction of values and to walk through acceptance, by using concepts from Darwinism and ACT.
Schoendorff, B. (2009). Faire Face à la Souffrance, Choisir la vie plutôt que la lutte avec la Thérapie d'Acceptation et d'Engagement.
- The first book on ACT in French. It is a bibliotherapy book based in part on the I-view model of Kevin Polk and Jerold Hambright.
- This is the first book on ACT in French. It's a self-help book based on Kevin Polk and Jerold Hambright's I-view.
Monestès, J. L. (2009). Faire la paix avec son passé. Paris: Odile Jacob.
- Nos souvenirs, particulièrement les plus douloureux, nous incitent à la lutte pour éviter leur réapparition. Ce livre sur la mémoire développe de nombreux concepts de l’ACT et les applique aux souvenirs des événements que nous aurions préféré ne pas vivre.
- It is our natural tendency to struggle when we are confronted to hurting memories. We would prefer to erase them if we could. This book on memory uses ACT concepts to deal with memories of events we would rather not have lived.

German (Deutsch)

Wengenroth, M. (2008). Das Leben annehmen. So hile die Akzeptanz- und Commitmenttherapie (ACT). Bern, Germany: Huber.
- An original German, ACT-based self-help book. Very good buzz about this book by ACT experts.

Polish (Polish)

Baran, L., Hyla, M., Kleszcz, B. (2019). Elastyczność psychologiczna. Polska adaptacja narzędzi dla praktyków i badaczy. Wydawnictwo Uniwersytetu Śląskiego.

Portuguese (Português)

Saban, M. T. (2015). Introdução à Terapia de Aceitação e Compromisso. Belo Horizonte: Ed. Artesã.
Lucena-Santos, P., Pinto-Gouveia, J., & Oliveira, MS (Eds.) (2015). Terapias Comportamentais of Terceira Geração: Guia para profissionais. Novo Hamburgo: Sinopsys Editora
- An original book including but not limited to ACT. Specifically, this book is a professional guide on third-wave behavioral therapies (Mindfulness-based Cognitive Therapy, Functional Analytic Psychotherapy, Behavioral Activation Therapy, Behavioral Activation, Mindfulness-Based Stress Reduction and Compassion Focused Therapy)
Boavista, R. (2012). Terapia of Aceitação e Compromisso (ACT): Purpose uma possibilidade para a clínica comportamental. Santo André: ESETec Editores Associados.
- In this book Rodrigo RC Boavista does a book review that contemplates philosophical assumptions, theoretical foundations, model of psychopathology and a few application scenarios of the ACT therapeutic approach.

Japanese (日本語)

Muto, T. (Ed.) (2017). 55歳からのアクセプタンス＆コミットメント・セラピー（ACT）超高齢化社会のための認知行動療法の新展開 [Turning 55 years old in super-aging society: Living oldness with Acceptance and Commitment Therapy]. Kyoto: Ratik.
Kumano, H. & Muto, T. (Eds.) (2009). Tokushuu-gou: Akuseputansu ando komittoment serapi. in the “Kokoro-no-Rinshou a la carte” Magazine for clinicians. Tokyo: Seiwa-shoten.
- Title translation: Special volume: Acceptance and Commitment Therapy.
Kumano, H. (2009). 21 seiki no jibun sagashi project: kara no ori kara dete, machi ni dekakeyou. Tokyo: Sanga.
- Title translation: The “Pursuit of myself” project in 21 century: Breaking the prison of conceptualized myself.
Muto, T. (Eds.) (2006). Akuseputansu ando komittoment serapi no bunmyaku: Rinshou-kudu-bunseki no maindofuru-na tenkai. Tokyo: Brain-shuppan.
- Title: Some contexts of Acceptance and Commitment Therapy: Mindfulness in Clinical Behavior Analysis .

Korean (조선말, 한국어)

Lee, Seonyoung (2017). 꼭 알고 싶은 수용-전념 치료의 모든 것: ACT와 친해지기. Soulmate. Seoul.

Spanish (Español)

García Higuera, JA (2007). Curso Teraperutico de Aceptación I y II. Madrid: Paradox.
- An ACT self help book with lots of exercises.
Barraca, J. (Ed.). (2005). The mente o la vida. An aproximation to the Terapia of Acceptance and Compromise. Bilbao: Desclée de Brouwer.
- An original edited ACT book in Spanish.
Wilson, KG, & Luciano, C. (2002). Acceptance and Commitment Therapy: A behavioral treatment focused on values. Madrid: Pirámide.
- An original ACT book in English ACT authors.
García Higuera, JA (2003). Terapia psicológica en el tartamudeo, from Van Riper to the terapia of acceptance and compromiso.Barcelona: Editorial Ariel. Visit this site web para más información.
- An ACT book dedicated to stuttering and its psychological treatment.
Luciano, C. (Ed.). (2001). Terapia of Acceptance and Compromise (ACT) and the Traastorno de Evitación Experiencial. A síntesis of casinos clinics. (Ed.) Valencia: Promolibro.
- An original ACT book in Spanish with a series of very creative single case studies.

Jen Plumb October 14, 2009 - 5:05pm

Samtaler som forandrer - behandlerens guide til ACT i teori og praksis

Drømmer du om at lære de effektive, evidensbaserede og håndgribelige strategier, som skaber vilde og varige forandringer for dine klienter og for dig selv? Samtaler som forandrer er behandlerens guide til ACT i teori og praksis. Bogen er skrevet af Rikke Kjelgaard, en af Danmarks største kapaciteter inden for ACT (Acceptance and Commitment Therapy). Her får du som behandler en grundig introduktion til ACT med masser af kliniske eksempler og øvelser. Du bliver præsenteret for de grundlæggende begreber og for modellens bærende principper. Du får en gennemgang af kerneprocesserne i ACT samt eksempler på, hvordan disse processer udspiller sig i det terapeutiske møde. Du følger med i en række samtaler som netop demonstrerer kerneprocesserne. Du lærer at lave sagskonceptualisering, at skabe fleksibilitetsprofiler, og du lærer, hvordan du designer dine egne metaforer. Du får desuden en række generelle tips til, hvad du skal gøre – og hvad du skal undgå at gøre – for at skabe samtaler, som forandrer.

Rikke February 13, 2024 - 12:56pm

Self-Help Books in Non-English Languages

This list is no longer being updated. Please click here for a list of ACT Books in 20+ Languages.

Original Non-English Self-Help Books

German

Waadt, M. (Author),& Acker, J. (2018). Das Selbsthilfebuch gegen Burnout: Mit Akzeptanz und Achtsamkeit den Teufelskreis durchbrechen. Berne, CHE: Hogrefe AG.
Wengenroth, M. (2008). Das Leben annehmen. So hilft die Akzeptanz- und Commitmenttherapie (ACT). Bern, Germany: Huber.

Danish

Ramussen, S. & Taggaard Nielsen, O. (2010) Introduktion til ACT. Copenhagen: Dansk Psykologisk Forlag. 2nd printing (2012).

Dutch

Bohlmeijer, E., & Hulsbergen, M. (2009). Voluit leven. Amsterdam, NLD: Boom.

French

Schoendorff, B. (2009). Faire face à la souffrance, choisir la vie plutôt que la lutte avec la Thérapie d'Acceptation et d'Engagement. Paris: Retz.
Le premier livre sur l'ACT en français. C'est un ouvrage de bibliothérapie qui se base en partie sur le modèle I-view de Kevin Polk et Jerold Hambright.

Portuguese

Bittar, E. (2011). Nao sou feliz … e agora? O que fazer quando todas as formulas fracassem? Uberlândia, Brazil: Imagine.

Spanish

García Higuera, J. A. (2007).Curso Terapéutico de Aceptación I y II. Madrid: Paradox.
An ACT self help book with 4 audio CDs with lots of exercises.

admin September 8, 2009 - 3:00pm

Other Self Help Books (2006-2009)

OTHER SELF HELP BOOKS

Kashdan, T. (2009). Curious? Discover the missing ingredient to a fulfilling life. New York, NY: Harper Collins.
Flowers, S. H. (2009). The Mindful Path Through Shyness: How Mindfulness and Compassion Can Free You From Social Anxiety, Fear, and Avoidance. Oakland, CA: New Harbinger Publications.
Vieten, C. (2009). Mindful Motherhood: Practical Tools for Staying Sane During Pregnancy and Your Child’s First Year. Oakland, CA: New Harbinger Publications.
McKay, M., & Sutker, C. (2007). Leave Your Mind Behind. Oakland, CA: New Harbinger.
McCurry, S. M. (2006). When a family member has dementia: Steps to becoming a resilient caregiver. Westport, CT: Praeger Publishers. - Although not directly on ACT or mindfulness, this book for caregivers does include a significant emphasis on acceptance (the author is one of the early ACT therapists from the University of Nevada, Reno and studied with Steve Hayes).

Community March 1, 2024 - 1:38pm

ACT /RFT Reader's Update 2008 - 2011 (Archives)

The ACT/RFT Reader's Update was published from 2008 - 2011. For up-to-date lists of ACT/RFT publications, go to the ACT Randomized Controlled Trials page, the State of the ACT Evidence page, the list of ACT Books, and the Publications section.

The ACT /RFT Reader's Update is an electronic newsletter provided for your information and perusal. This online newsletter provides summaries of recent, ACT and RFT articles (or related articles) published in peer-reviewed journals. In addition, citations for the latest books, book chapters, and unpublished dissertations will be listed.

Our main aim with this update is to keep the ACT/RFT community informed. We hope to include information that is relevant, scientifically sound, and of interest in the ACT/RFT community. Our purpose is not to recreate the abstract of these articles, but to provide a broader summary of the article. However, are goal is to keep the "busy" reader in mind, and therefore, we will work to keep the summaries brief.

Reviewers include:
Robyn Walser, PhD
Christi Ulmer, PhD
Maggie Chartier, MPH, MS
Ian Stewart, PhD
Miguel Rodríguez Valverde, PhD

admin January 11, 2008 - 7:24pm

ACT/RFT Readers Update 2011

Dear Contextual Science Community,

We are happy to be putting out our full 2011 ACT/RFT Reader’s Update. In this Update we review assessment, chronic pain, experiential avoidance, pilot studies, RCT’s, relational frame theory and several research reviews. We hope you find the information helpful. Please take a look at the attached and find what interests you.

It has been interesting times at the Update, with change in editorial/writer staff (a big welcome to Katherine Young, Jeannette Tappe, Tam Nguyen and Aimee Zhang) and other unanticipated delays with this issue, we have been pressed to finish up and post.

We are also looking forward to including and perhaps featuring articles found in the Journal of Contextual Behavioral Science. We hope everyone is enjoying the journal and finding it useful. What a great contribution to ACBS! http://contextualscience.org/JCBS

Lastly and importantly, we are looking forward to ACBS World Conference in Sydney, Australia, July 8-12. The World Conference is always exciting, engaging and fun! Many great ideas for projects, studies and papers are generated at the conference and it will be sure to provide ACT/RFT Reader’s Update staff with plenty more to review! http://contextualscience.org/wc11

Warm Regards,

Maggie Chartier, Psy.D., MPH
Barbara Mazina, B.A.
Tam Nguyen, Ph.D.
Katie Sears, Ph.D.
Ian Stewart, Ph.D.
Jeannette Tappe, M.A.
Thuy Tran, B.A.
Robyn Walser, Ph.D.
Katherine Young, M.S.
Aimee Zhang, B.S.

ACBS staff April 10, 2013 - 12:11pm

ACT/RFT Reader's Update 2010

Dear ACT Community,

We are excited….and relieved to put out two Reader’s Updates this round. Please log in to download the attachments from this webpage.

It is really great to see all of the work and writing that is being done in the areas of ACT, RFT and mindfulness. It is keeping us busy and energized as reviewers. Find in the Update, summaries designed to provide you with a quick overview of topics and issues, with links in the document to more detailed information.

In Update “10finalb” you will find summaries, references and abstracts on acceptance, addiction, assessment, case studies, children/adolescents, chronic pain, experiential avoidance and RFT.

In Update “10finalcd,” in addition to some of the same topics above, you will find summaries, references and abstracts on anxiety and depression, RCT’s and research reviews. In this issue we also wanted to feature RFT. It is the first summary presented in the Update. Ian Stewart has done an excellent job. He has thoughtfully put together information in a effort to keep us abreast of research this area. A big thanks to Ian!

We are diligently working on the next issue: Coming soon to a list-serve near you!

Finally, if you know of any articles, studies or other information that we should include in our next issue and may not be easily findable by regular search engines, please let us know. Also, be sure to let us know if we missed something.

Enjoy!

Reviewers and Editors

Maggie Chartier

Barbara Mazina

Katie Sears

Ian Stewart

Thuy Tran

Robyn Walser

Douglas Long June 21, 2012 - 5:33am

ACT/RFT Reader's Update: Articles from early 2010 (November, 2011)

Dear Colleagues,

Welcome to this edition of the ACT/RFT Reader’s Update.

In this issue, as in all issues, we provide a summary of the literature published related to acceptance and commitment therapy, mindfulness and relational frame theory. We link summaries to particular topics and provide a review of the articles. Feel free to read the summaries and find the links to the references and abstracts related to the summaries right in the document. For a taste of what is in the Update, we summarize 3 articles on acceptance approaches to treatment, 3 on addiction that compare CBT to ACT, 1 on assessment by Wilson – the VLQ is alive and well -, 2 case study designs looking at the treatment of GAD and cancer, 3 articles on mindfulness based approaches with children and parents, 4 articles on experiential avoidance, 5 on mindfulness including how mindfulness works with managing emotions, intrusive thoughts, stress reduction and substance use. Finally, we have 3 on RFT reviewed by Ian – Thanks Ian!

We have sorted and distributed articles to our reviewers for the first half of 2011. We are looking forward to the next round.

Please let us know if we missed anything that we should include or inform us of dissertations, etc.

Thanks and Enjoy!

Kind Regards,

Robyn D. Walser, Ph.D.

Douglas Long November 20, 2011 - 6:32pm

ACT/RFT Reader's Update: Final 2009 Review (July, 2010)

Science and Practice: ACT /RFT Reader’s Update: Final 2009 Review

Welcome to the ACT/RFT Reader’s update. This is the last issue reviewing the literature on ACT and RFT from 2009. We will be publishing updates for 2010 in late summer, fall and winter.

To kick off the issue, we want to extend a thank you to Dr. Chad Drake who has been with the Update since its inception. We thank Chad as he closes the “Update chapter of his life” and wish him much success in his new and fun endeavors. Thanks Chad!

In this issue, we summarize articles on assessment, ACT and diagnostic populations, experiential avoidance, behavioral health, RFT, mindfulness and “The Great Debate”.

The attached PDF includes a Table of Contents that allows you to “click” directly to the summary of multiple articles covering a topic and/or references and abstracts that you may be interested in. In addition, citations for the latest books, book chapters, editorials, and unpublished dissertations are listed.

Our aim with this update is to provide information that is clinically relevant, scientifically sound, and of interest in the ACT/RFT community. We have worked to keep the “busy” reader in mind and hope that you find the Update useful.

** If you are a graduate student working on an ACT/RFT study and would like to have us include your dissertation or thesis citation in this update,please send us an email backchannel.

**If you have published an editorial you would like us to include that citation, please send us an email back channel.

We hope you will find our e-mail updates of interest and value.

Our editors and reviewers include:
Robyn Walser, PhD
Maggie Chartier, PhD, MPH
Katie Sears, PhD
Thuy Tran, BS
Chad Drake, PhD
Elizabeth Gifford, PhD
Ian Stewart, PhD
Christi Ulmer, PhD
Miguel Rodríguez Valverde, PhD
Darrah Westrup, PhD

Jen Plumb July 9, 2010 - 9:28pm

ACT/RFT Reader's Update (December, 2009)

Science and Practice: ACT/RFT Reader’s Update December, 2009

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Acceptance and Values-Based Action in Chronic Pain: A Study of Treatment Effectiveness and Process Cognitive-behavioral approaches to pain management have an established record of empirical support. However, as true with other behavioral problems, the mechanism by which improvement occurred is inconsistent with the theoretical underpinnings of CBT. In a recent paper, Vowles and McCracken add to their ongoing line of research in acceptance-based approaches to the treatment of chronic pain. In their paper, they present their findings of an inter-disciplinary treatment program based in Acceptance and Commitment Therapy, with a focus on acceptance and values-based action. One-hundred seventy-one participants completed the program which consisted of 3 to 4 weeks of inpatient treatment for about 30 hours per week. Participants improved across almost all domains, including pain, depression, pain-related anxiety, disability, medical visits, work status, and physical performance, and effect sizes for these improvements were medium to large. Analysis of reliable change revealed that 75.4% of participants improved in at least one key domain assessed. In contrast with CBT-based approaches to pain management, improvements across these domains were associated with ACT's proposed mechanisms of action, namely, acceptance of pain and values-based action. The authors conclude that these findings provide support for the ACT model of treatment for chronic pain, and the processes associated with improvement – acceptance and values-based action.

Vowles, K., & McCracken, L. (2008). Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. Journal of consulting and clinical psychology, 76(3), 397-407.

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Rule-Governed Behavior and Psychological Problems Humans, uniquely among animals, can come to understand and respond to linguistic rules, both effective ones and not so effective ones. The effective ones help us to learn and adapt to our environment. The ineffective ones can cause maladaptive behavior and diminish our lives considerably. This paper presents a functional analysis of patterns of rule-governed behavior (RGB) and shows how rules can contribute to psychopathology. Rules have been described as antecedent stimuli that alter the functions of stimuli in our environment. They allow us to respond to that environment in complex and efficacious ways. But what are rules? Relational Frame theory suggests that we humans learn to respond in accordance with abstract relational patterns based on cues (e.g., SAME). Rules are essentially combinations of cues that specify particular relations between environmental stimuli and between environment and behavior and thus allow us to respond in new ways (‘transformation of function’). The paper describes three functional patterns of RGB. These are pliance, tracking and augmental rule following. Pliance is RGB under the control of a history of socially mediated reinforcement for coordination between behavior and antecedent verbal stimuli (rules). A typical example might be a child obeying the rule ‘Don’t touch my laptop’ because their parent has given them this rule and because their parent has previously provided consequences for following or not following rules. Tracking is RGB under the control of a history of coordination between the rule and the way the environment is arranged independently of the rule. An example might be a child obeying the parental rule ‘Eat your breakfast because it will give you more energy’ because in the past the child has experienced the effect of other rules that have been accurate in their description of the environment. If this rule also shows coordination (i.e., the child finds an increase in energy when they eat breakfast), then this will further strengthen tracking behavior. Augmenting is RGB due to relational networks that alter the degree to which events function as consequences. The example given is ‘Eat your vegetables to be a big strong boy’. If this rule makes vegetable eating more reinforcing then it might be described as augmenting. Each of these patterns has its advantages and its disadvantages, including maladaptive behavior. It’s useful for children to learn pliance since this allows them to acquire useful adaptive habits, but doing things just because one is told to can make one insensitive to one’s environment. Tracking allows independence from social whim, but tracking can also lead to ineffective behavior; for example, tracking short term reinforcement can mean one misses longer term reinforcement. Augmenting is the most advanced form of rule governed behavior and as such it can interact with and reinforce either of the other two functional patterns resulting in strongly adaptive or maladaptive patterns. Experiential avoidance can be a product of the latter while valuing, an important part of the antidote to EA, is an example of the former. Törneke, Luciano and Valdivia (2008) have provided an excellent description of RGB and its relationship to psychopathology.

Törneke, N. Luciano, C. & Valdivia Salas, S. (2008). Rule-Governed Behavior and Psychological Problems. International Journal of Psychology and Psychological Therapy, 8 (2), 141-156.

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Brief Review: A Parametric Study of Cognitive Defusion and Believability The effects of the “Milk, milk, milk” exercise are dependent upon the length of the intervention: Reducing distress in respect to private events has been a major emphasis of traditional behavioral and cognitive behavioral therapies. The inclusion of mindfulness interventions in some contemporary therapies like ACT has shifted this focus from distress reduction to changing the behavior regulatory functions of distressing private events. One means of examining this change is by asking clients about the believability of their thoughts. Defusion interventions represent efforts to disrupt this behavior regulation, and the “milk, milk, milk” exercise is the intervention examined in this article. Two studies examined the effect of this exercise on the emotional discomfort and believability of a negative, self-relevant word identified by the participant as sufficiently problematic. Each study varied the amount of time spent repeating the word – 0, 3, or 20 seconds in study 1 and 1, 10, or 30 seconds in study 2. A rationale for the procedure and training with the word “milk” was provided before each intervention. Results showed that emotional distress reduced significantly within 3-10 seconds, while believability reduced significantly only after 20-30 seconds. The difference in timing for these reductions suggests that discomfort and believability are functionally distinct behaviors. The authors suggest extending defusion exercises until the believability of thoughts, rather than just emotional distress, diminishes.

Masuda, A., Hayes, S. C., Twohig, M. P., Drossel, C., Lillis, J., & Washio, Y. (2009). A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts. Behavior Modification, 33, 250-262.

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Brief Review: Relational Frame Theory and Social Categorization The Matching-to-Sample procedure can transform the functions of arbitrary stimuli in the Implicit Associations Test: This study examined the acquisition of obesity stigma to arbitrary stimuli. More specifically, the matching-to-sample (MTS) procedure was used to provide relational conditioning sufficient to generate a transformation of stimulus functions for stigma to images of either horizontal or vertical lines. The Implicit Associations Test (IAT) was used to detect this transformation of functions. Fifty undergraduate psychology students engaged in a series of five computerized tasks: (1) an IAT containing evaluative words and images of horizontal and vertical lines, to confirm a lack of pre-existing bias, (2) an established IAT for detecting implicit evaluative bias toward obesity, to confirm the presence of pre-existing bias, (3) two MTS tasks providing relational conditioning sufficient to generate the transfer of positive and negative evaluative functions to images of horizontal and vertical lines, (4) the same IAT used in step 1, to assess for the acquisition of bias, and (5) the same IAT used in step 2. Results confirmed no pre-existing bias at time 1, a large and significant predicted bias at time 2, and a small and significant predicted bias at time 4. The results of this study are discussed in respect to an RFT account of the development of stigma and social categorization and contrasted with a more mainstream, cognitive account known as the Social Knowledge Structure.

Weinstein, J. H., Wilson, K. G., Drake, C. E., & Kellum, K. K. (2008). A relational frame theory contribution to social categorization. Behavior and Social Issues, 17, 39-64.

Revised/Reviewed by: Walser, R., Chartier, M., Sears, K., Drake, C., Valverde, M., Stewart, I., Ulmer, C., & Westrup, D. Read the ACT RFT Reader's Update: References & Abstracts, 2008 in an interactive PDF, attached below.

admin November 24, 2009 - 4:51pm

ACT/RFT Reader's Update (Fall, 2008)

Science and Practice: ACT /RFT Reader's Update Fall, 2008

Welcome to ACT/RFT Reader's Update:

In our second issue we summarize 5 articles recently published in peer-reviewed journals. The references to full citations and whether they are available for download on the ACBS website is also included. Citations for the latest books, book chapters, and unpublished dissertations are listed at the end of the update. If you don't see your recently published article….hang on, we continue to work on future issues and have a fair number of articles that are being reviewed and summarized for our coming issues. However, if you are publishing or have recently published please make us aware by either sending us the reference or pdf. Thanks.

We hope you will find our e-mail updates of interest and value.

Enjoy your read!

Our editors and reviewers/writers:

Editors:

Robyn D. Walser, Ph.D.
Maggie Chartier, MPH, MS

Reviewers/Writers:
Chad Drake, MA
Miguel Rodríguez Valverde, PhD
Ian Stewart, PhD
Christi Ulmer, PhD

This issue of Science and Practice: ACT/RFT Readers Update contains 5 summaries:

ACT ARTICLES AND RELATED TOPICS

Acceptance and commitment training reduces prejudice and promotes diversity-oriented behaviors in college students

Despite increased efforts at promoting diversity in recent years, prejudice continues to result in diminished quality of life for ethnic, racial and religious minorities across numerous life domains. Interventions designed to reduce prejudice have been moderately successful with short-term improvements, but do not seem to promote sustained equitable attitudes and behavior. In fact, in some instances, the interventions actually result in an increased bias. ACT may be particularly applicable to prejudice due to its focus on intransigent and difficult cognitions. Luoma and Hayes compared a brief ACT Training protocol to an education-based prejudice awareness training intervention for reducing racial and ethnic prejudice in college students. Material was presented to students using a counterbalanced within-group design such that the impact of each approach could be evaluated independently. The outcome measure, developed for this study, consisted of items assessing the following: awareness of bias; acceptance and flexibility; thought control and defusion; and positive actions. Student responses suggest that the ACT training produced greater reductions in prejudice across most dimensions, and that only ACT training promoted greater intention to engage in diversity-oriented behaviors. Changes in these positive intentions were partially mediated by acceptance and flexibility, and defusion processes explained more variance in positive intention outcomes than acknowledgement of bias. The authors suggest that the combined findings of this study and a previous ACT-based study on prejudice lend preliminary support to an ACT-RFT based model of understanding and reducing prejudice. The findings are also consistent with the theory underlying acceptance-based approaches stating that it is the relationship with thought rather than the content of thought that matters. Limitations of the study include the use of an unvalidated outcome measure, the potential self-selection bias of students who choose to enroll in a class on the psychology of racial differences, the potential for bias of the interventionist in favor of ACT, and a short follow-up interval. Future studies are proposed using a more intensive intervention and assessing longer-term outcomes. Given the need for empirically supported approaches to address prejudice, the findings of the current study are promising. In terms of clinical application, the authors propose that similar processes are likely in play with regard to mental health stigma, and that cognitive processes that promote prejudice are themselves psychologically damaging.

Read the Article:

Lillis, J., & Hayes, S. C. (2007). Applying acceptance, mindfulness, and values to the reduction of prejudice: A pilot study. Behavior Modification, 31(4), 389-411.
________________

ACT and CT for anxiety and depression, a randomized controlled effectiveness trial

For some period of time there has been discussion and even argumentation between those who hold true to cognitive models of intervention (e.g. Beckian) and acceptance models of intervention (e.g. Hayesian). Forman and colleagues take a closer look. They explain that Cognitive Therapy (CT) has a mixed record of success in producing theoretically-consistent mediation of treatment outcomes while Acceptance and Commitment Therapy (ACT) has a relatively impressive, though preliminary record, of the same. Given that only a handful of studies have directly compared these treatments and that all contained methodological shortcomings the authors undertook that task of comparing each therapy's ability to produce mediation and positive outcomes among an outpatient sample of college students in a well-controlled trial. Services were provided by clinical psychology doctoral candidates working at a student counseling center. Outcome measures included self-reports of symptoms (BDI-II, BAI, OQ-45) and self-reports of quality of life (QOLI, SLS). Two mediational measures were administered (KIMS, AAQ). The study also included measures of treatment fidelity, therapist allegiance, and participant expectancies of treatment. Results showed that all measures were comparable between treatments, and that each treatment generated large effect sizes. Mediational analyses showed that the observing subscale of the KIMS more strongly (though nonsignificantly) predicted outcomes for CT, while the AAQ and the acting with awareness and acceptance subscales of the KIMS more strongly (and significantly) predicted outcomes for ACT. The authors reported that "changes in "observing" and "describing" one's experiences were more strongly associated with outcomes for those in the CT group relative to those in the ACT group, whereas experiential avoidance, acting with awareness, and acceptance were more strongly associated with outcomes for those in the ACT group" (p. 792). Although, the authors concluded that "these findings support the notion that CT and ACT are functionally distinct from one another" (p. 792), it was never explained why the capacity to observe and describe one's private experiences is a fundamental component of CT but not ACT.

Read the Article:

Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behavior Modification, 31, 772-799.

RFT ARTICLES

How does multiple-exemplar training and naming establish derived equivalence in an infant?

Stimulus equivalence at its simplest can be described as follows. Imagine I train someone in the following two relations between physically different arbitrary stimuli: Pick stimulus B when you see stimulus A, and pick stimulus C when you see stimulus B. If given the opportunity, a verbally able human might subsequently go on to demonstrate further relations, without being trained to do so, including picking A when he sees B, and picking B when he sees C (i.e., reversing the trained relations, referred to as symmetry), picking C when he sees A (i.e., combining the trained relations, referred to as transitivity) and picking A when he sees C (a combination of symmetry and transitivity). This pattern of derived responses has been called stimulus equivalence, because it appears that, suddenly and unexpectedly and without being trained to do so, the person is treating a number of physically different stimuli as mutually substitutable for or equivalent to each other. There is growing interest in stimulus equivalence research as only verbally able subjects seem to be able to show this pattern readily, suggesting a link between equivalence and language. But what is the nature of this link? How are the two connected? The present paper discusses two theoretical approaches that claim to account for this link - Relational Frame Theory (e.g., Hayes et al., 2001) and Naming Theory (Horne & Lowe, 1996). More importantly, however, the paper reports a series of experiments involving training an infant in relational responding that provide important additional evidence pertaining to the debate between these approaches. More specifically, the results add to evidence in favour of the RFT account, while demonstrating a phenomenon that directly contradicts Naming Theory. This study is a significant empirical contribution for a number of reasons (i) It demonstrates the use of multiple exemplar training to establish generalized contextually controlled receptive mutual entailed relational responding; (ii) it provides the youngest empirical example of coordinate (sameness) combinatorial entailed relational responding (equivalence) ever recorded; and (iii) it provides extremely important evidence vis-a-vis the Naming Theory / RFT debate by providing empirical evidence that directly contradicts a core tenet of Naming Theory while being consistent with RFT.

Read the Article:

Luciano, C., Becerra, I. G., & Valverde, M. R. (2007). The role of multiple-exemplar training and naming in establishing derived equivalence in an infant. Journal of the Experimental Analysis of Behavior, 87(3), 349-365.
________________

Can the Implicit Relational Assessment Procedure be faked? First evidence says no.

The Implicit Relational Assessment Procedure (IRAP) is a computer-based task for the assessment of implicit cognitions recently devised within the theoretical framework of RFT. It is a latency-based response measure that intends to assess the participants' existing verbal-relational networks (i.e. beliefs). It works by requiring participants to respond as quickly and accurately as possible across trials when presented with particular relations (among sample and target stimuli) that may be consistent or inconsistent with their beliefs (i.e. relational networks). The idea is that participants will be faster when required to respond to stimulus relations that are consistent (e.g. categorizing words like love or peace as pleasant, and words like vomit or death as unpleasant) than to stimulus relations that are inconsistent with their verbal histories (e.g. categorizing vomit or death as pleasant, and love or peace as unpleasant). This idea is supported by empirical evidence from several recent studies. As with other implicit measures, like the Implicit Association Test (IAT), one of the strengths of the IRAP is that it may be less sensitive than questionnaires and other explicit measures to assess deliberate attempts to conceal information about one's own socially sensitive attitudes. This study attempted to see to which extent this is the case (i.e. whether the IRAP can be faked). Three groups of participants underwent two consecutive exposures of the IRAP task with the same stimuli (the words pleasant and unpleasant as samples, the words similar and opposite as response options, one set of six pleasant target words, and one set of six unpleasant target words). Between both exposures, one group was informed about how the IRAP works. Another group received the same information and was told to fake the IRAP, without a specific strategy to do so. The third group received the same information and were also provided with a strategy, namely slowing down on consistent trials and going fast on inconsistent trials. Results showed no evidence of faking in any condition. All groups showed an IRAP effect in the second exposure regardless of the instructions or strategies received. According to a post-task questionnaire, only two participants in the third group reported using the specific strategy they had received. All in all, participants found it difficult to fake the IRAP, even if provided with specific strategies. This contrasts with previous findings with the IAT, which can be successfully faked when explicitly told how to do so. This observed resistance to deliberate attempts to fake performance renders the IRAP a solid procedure for the assessment of implicit cognitions.

Read the Article:

McKenna, I., Barnes-Holmes, D., Barnes-Holmes, Y., & Stewart, I. (2007). Testing the Fake-ability of the Implicit Relational Assessment Procedure (IRAP): The First Study. International Journal of Psychology and Psychological Therapy, 7, 253-268. (in English)
______________________

What can RFT add to the study of pain?

The current study focuses on an RFT interpretation of the way that pain takes part in complex behavioural episodes for humans. It is a theoretical/conceptual study that reviews functional-contextual approaches to the study of private events specifically related to pain and with a special emphasis in recent research in verbal behaviour, behaviour-behaviour relations, and transformation of psychological functions. The review is divided into four parts. The first summarizes the philosophical assumptions of functional-contextualism and its implications for the study of pain (e.g. the extent to which explanations of pain allow for effective action as the criterion against which these explanations should be tested). The second focuses on the classical behaviour-analytic point of view, where pain experiences have been conceptualized as private events that exert discriminative control over subsequent behaviours (e.g. abuse of pain-killers, inactivity, social isolation, etc.). This discriminative function (behaviour-behaviour relation) is the product of specific histories of reinforcement along the individual's development, in direct-contingency terms. This view is illustrated with the presentation of the contributions of Schoenfeld and, more specifically, of Fordyce. RFT is proposed as a more comprehensive framework for the behaviour ral study of pain, a framework where verbal (derived) histories can be included as part of the explanation. In line with this, pain-related clinical problems are conceptualized as a form of experiential avoidance disorder, where it is the verbal functions of pain, rather than pain itself, that limit the individual's life (i.e. the consideration of pain as a literal barrier for engaging in valued actions). This is described in the third part of the article. Finally, the last part of the article presents a general overview of ACT and describes its implications for the treatment of pain-related problems.

For more information, read the original article in Spanish:

Gutiérrez Martínez, O., & Luciano Soriano, C. (2006). Un studio del dolor en el marco de la conducta verbal. International Journal of Clinical and Health Psychology, 6, 169-188. [A study of pain in the framework of verbal behavior: from the contributions of W. E. Fordyce to Relational Frame Theory (RFT)]

(for correspondence and reprints): olgaguti@ugr.es

BOOKS

Ciarrochi, J. V., & Bailey, A. (2008). A CBT practitioner's guide to ACT. Oakland, CA: New Harbinger.

BOOK CHAPTERS

DISSERTATIONS

Barthold, C., & Hoffner, C. (2007). Factors affecting the generalization of 'wh-' question answering by children with autism. Dissertation Abstracts International Section A: Humanities and Social Sciences, Vol 68(4-A): 1403.

EDITORIALS AND COMMENTARIES

Hayes, S. (2007). Hello Darkness. Psychotherapy Networker, Sept/Oct. 46-52.

Hummelen, J. W., & Rokx, T. A. J. J. (2007). Individual-context interaction as a guide in the treatment of personality disorders. Bulletin of the Menninger Clinic, 71(1): 42-55.

Muran, J. C. (2007) Commentary: Language, Self, and Diversity. In S. C. Hayes (Ed.), Dialogues on difference: Studies of diversity in the therapeutic relationship ) pp. 275-279. Washington, DC, US: American Psychological Association.

admin September 28, 2008 - 1:40pm

ACT/RFT Reader's Update (Winter, 2007)

Welcome.... to the first issue of the ACT /RFT Reader's Update, an electronic newsletter provided for your information and perusal. This online newsletter provides summaries of recent, ACT and RFT articles (or related articles) published in peer-reviewed journals. In addition, citations for the latest books, book chapters, and unpublished dissertations will be listed. This will be an ongoing project, and new article summaries will be distributed via email every 4 months. You can identify these email summaries by the subject title "ACT/RFT Readers Update". Our main aim with this update is to keep the ACT/RFT community informed. We hope to include information that is relevant, scientifically sound, and of interest in the ACT/RFT community. Our purpose is not to recreate the abstract of these articles, but to provide a broader summary of the article. However, are goal is to keep the "busy" reader in mind, and therefore, we will work to keep the summaries brief. Additionally, we had to start somewhere, so we are only including summaries of some of the most recent articles.....and our next issue will include more from 2007 (such as ACT and diabetes and social anxiety disorder). We will conduct regular searches, however, if we missed your publication (from mid-2007 until now), please let us know. ** If you are a graduate student working on an ACT/RFT study and would like to have us include your dissertation or thesis citation in this update, please send us an email backchannel. **If you have published an editorial and you would like us to include that citation, please send us an email back channel. We hope you will find our e-mail updates of interest and value. If you have questions, please contact Robyn Walser, Robyn.Walser@va.gov or Maggie Chartier, maggie_chartier@yahoo.com Our reviewers include: Robyn Walser, PhD Christi Ulmer, PhD Maggie Chartier, MPH, MS Ian Stewart, PhD Miguel Rodríguez Valverde, PhD This issue contains 8 summaries. Please find references at end of summary and references listing at end of document: ACT ARTICLES AND RELATED TOPICS Acceptance and pain in children.... The literature supporting the use of cognitive-behavioral interventions for chronic pain in adults is fairly extensive. Nevertheless, considerably less empirical support is available for psychological approaches to pain in children. Even more limited is the literature on psychological approaches to idiopathic (of unknown cause) chronic pain in youths. Acceptance-based approaches have been implemented into behavioral pain treatments in adults, and have been found to be associated with better outcomes. The authors of a recent study investigated the impact of an ACT intervention with an exposure component for increased functioning and school attendance in 14 adolescents experiencing idiopathic chronic pain. The intervention was administered in individual therapy sessions tailored to the individual patient, but generally followed a format that included education, ACT, and exposure. Parents were also seen in separate sessions to provide guidance on an intervention-consistent parental coaching role versus a caretaking role. The number of sessions varied across patients. Post-intervention data revealed large effect sizes for improvements in the primary outcomes (functioning and school attendance) in addition to the secondary outcomes (pain intensity, pain interference, and catastrophizing). Interestingly, pain intensity and interference decreased following this intervention despite the absence of intervention components targeting pain reduction. Limitations of the study included lack of a control group, variability in session number and therapeutic skills, and absence of a measure of the proposed mechanism of action (psychological flexibility). Despite the limitations, this pilot study contributes to a nascent area of research on the treatment of chronic pain in youths, and suggests a potential role for ACT-based interventions in this population. Read the Article: Wicksell, R. K., Melin, L., & Olsson, G. L. (2007). Exposure and acceptance in the rehabilitation of adolescents with idiopathic chronic pain - A pilot study. European Journal of Pain, 11(3), 267-274. __________ Hair pulling and experiential avoidance... Trichotillomania (TTM) is estimated to be present in up to 3.4% of the population and is associated with significant psychosocial difficulties. Previous research has identified several specific cognitions and affective states that are associated with the tendency to engage in hair pulling. A recent internet-based study investigated the potential relevance of the stance of the TTM sufferer towards aversive thoughts and emotions in hair pulling severity. More than 700 individuals reporting a diagnosis of TTM completed an anonymous online survey assessing: DSM-IV TTM criteria; hair pulling severity, urge, behavior and consequences; shame; self-perceived appearance; and fear of negative evaluation; and experiential avoidance. In spite of the waning criticism of internet-based research, the sample characteristics suggest that is was similar to those of studies completed in clinical settings, and the reported internal consistencies of the employed measures suggested that participants provided meaningful responses. As found in previous research, hair pulling behavior was associated with greater negative cognitions. However, in the current study, these associations were either significantly reduced or eliminated when experiential avoidance was introduced as a mediator. Under the premise that aversive cognitions are functionally related to hair pulling behavior, clinicians commonly target thought content using a cognitive restructuring approach to TTM. However, the findings of the current study suggest that targeting avoidance may result in a greater degree of behavior change. Replication of this study is needed in a clinical sample and should include longitudinal data to explore causal pathways plus a larger battery of private events should be investigated. Despite the need for additional study, the findings of the current study implicate experiential avoidance as a potentially critical factor in the understanding and treatment of TTM. Read the Article: Norberg, M. M., Wtterneck, C. T., Woods, D. W., & Conelea, C. A. (2007). Experiential avoidance as a mediator of relationships between cognitions and hair-pulling severity. Behavior Modification, 31, 367-381. __________ Preliminary findings suggest that ACT is useful for coping with psychological distress related to breast cancer. A recent article in the Spanish journal of psychooncology (Psicooncología) suggests that psychological problems resulting from diagnosis, treatment, and possible sequels of breast cancer, can be analysed as a form of an experiential avoidance disorder. The authors explored the application of an acceptance-based psychological intervention to these problems in a Spanish sample, comparing it with a more traditional intervention based on cognitive-control. Twelve women (ages 42 to 50) that had been diagnosed and treated for breast cancer took part. Half of them were randomly assigned to treatment with a brief adaptation of Acceptance and Commitment Therapy. This acceptance-based protocol focused on the clarification of personal values, the detection and acceptance of psychological barriers to acting towards those values, and on the continued practice of cognitive defusion through experiential exercises and metaphors. The other six women were treated with a brief adaptation of the official cognitive-behavioral program of the Spanish Association Against Cancer. This protocol focused on analysing the relationships among disease-related thoughts, feelings, and actions, and in the modification of those cognitions and emotions through several strategies (e.g. identification and management of automatic dysfunctional emotional reactions, emotional ventilation techniques, breathing and relaxation techniques for anxiety control, etc.). The general aim was to promote a sense of personal control over problematic private events, and to encourage a positive coping style. Overt behavioral components (exposure and activity planning) were explicitly excluded from this protocol. Both interventions were administered in eight sessions (two initial individual sessions, five group sessions, and a final individual session), with pre- and post -treatment assessment, and up to 12-month follow-ups. Post-treatment effects were similar for both conditions, but after one year, ACT was significantly more effective, with improvements in anxiety and depression scores, quality of life scores, and affected valued life areas. Despite the key limitation in terms of generalizability due to the small sample size, the results are promising and these findings point to ACT as a potentially effective treatment for disease-related psychological distress in long-term medical conditions. Read the Original Article in Spanish: Páez, M. B., Luciano, C., & Gutiérrez, O. (2007). Tratamiento psicológico para el afrontamiento del cáncer de mama. Estudio comparativo entre estrategias de aceptación y de control cognitivo. Psicooncología, 4, 75-95. [Psychological treatment for coping with breast cancer. A comparative study of acceptance and cognitive-control strategies]. __________ Can brief training for new therapists in ACT and CBT be effective? Many psychotherapy effectiveness trials use experts in the therapies they are testing. In this Finnish study, the authors wanted to first reduce this professional bias common in many head-to-head trials, by using graduate-level therapists. They explored level of training, regardless of therapeutic intervention, required to achieve significant psychological effects in treated individuals. Therapists were taught both CBT and ACT, through a combination of lectures, reading, and case supervision. Each therapist delivered a CBT treatment and an ACT treatment. The only criteria for entry into the study was a desire for individual therapy, thus a range of diagnoses were represented in the study population of 28. The techniques used within each model were based on a functional analysis case formulation model, and as such there was some overlap in techniques. For example, both interventions set treatment goals, used behavioral activation and exposure; and the treatments were problem, not syndrome focused. Overall, ACT showed significantly larger effect sizes at post and follow-up for symptom improvement. Both groups showed improvements on symptom reduction, but the ACT group was "virtually indistinguishable" from community norms. CBT showed more rapid improvement in self-confidence than ACT, and ACT improved acceptance of private experience more than CBT. When controlling for self-confidence, acceptance remained a significant predictor of improved outcome on the SCL-90 at both post and follow-up assessment. There were no differences between the two on client satisfaction or client willingness to recommend the therapy. There were also no differences post treatment in the therapist comfort with therapy or how much they felt they had helped their clients, although therapists reported more discomfort and confusion about learning and delivering ACT. So the answer is, yes. Brief training in either ACT or CBT with novice therapists produced moderately good psychological effects. The authors emphasize in their discussion of the limitations that this was not an effectiveness trail comparing the two therapies, but rather an effectiveness trial focusing on the issues of brief training and competency. Read the Article: Lappalainen, R., Lehtonen, T., & Skarp, E. (2007). The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification, 31(4), 488-511. __________ Do we need to challenge thoughts in CBT? The title says it all. In this review of CBT component analyses, the authors investigate the 'three anomalies of CBT' put forth by Steve Hayes in a previous paper. These are that component analyses do not show added value of cognitive interventions; that there is often early rapid improvement in CBT prior to cognitive intervention; and that changes in cognitive mediators (thoughts/beliefs) don't seem to precede symptom changes. The authors found 13 component analysis for Cognitive Therapy (CT) in the treatment of depression and anxiety, published since 1980 in English. There were no significant differences between conditions that targeted cognitive process only or primarily and comparison groups that often included behavioral activation (BA). In many cases, BA was found to be as effective as CT and/or Automatic Thought (AT) interventions. To quote the authors, "the case at issue is not that CT performed poorly, but that BA performed so well." They discussed preliminary findings from a long-term large-scale project that has been presented at conferences (but not yet published) in which BA performed as well as antidepressant medication, and that both were superior to CT. For anxiety disorders, cognitive interventions have not been found to be more effective than disorder-specific exposure techniques. In addressing the second anomaly the authors concluded that that early responding has insufficient evidence to support CT. And as for the third, it appears that there is insufficient evidence to support cognitive mediation as a mechanism of change in therapy. The authors conclude that, almost without exception, among component analysis studies, there was no difference in effectiveness between the behavioral and cognitive components of CBT. The cognitive interventions appeared to add no additional value to behavioral interventions. The authors called CT theorists and researchers to task, requesting further investigation of the fundamental tenets of CT therapy. Read the Article: Longmore, R. J., & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, 27(2),173-187. RFT ARTICLES Training more-than/less-than relations can facilitate derived comparative relations in young children ... One critical assumption in RFT is that relating events is operant behavior. This is a challenge to demonstrate empirically, since relating is theorized to develop early in life. Examining relatively complex relations among older, more manageable subjects is one means of avoiding certain difficulties in this analysis. This study was conducted with four normally functioning females between four and five years old. The design of the study involved a multiple baseline across participants in groups of two. Stimuli were paper slips displaying arbitrary pictures. Sessions were conducted between 1 and 3 times weekly, each lasting between 40 and 60 minutes. Participants required between 2 and 6 months to complete the study. All participants displayed deficiencies in more-than/less-than relating before training and demonstrated derived performances after sufficient training. Two of the four participants required non-arbitrary training among differing stacks of pennies before demonstrating criterion responding in training with arbitrary stimuli. In summary, these results provide evidence supporting the contention that relating events is an operant class, and that a repertoire of relating among non-arbitrary events may be a prerequisite for arbitrarily applicable derived relational responding. Read the Article (available for download on the ACBS website): Berens, N. M., & Hayes, S. C. (2007). Arbitrarily applicable comparative relations: Experimental evidence for a relational operant. Journal of Applied Behavior Analysis, 40, 45-71. __________ Combinatorial entailment in young children is facilitated by multiple exemplar training... RFT is built on the basic tenet that relating events is a generalized operant. In other words, the ability to derive relations among arbitrary stimuli develops from explicit training with multiple exemplars in early life. Consistent with this assumption, a former study found that derived symmetrical relations among the majority of a sample of 4-5 year old children were contingent upon explicit training with multiple exemplars. The current work contains two studies, each incorporating a multiple baseline design. Participants were two female and two male children between the ages of 4:6 and 4:10 years/months. The first study examined the repertoire for symmetrical relations using the procedures of the former study. Participants received conditional discrimination training for an action (e.g., clapping, waving) given an object (e.g., doll, truck). Subsequently they were tested for symmetrical relations between the action and the object. All children successfully derived symmetrical relations without encountering exemplar training. The second study examined for equivalence relations, building upon the training provided in the first study. A new set of actions (e.g., touching forehead, touching shoulder) were trained in respect to the objects. Subsequently the children were tested for equivalence relations between the actions trained in the first study and the new actions. Three of the four children required exemplar training for equivalence before demonstrating derived equivalence. These results support the developmental trajectory hypothesized in RFT, and suggest a means of remediation for delayed or absent relational abilities. Read the Article: Gomez, S., Lopez, F., Martin, C. B., Barnes-Holmes, Y., & Barnes-Holmes, D. (2007). Exemplar training and a derived transformation of functions in accordance with symmetry and equivalence. Psychological Record, 57, 273-294. __________ RFT and Perspective-taking in children with high-functioning autistic spectrum disorder . The current research involves using a test of perspective taking based on the Relational Frame Theory to (i) compare normally developing children and autistic children and (ii) demonstrate how perspective taking skills may be trained when they are deficient. According to RFT, language essentially involves relating things in accordance with particular learned patterns referred to as relational frames. Perspective taking is one specific pattern of relating or 'relational framing' in which the relating depends on the perspective of the person who is doing the relating. According to RFT, there are three core relational patterns or frames involved in perspective taking: I-YOU, HERE-THERE and NOW-THEN. This article reports on two experiments focusing on perspective taking in normal and autistic subjects. In the first experiment they use an RFT-based test of perspective taking to compare two groups of 9 children each. One of these groups is composed of normally developing children while the other is composed of high functioning autistic children. Results from this first experiment were that (i) there was a significant difference between the means scores for the normal and autistic groups of children on both the clinical tests; (ii) across both groups, most errors in the perspective taking test were made on reversed relations and there was a significant difference between performance on the simple and reversed level tasks; (iii) the two groups - normally developing and autistic - differed significantly as regards to performance on the reversed relations tasks but not as regards to performance on either of other two task types; (iv) there was a correlation across all subjects between performance on the NOW-THEN reversed relations task and Daily Living Skills scores. The researchers suggest that despite a small sample size, the results provide support for the RFT account of perspective taking as deictic relational responding in that autistic children did perform more poorly than the normally developing children in the relational perspective-taking tasks provided. They performed significantly more poorly in the reversed relational tasks than in the simple tasks. They did not perform significantly more poorly in the double reversed relational tasks than in the simple tasks. However, as the researchers point out, this may be because these tasks may be answered correctly without necessarily responding appropriately in accordance with deictic relations. In the second experiment, the researchers used the RFT tasks employed in Experiment 1 combined with appropriate feedback (cartoon animations for correct responses) to train up perspective taking ability in two of the children from the normally developing group from the first experiment. The results showed that the relational pattern involved in perspective taking could indeed be trained up as RFT would predict. They suggest that this implies that the RFT account of perspective taking is a useful one, and that RFT-based perspective taking tasks such as those used in the current experiments may be used in future work to train up perspective taking in autistic children. Read the Article: Rehfeldt, R.A., Dillen, J.E., & Ziomek, M.M.(2007) Assessing Relational Learning Deficits in Perspective-Taking in Children with High-Functioning Autism Spectrum Disorder. Psychological Record, 57(10), 23-47. BOOKS Gregg, J. A., Callaghan, G. M., & Hayes, S. C. (2007). Diabetes lifestyle book. Oakland, CA: New Harbinger Press. Follette, V. M., & Pistorello, J. (2007). Finding life beyond trauma. Oakland, CA: New Harbinger Press. Hayes, S. C., Bond, F. W., Barnes-Holmes, D., & Austin, J. (2007). Acceptance and Mindfulness at Work: Applying Acceptance and Commitment Therapy And Relational Frame Theory to Organizational Behavior Management. Binghamton, NY: Haworth Press. Lejeune, C. (2007). The Worry Trap: How to Free Yourself from Worry & Anxiety using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Press. Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An acceptance and commitment therapy skills-training manual for therapists. Oakland, CA: New Harbinger Press. Walser, R., & Westrup, D. (2007). Acceptance & Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder: A Practitioner's Guide to Using Mindfulness & Acceptance Strategies. Oakland, CA: New Harbinger Press. Zettle, R. D. (2007). ACT for depression: A clinician's guide to using acceptance and commitment therapy in treating depression. Oakland, CA: New Harbinger Press. Also: Check out the ACT in ACTion DVD set. Available at newharbinger.com BOOK CHAPTERS Pierson, H., & Hayes, S. C. (2007). Using acceptance and commitment therapy to empower the therapeutic relationship. In P. Gilbert & R. L. Leahy (Eds.), The therapeutic relationship in the cognitive behavioral psychotherapies (pp. 205-228). New York, NY: Routledge/Taylor & Francis Group. Twohig, M. P., Pierson, H. M., & Hayes, S. C. (2007). Acceptance and Commitment Therapy. In N. Kazantzis & L. L'Abate (Eds.), Handbook of homework assignments in psychotherapy: Research, practice, prevention (pp. 113-132).New York, NY: Springer Science + Business Media. DISSERTATIONS Pellowe, M. E. (2007). Acceptance and commitment therapy as a treatment for dysphoria. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 67(9-B), 5418. Braekkan, K. C. (2007). An acceptance and commitment therapy intervention for combat veterans with posttraumatic stress disorder: Preliminary outcomes of a controlled group comparison. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 67(12-B), 7365. EDITORIALS Curran, J., & Houghton, S. (2007). Moving beyond mechanism. Mental Health Practice, 10(8), 20-23. Blackledge, J. T. (2007). Disrupting verbal processes: Cognitive defusion in Acceptance and Commitment Therapy and other Mindfulness-based Psychotherapies. The Psychological Record, 57(4).

admin September 28, 2008 - 1:38pm

ACT with Special Populations or in Specific Settings

ACT is a general model of the language and cognition processes involved in reducing psychological suffering and promoting human well-being. As such, it is not a specific set of techniques. Any ACT intervention is an instance of a general psychological strategy which is designed to be flexibly applied. ACT can be applied in short interventions done in minutes or hours, as well as in interventions which take many sessions. ACT can be used in groups, individual sessions, classroom settings, couples therapy, bibliotherapy, workplace trainings, and much more. Be sure to check out our collection of ACT treatment protocols and list of books for Specific Populations.

There are several Special Interest Groups (SIGs) focused on specific populations and settings. This is a partial list of SIG topics. To see the full list of Special Interest Groups, click here.

admin November 28, 2007 - 11:23pm

Fellow Travelers

The third generation of cognitive behavior therapy (CBT) has been defined this way:

Grounded in an empirical, principle-focused approach, the third wave of behavioral and cognitive therapy is particularly sensitive to the context and functions of psychological phenomena, not just their form, and thus tends to emphasize contextual and experiential change strategies in addition to more direct and didactic ones. These treatments tend to seek the construction of broad, flexible and effective repertoires over an eliminative approach to narrowly defined problems, and to emphasize the relevance of the issues they examine for clinicians as well as clients. The third wave reformulates and synthesizes previous generations of behavioral and cognitive therapy and carries them forward into questions, issues, and domains previously addressed primarily by other traditions, in hopes of improving both understanding and outcomes. (Hayes, 2004)

The most unique characteristic of the third wave interventions is the degree of emphasis on contextual and experiential change strategies, including acceptance, defusion, mindfulness, relationship, values, emotional deepening, contact with the present moment, and the like. The purpose of experiential and contextual strategies of this kind is to rapidly alter the function of problematic psychological events, even if their form or frequency does not change or changes only slowly. Mindfulness-based and acceptance technologies show that focus quite clearly. For example, Segal, Teasdale, and Williams (2004) state: “Unlike CBT, there is little emphasis in MBCT on changing the content of thoughts; rather, the emphasis is on changing awareness of and relationship to thoughts.”

It is worth noting that this step is being taken both by techniques that are quite behavior analytic and thus philosophically contextualistic in their rationalization (e.g., Behavioral Activation, ICBT, DBT, ACT, FAP), and by techniques that are quite cognitive in their rationalization (e.g., MBCT, Metacognition).

This is important, because it means that the mainstream itself is changing and there are new opportunities for connection and communication across old boundaries. In a kind of dialectical synthesis of a previous thesis and antithesis, the new wave therapies seem to be healing old wounds and divisions between behavioral and cognitive perspectives. Evidence for this view can be found in the synergies between technologies across of the spectrum of third wave interventions, and in the ways that each of these new approaches has breadth across these divisions regardless of its home of origin. The third wave interventions are not a rejection of the first and second waves of behavioral and cognitive therapy so much as a transformation of these earlier phases into a new, broader, more interconnected form. Thus, while the implications may be revolutionary, the processes giving rise to these developments are evolutionary – as might be expected in an explicitly empirical tradition.

We invite child pages to be added in any of the methods and approaches that are part of a more contextual approach (simply click the "add child page" link at the bottom of the relevant page).

Steven Hayes August 14, 2005 - 11:37am

Fellow Travelers FAQ

Click on a question below to view its answer!

ACBS Members: To suggest a question for someone to answer, click on the "add new comment" link at the bottom of this page and enter your question. To provide a question and an answer to this FAQ, click on the "add child page" link at the bottom of this page.

Eric Fox August 16, 2005 - 2:00pm

What characterizes the so-called third wave behavior therapies?

”Grounded in an empirical, principle-focused approach, the third wave of behavioral and cognitive therapy is particularly sensitive to the context and functions of psychological phenomena, not just their form, and thus tends to emphasize contextual and experiential change strategies in addition to more direct and didactic ones. These treatments tend to seek the construction of broad, flexible and effective repertoires over an eliminative approach to narrowly defined problems, and to emphasize the relevance of the issues they examine for clinicians as well as clients. The third wave reformulates and synthesizes previous generations of behavioral and cognitive therapy and carries them forward into questions, issues, and domains previously addressed primarily by other traditions, in hopes of improving both understanding and outcomes.” (quote from Hayes, 2004).

These are very broad characterizations and there is no clear dividing line between various historical aspects of the behavior therapy tradition.

Steven Hayes July 31, 2005 - 9:50am

How does Relational Frame Theory (RFT) relate to traditional CBT-theories?

That question is a huge one. RFT seeks a broad understanding of cognition. In the long run it could be more important than ACT because if it works the whole of psychology could change.

RFT is developmental, contextual, and behavioral. It gives you ideas about what to change to make things happen. It is so basic that it goes all the way down to animal behavior and human infants; and yet so broad in scope that it has clear implications for our understanding of social processes or such human activities as religion.

We have never had an empirically adequate behavioral, contextual account of cognition. Now we have at least the beginnings of one and it seems to be braking down the artificial barriers between cognitive and behavioral science.

The theories underlying CBT and CT are not like that. They have relatively low scope and they emerged typically from clinical concerns. They do not pretend to be the functional equivalent in cognition for what “behavioral principles” are in non-verbal behavior.

You have to be impressed with what the traditional behavior therapists were able to do with traditional behavioral principles, in part because these principles emphasized manipulable contextual variables. Imagine what we might do with a theory of cognition that emphasized manipulable contextual variables, if the theory was relatively adequate. Maybe a lot.

Steven Hayes July 31, 2005 - 9:54am

ACT, evolutionary biology and severe mental illness

Originally submitted by user dixonph on 7/30/2014:

Edward Hagen's paper: Delusions as Exploitative Behavior
http://bit.ly/1ppVlnu echoes themes of ACT theorists. ACT is held by the founders as a possible aid for even severe psychotic disorders. Contextual behavior theory is not mentioned as such in Hagen's paper. I don't know if Hagen is involved with mental illness treatments, or ACT specifically. The paper seems to be very much in line with ACT principles. That is why I mention it here. I see a connection.

If even severe mental illness is an evolutionary adaptive survival mechanism manifested as a result of a failed social context, then how can ACT help reintegrate the modern sufferer into more successful social connections?

Can there be communities where ACT functions to create an experience of acceptance and support for sufferers even outside the therapeutic setting?

I am looking to see if Edward Hagen is involved with ACBS/ACT. His paper states that he believes anti-psychotic medication will not really help someone with what is called delusional disorder (semi-plausible delusions, continued day to day routine functioning), which is distinct from the bizarre delusions of schizophrenia. He also mentions the harmful side effects of the medications.

I am interested in the potential for ACT in supportive community for mental health sufferers.

Any known efforts among ACT practioners?

Jennifer Krafft March 9, 2016 - 6:45pm

Differences/Similarities between ACT/DBT

ACT and DBT could be considered sister/brother technologies. Both have been described as part of the "third wave" of cognitive-behavioral therapies, which also includes therapies such as mindfulness-based cognitive therapy and integrative behavioral couples therapy (and potentially the new modern behavior analytic form of behavioral activitation by the deceased Jacobson and colleagues that seems to be outperforming cognitive therapy for depression in two trials). This new set of therapies, all of which have a commitment to empirical evaluation and science, tend to differ in important ways from traditional CBT. For example, the third wave tends to pay more attention to secondary change in the area of thoughts and feelings. Traditional CBT tries to help people directly change thoughts and feelings, sort of an in-with-the-good out-with-the-bad approach to cognitive and emotional content. These third wave approaches focus on helping people to change their relationship to these private experiences, rather than trying to change the form, situational sensitivity, or content of these experiences. Emphasis then tends to turn to being effective in one's life and away from working to feel GOOD. Another way to put this is that these therapies tend to help people learn how to FEEL good, rather than to try to feel GOOD. Anyways, there are papers written about this new set of therapies and their similarities and differences for those who want more info.

Here's a little about what I see as differences/similiarities between DBT and ACT, with the disclaimer that I am far from an expert on DBT. DBT and ACT both emerge from a behavioral tradition. Both share the similarity of emphasizing acceptance, mindfulness, and effectiveness of action. In at least those domains they are quite similar. In terms of the theory that underlies them, they are quite different. ACT is closely tied to a modern behavior analytic theory of language and cognition called Relational Frame Theory (RFT), which underlies the approach, and also to traditional behavior analytic principles such as reinforcement. The first clinical trials on ACT were published several years before DBT (in 1985-86 with depression), but then Steve Hayes decided that ACT needed a firmer theoretical foundation and this lead to about 15 years of research and dozens of studies on RFT before the next application of RFT (an ACT clinical trial on psychosis) was published in 1999. My experience with DBT is that its focus has been on developing a technology that is practical, pragmatic, and manualized, with less of an emphasis on developing a comprehensive theory of human behavior. ACT is very closely tied to the broader tradition of behavior analysis and could be considered a form of clinical behavior analysis while DBT seems to be more closely tied to traditional behavior therapy.

In terms of overlap in specific techniques between ACT and DBT, the overlap appears limited. There seems to be very little overlap in terms of the specific techniques, exercises, and metaphors used in session (with the exception of general mindfulness exercises).

In terms of the evidence base, DBT undoubtedly has a stronger evidence with more replication in the more limited areas that it has been tested (e.g., parasuicidality/substance abuse), while ACT has been examined in a wider variety of clinical trials, with less replication, with more disorders (e.g., chronic pain, substance abuse, depression, workplace settings, anxiety, and a dozen or so other), probably due to the broader scope of its underlying theory.

[this is exerpted from an email to a listserv in Oregon and I thought others might be interested in this. Feel free to modify or comment on any disagreement/inconsistencies/extensions]

Jason Luoma February 10, 2006 - 2:39pm

Glossary

Glossary of Terms

(en español)

ejneilan@hotmail.com September 15, 2008 - 7:35pm

Cfunc

A context that controls the transformation of stimulus functions. Pronounced "cee funk." (Note: the "func" portion of this term typically appears as subscript, which is difficult to implement in HTML).

ejneilan@hotmail.com September 15, 2008 - 8:08pm

Crel

A context that controls framing events relationally. While these can include nonarbitrary features of the relata in some circumstances, the same relational behavior must also be controlled by arbitrary contextual cues in other circumstances in order to define the response as arbitrarily applicable. Pronounced "cee rel." (Note: the "rel" portion of this term typically appears as subscript, which is difficult to implement in HTML).

ejneilan@hotmail.com September 15, 2008 - 9:05pm

acceptance

Acceptance is defined in ACT as "actively contacting psychological experiences -- directly, fully, and without needless defense -- while behaving effectively." (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996, p. 1163)

ejneilan@hotmail.com September 15, 2008 - 7:41pm

analytic-abstractive theory

Organized sets of behavioral principles emerging from coherent sets of functional analyses that are used to help predict and influence behaviors in a given response domain.

ejneilan@hotmail.com September 15, 2008 - 7:43pm

arbitrarily applicable relational responding

Learned relational responding that can come under the control of arbitrary contextual cues, not solely the formal properties of relata nor direct experience with them.

ejneilan@hotmail.com September 15, 2008 - 7:48pm

arbitrary

By social whim or convention. It is arbitrary, for example, that English speakers use the word "apple" to refer to a particular type of fruit. Speakers in other language communities choose entirely different words to refer to that type of fruit.

ejneilan@hotmail.com September 15, 2008 - 7:50pm

augmenting

A form of rule-governed behavior controlled by relational networks that alter the degree to which events function as consequences. The rule itself is called an augmental.

ejneilan@hotmail.com September 15, 2008 - 7:56pm

behavior analysis

A natural science of behavior that seeks the development of an organized system of empirically-based verbal concepts and rules that allow behavioral phenomena to be predicted and influenced with precision, scope, and depth. By studying the current and historical context in which behavior evolves, behavior analysts strive to develop analytic concepts and rules that are useful for predicting and changing behavior in a variety of settings. The most well-established behavioral principles of this sort are those related to classical and operant conditioning, such as B. F. Skinner's principles of reinforcement. The core analytic unit of behavior analysis is the operant (or multiterm contingency). An operant analysis defines behavior in terms of its relation to antecedent events and consequences, and learning is understood to be a function of the inherent interdependence between these features. This contextual approach to studying behavior has resulted in a robust science with many powerful applications in nearly every area of human endeavor. Behavior analysis is supported by a philosophy of science known as functional contextualism. See the Association for Behavior Analysis (www.abainternational.org) and the Cambridge Center for Behavioral Studies (www.behavior.org) for more information.

ejneilan@hotmail.com September 15, 2008 - 7:58pm

behavioral principles

Ways of speaking about behavioral interactions that are high in precision and scope. Reinforcement theory is based on a set of principles that meet these criteria.

ejneilan@hotmail.com September 15, 2008 - 8:01pm

combinatorial entailment

A defining feature of relational frames that refers to the ability to combine mutually related events into a relational network under forms of contextual control that can include arbitrary contextual cues. Combinatorial entailment applies when in a given context A is related in a characteristic way to B, and A is related to C, and as a result a relation between B and C is now mutually entailed. The specific form of the network does not matter. It would be as correct to say that combinatorial entailment applies when in a given context A is related in a characteristic way to B, and B is related to C, and as a result a relation between A and C is now mutually entailed. Combinatorial entailment can be represented by the formula below.

comb ent.jpg

ejneilan@hotmail.com September 15, 2008 - 8:17pm

complete relational network

Networks of events containing Crel terms that set the occasion for the relational activity necessary to specify a relation between the events in the network.

ejneilan@hotmail.com September 15, 2008 - 8:51pm

contextual psychology

Contextual Psychology refers to the study of organisms (both human and non-human) interacting in and with a historical and current situational context. It is an approach based on contextualism, a philosophy in which any event is interpreted as an ongoing act inseparable from its current and historical context and in which a radically functional approach to truth and meaning is adopted. This website is devoted to the development of a progressive psychological science based on functional contextualism, a variant of contextualism focused on the construction of practical, scientific knowledge. This scientific form of contextual psychology is virtually synonymous with the field known as behavior analysis.

ejneilan@hotmail.com September 15, 2008 - 8:55pm

contextualism

Although this term has more general meanings, as applied in RFT it refers to a philosophy of science based on the root metaphor of an going historical act in context as its analytical unit, and utilizing a truth criterion of successful working as tied to a specific set of analytic goals.

ejneilan@hotmail.com September 15, 2008 - 8:58pm

continuity assumption

The assumption that more recent life forms contain the features of older life forms within the same evolutionary stream.

ejneilan@hotmail.com September 15, 2008 - 8:59pm

coordination

The frame of coordination is perhaps the most common type of relational responding. It incorporates the relation of identity, sameness, or similarity. This relational frame is probably the first to be abstracted sufficiently to enable its application to become arbitrary, in part because it is the only relation in which derived and trained relations are the same, regardless of the number of stimuli that participate in relational networks consisting purely of this response frame. Naming is an example of the frame of coordination at its simplest.

ejneilan@hotmail.com September 15, 2008 - 9:01pm

deictic frames

Deictic relations specify a relation in terms of the perspective of the speaker such as left/right; I/you (and all of its correlates, such as "mine"; here/there; and now/then. Some relations may or may not be deictic, such as front/back or above/below, depending on the perspective applied. For example, the sentence "The back door of my house is in front of me" contains both a spatial and deictic form of "front/back." Deictic relations seem to be a particularly important family of relational frames that may be critical for perspective-taking. An example is the three frames of I and YOU, HERE and THERE, and NOW and THEN. These frames are unlike the others mentioned previously in that they do not appear to have any formal or nonarbitrary counterparts. Coordination, for instance, is based on formal identity or sameness, and "bigger than" is based on relative size. In contrast, frames that depend on perspective cannot be traced to formal dimensions in the environment at all; instead, the relationship between the individual and other events serves as the constant variable upon which these frames are based.

ejneilan@hotmail.com September 15, 2008 - 8:13pm

depth

Depth means that analytic concepts relevant to one level of analysis (e.g., the psychological level) cohere with (or at least do not contradict) well-established and workable concepts at other levels of analysis (e.g., the anthropological level).

ejneilan@hotmail.com September 15, 2008 - 10:03pm

distinction

The frame of distinction also involves responding to one event in terms of the lack of a frame of coordination with another, typically also along a particular dimension. Like a frame of opposition, this frame implies that responses to one event are unlikely to be appropriate in the case of the other, but unlike opposition, the nature of an appropriate response is typically not defined. If I am told only, for example, "this is not warm water," I do not know whether the water is ice cold or boiling hot. When frames of distinction are combined, the combinatorially entailed relation is weak. For example, without additional disambiguating information, if two events are different than a third event, I do not know the relation between these two beyond the fact of their shared distinction.

ejneilan@hotmail.com September 15, 2008 - 10:04pm

families of relational frames

Relational frames can be roughly organized into families of specific types of relations. This list is not exhaustive, but serves to demonstrate some of the more common frames and how they may combine to establish various classes of important behavioral events.

frames of coordination
frames of opposition
frames of distinction
frames of comparison
hierarchical frames
deictic frames
other families: other families of relations include spatial relations such as over/under and front/back, temporal relations such as before/after, and causal/contingency relations such as "if...then"

The foregoing families of relational frames are not final or absolute. If RFT is correct, the number of relational frames is limited only by the creativity of the social/verbal community that trains them. Thus the foregoing list is to some degree tentative. For example, TIME and CAUSALITY can be thought of as one or two types of relations. It is not yet clear if thinking of them as either separate or related may be experimentally useful, relative to the goals of RFT. Thus, while the generic concept of a relational frame is foundational to RFT, the concept of any particular relational frame is not. The purpose in constructing a list of frames is to provide a set of conceptual tools, some more firmly grounded in data than others, that may be modified and refined as subsequent empirical analyses are conducted. To see some brief examples of common families of relational frames, please watch the video families below.

ejneilan@hotmail.com September 15, 2008 - 10:07pm

formative augmenting

A form of rule-governed behavior controlled by relational networks that establish given consequences as reinforcers or punishers.

ejneilan@hotmail.com September 15, 2008 - 11:52pm

frames of comparison

The family of comparative relational frames is involved whenever one event is responded to in terms of a quantitative or qualitative relation along a specified dimension with another event. Many specific subtypes of comparison exist (e.g., bigger/smaller, faster/slower, better/worse). Although each subtype may require its own history, the family resemblance may allow the more rapid learning of successive members. The different members of this family of relations are defined in part by the dimensions along which the relation applies (e.g., size; attractiveness; speed). Comparative frames may be made more specific by quantification of the dimension along which a comparative relation is made. For example, the statement "A is twice as fast as B and B is twice as fast as C" allows a precise specification of the relation within all three pairs of elements in the network.

ejneilan@hotmail.com September 15, 2008 - 11:58pm

frames of coordination

ejneilan@hotmail.com September 16, 2008 - 12:06am

frames of distinction

ejneilan@hotmail.com September 16, 2008 - 12:09am

frames of opposition

Opposition is another early relational frame. In natural language use, this kind of relational responding involves an abstracted dimension along which events can be ordered and distinguished in equal ways from a reference point. Along the verbally abstracted dimension of temperature, for example, cool is the opposite of warm, and cold is the opposite of hot. The specific relational frame of opposition typically (but not necessarily) implicates the relevant dimension (e.g., "pretty is the opposite of ugly" is relevant to appearance). Opposition should normally emerge after coordination because the combinatorially entailed relation in frames of opposition includes frames of coordination (e.g., if hot is the opposite of freezing and cold is the opposite of hot, then cold is the same as freezing).

ejneilan@hotmail.com September 16, 2008 - 12:13am

framing events relationally

Framing events relationally (or "framing relationally" or "relational framing") refers to a specific type of arbitrarily applicable relational responding that has the defining features in some contexts of mutual entailment, combinatorial entailment, and the transformation of stimulus functions. Framing events relationally is due to a history of relational responding relevant to the contextual cues involved; and is not solely based on direct non-relational training with regard to the particular stimuli of interest, nor solely to nonarbitrary characteristics of either the stimuli or the relation between them. The action of framing events relationally is often referred to in the noun form of "relational frame." Various families of relational frames, or ways of framing events relationally, have been identified.

ejneilan@hotmail.com September 16, 2008 - 12:17am

functional contextualism

A specific form of contextualism with the a priori analytic goals of the prediction-and-influence of behavioral events, with precision, scope, and depth. "Prediction-and-influence" is hyphenated here to emphasize its fundamental inseverability in functional contextualism, even though in practical terms it is possible only to reach one goal and not the other. Functional contextualism supports the science of behavior known as behavior analysis.

ejneilan@hotmail.com September 16, 2008 - 12:27am

generalized operant

Operants are purely functional units of analysis, organized by their common antecedent, consequential, and motivational sources of control. However, because topographical and functional classes of behavior-environment interactions often overlap, operants are sometimes thought of in topographical terms. The word "generalized" (or similar terms, such as "purely functional" or "overarching") is used to emphasize that this particular operant is not usefully thought of in topographical terms.

ejneilan@hotmail.com September 16, 2008 - 12:36am

hierarchial frames

Hierarchical relations or hierarchical class memberships have the same diode-like quality of frames of comparison, but the combinatorially entailed relations differ because the hierarchical relation itself is the basis for a frame of coordination. For example, if Tom is the father of Simon and Jane, then Simon and Jane are known to be siblings. If Tom is taller than both Simon and Jane, however, the relative heights of Simon and Jane are unknown. Hierarchical relations are essential to many forms of verbal abstraction.

ejneilan@hotmail.com September 16, 2008 - 12:38am

listening with understanding

The responses of listeners that are based on framing events relationally.

ejneilan@hotmail.com September 16, 2008 - 12:40am

motivative augmenting

A form of rule-governed behavior controlled by relational networks that alter the degree to which previously established consequences function as reinforcers or punishers.

ejneilan@hotmail.com September 16, 2008 - 12:55am

mutual entailment

A defining feature of relational frames that refers to its fundamental bidirectionality under forms of contextual control that can include arbitrary contextual cues. Mutual entailment applies when in a given context A is related in a characteristic way to B, and as a result B is now related in another characteristic way to A. Mutual entailment can be represented by the formula below.

Mutual entailment.jpg

ejneilan@hotmail.com September 16, 2008 - 1:00am

opposition

ejneilan@hotmail.com September 16, 2008 - 1:03am

pliance

A form of rule-governed behavior under the control of a history of socially-mediated reinforcement for coordination between behavior and antecedent verbal stimuli (i.e., the relational network or rule), in which that reinforcement is itself delivered based on a frame of coordination between the rule and behavior. Stated another way, pliance requires both following a rule and detection by the verbal community that the rule and the behavior correspond. Mere social consequation does not define pliance. The rule itself is called a ply.

ejneilan@hotmail.com September 16, 2008 - 1:11am

pragmatic verbal analysis

Framing events relationally under the control of abstracted features of the nonarbitrary environment that are themselves framed relationally. Stated in other words, pragmatic verbal analysis involves acting upon the world verbally, and having the world serve verbal functions as a result.

See below for an illustration of RFT's interpretation of pragmatic verbal analysis/problem solving.

ejneilan@hotmail.com September 16, 2008 - 1:13am

precision

Precision means that there are relatively few ways to explain or describe a given phenomenon with a set of analytic concepts. The fewer ways a given phenomenon can be explained or described with a set of concepts the better.

ejneilan@hotmail.com September 16, 2008 - 6:53pm

problem solving

Although problem-solving has both non-verbal and verbal connotations, in a verbal sense problem-solving refers to framing events relationally under the antecedent and consequential control of an apparent absence of effective actions. When the particular problem involves the stimulus functions of the nonarbitrary environment, verbal problem-solving can be said to be pragmatic verbal analysis that changes the behavioral functions of the environment under the antecedent and consequential control of an apparent absence of effective action.

See below for an illustration of RFT's interpretation of pragmatic verbal analysis/problem solving.

admin September 16, 2008 - 6:56pm

relata

Events that are in a relational network.

ejneilan@hotmail.com September 16, 2008 - 7:49pm

relational frame

A specific type of arbitrarily applicable relational responding that has the defining features in some contexts of mutual entailment, combinatorial entailment, and the transformation of stimulus functions. Relational frames are due to a history of relational responding relevant to the contextual cues involved; and is not solely based on direct non-relational training with regard to the particular stimuli of interest, nor solely to nonarbitrary characteristics of either the stimuli or the relation between them. While used as a noun, it is in fact always an action and thus can be restated anytime in the form "framing events relationally." Various families of relational frames have been identified.

ejneilan@hotmail.com September 16, 2008 - 7:50pm

relational network

A relational frame is the smallest relational network that can be defined, although the term network is usually used to refer to combinations of relational frames, such as A is more than B, B is the same as C, C is less than D. The term network is also used to describe relations between or among relational frames, such as, if A is more than B, and C is more than D, then the relation between A and B participates in a frame of coordination with the relation between C and D.

ejneilan@hotmail.com September 16, 2008 - 7:54pm

relational responding

Responding to one event in terms of another. See below for an illustration depicting the difference between relational responding and non-relational responding.

ejneilan@hotmail.com September 16, 2008 - 7:56pm

rule-governed behavior

a.k.a., RGB

In its most general terms, behavior controlled by a verbal antecedent. However, behavior controlled by verbal antecedents is more likely to be termed "rule governed" if the verbal antecedent forms a complete relational network that transforms the functions of the nonarbitrary environment.

See below for an illustration of RFT's interpretation of rule-governed behavior.

ejneilan@hotmail.com September 16, 2008 - 7:58pm

scope

Scope means that a broad range of phenomena can be analyzed with a given set of analytic concepts (the broader the range the better, so long as precision is not compromised).

ejneilan@hotmail.com September 16, 2008 - 8:01pm

strategic problems

Those verbal problems in which the problem solver has placed the desired goal or purpose into a relational frame.

ejneilan@hotmail.com September 16, 2008 - 8:02pm

thinking

Although thinking has both non-verbal and verbal connotations, in a verbal sense it is a reflective behavioral sequence, often private, of pragmatic verbal analysis that transforms the functions of the environment so as to lead to novel, productive acts.

ejneilan@hotmail.com September 16, 2008 - 8:05pm

tracking

A form of rule-governed behavior under the control of a history of coordination between the rule and the way the environment is arranged independently of the delivery of the rule. The rule itself is called a track.

ejneilan@hotmail.com September 16, 2008 - 8:06pm

transfer of stimulus functions

A specific type of transformation of stimulus functions between two relata when they participate in a frame of coordination.

ejneilan@hotmail.com September 16, 2008 - 8:11pm

transformation of stimulus functions

A defining feature of relational frames that refers to the modification of the stimulus functions of relata based on contextual cues that specify a relevant function (Cfunc) and the relational frame that these events participate in (Crel). The transformation of stimulus functions can be represented by the formula below.

Transformation of stimulus functions.jpg

ejneilan@hotmail.com September 16, 2008 - 6:49pm

valuative problems

Those verbal problems in which the goal is to place a desired goal or purpose into a relational frame.

ejneilan@hotmail.com September 16, 2008 - 8:15pm

varieties of relational frames

frames of coordination
frames of opposition
frames of distinction
frames of comparison
hierarchical frames
deictic frames
other families: other families of relations include spatial relations such as over/under and front/back, temporal relations such as before/after, and causal/contingency relations such as "if...then"

ejneilan@hotmail.com September 16, 2008 - 8:16pm

verbal behavior

The action of framing events relationally.

ejneilan@hotmail.com September 16, 2008 - 8:21pm

verbal stimuli

Stimuli that have their effects because they participate in relational frames.

ejneilan@hotmail.com September 16, 2008 - 8:23pm

The Three Earliest ACT Protocols

Sleuthing exactly when the first ACT protocols were written is tricky due to the passage of time, and the fact that computers did not exist so duplicate records meant carbon paper copies on onion skin kept in files and packed in cardboard boxes as moves occurred or new jobs were secured. Thus the reasoning for dating is included below.

The first ACT protocol was likely written by Steve Hayes in late Spring of 1981. At that time the name was "Comprehensive Distancing". An attachment to this page contains that very first protocol ("1981 Big D Manual S C Hayes") which is only 3 pages long. But its clear from the "manual" (an outline really) that the students knew the metaphors and exercises. Steve thinks his "night on the carpet" (www.bit.ly/StevesFirstTED) was during the 1980-81 winter break and that he came back to the lab ready to push hard on studying what he had experienced. He thinks he remembers conducting a workshop in the lab soon after and the "manual" was written after that in the 1981 Spring semester.

The next protocol was written soon after in 1981. Here is how we know that: the study was an analogue study on pain tolerance and it was presented at the Association for the Advancement of Behavior Therapy (now AABT) in 1982:

Hayes, S. C., Korn, Z., Zettle, R. D., Rosenfarb, I., & Cooper, L. (November 1982). Rule‑governed behavior and cognitive behavior therapy: The effects of comprehensive cognitive distancing on pain tolerance. Paper presented at the meeting of the Association for Advancement of Behavior Therapy, Los Angeles.

That means the study was finished by about March of 1982 so it could be submitted.

But Rob Zettle (Steve Hayes's first doctoral student) thinks he likely used that pain manual to help write the manual for his dissertation on Cognitive Therapy vs ACT for depression. One reason to think that: the onion skin carbon copy of that pain protocol was only found in February 2024 (!) while looking for the first "Big D" manual, and Rob found it not in the files for the pain study, but in the cardboard box of files for his dissertation ... as if the protocol was relocated for his reference.

Rob recalls running two subjects for his dissertation project in Greensboro before he left for his internship at the Center for Cognitive Therapy in Philadelphia in the summer of 1982. For that reason he thinks he was writing that protocol in the Fall 1981. His dissertation was conducted with the cooperation and support of Aaron Beck (note, ACT was never "at war" with Tim Beck!) and was defended in 1984 under the title "Cognitive Therapy of Depression: A Conceptual and Empirical Analysis of Component and Process Issues" (ProQuest Dissertations Publishing, 1984, 8509189). Incidentally in the context of the recent move toward ACT as a form of "Process-Based Therapy" it is worth noting the title of this first randomized controlled clinical trial on ACT! ACT was always a form of process-based therapy -- it's just now we have a name for that view.

The pain study was put in a file drawer, not because it was bad but because it was good, and Steve thought it would be more prudent to work out the issues of process measures, components, basic principles of rule-governance and relational framing, and philosophy of science issues before emphasizing outcomes alone.

That took far longer than anyone thought at the time and thus the pain study was only published in 1999, 17 years after it was finished: Hayes, S. C., Bissett, R., Korn, Z., Zettle, R. D., Rosenfarb, I., Cooper, L., & Grundt, A. (1999). The impact of acceptance versus control rationales on pain tolerance. The Psychological Record, 49, 33-47.

An unfortunate historical note is that the pain manual was lost -- although Steve remembered seeing it more than once over the years, it was simply not in Steve's box of materials about the pain study when ACT began to be studied again for outcomes in the late 1990's. This meant that the two labs that were first interested -- Dermot Barnes-Holmes and Bryan Roche -- had to wander in the wilderness trying to replicate it. Both labs eventually did, but it took years to dial in the preparation, so progress was needlessly delayed and effort was wasted. That is one reason why finding the actual manual (25 years after its publication and 42 years after the study itself!) is of such historical importance.

Rob Zettle has written a history of this era and later eras of ACT development. The article describing these early days and more is attached below.

Steven Hayes February 29, 2024 - 8:23pm

ACT Books

There are many books, audiobooks, and other materials to help you learn more about ACT and CBS. There may seem like a lot of choices in some areas. And there are, which is a testament to how quickly the ACT work has grown.

ACT Books

Other books of interest:

Books in languages other than English

Translated ACT and RFT books in 20+ languages

Community December 16, 2019 - 4:14pm

ACT FAQ

Click on a question below to view its answer!

ACBS Members: To suggest a question for someone to answer, click on the "add new comment" link at the top of this page and enter your question. To provide a question and an answer to this FAQ, click on the "add child page" link at the top of this page.

Steven Hayes May 2, 2005 - 10:02am

How does ACT differ from traditional CBT interventions?

ACT is part of the behavior therapy / behavior analysis / and cognitive behavior therapy tradition writ large so it would be silly to compare ACT to CBT as a whole which ACT is part of and which ACT has been influencing. “Traditional CBT-interventions” presumably means interventions organized around the idea that thoughts cause emotions and behavior. Even that subsection encompasses a broad range of things – theoretically and procedurally, so only generalizations are possible given such a question. What is different is the philosophy, basic science, applied theory, targeted processes of change, and many of the techniques of change. That is a pretty long list and it would take volumes to fully explain them. In outline form: 1. Philosophy ACT is rooted in the pragmatic philosophy of functional contextualism, a specific variety of contextualism that has as its goal the prediction and influence of events, with precision, scope and depth. Contextualism views psychological events as ongoing actions of the whole organism interacting in and with historically and situationally defined contexts. These actions are whole events that can only be broken up for pragmatic purposes, not ontologically. Because goals specify how to apply the pragmatic truth criterion of contextualism, functional contextualism differs from other varieties of contextualism that have other goals, such as hermeneutics, narrative psychology, dramaturgy, social constructionism, feminist psychology, Marxist psychology, and the like which are forms of ”descriptive contextualism” because their goal seems to be to appreciate the participants in the whole event. There are contextualistic varieties of CBT (the constructivists, for example) but they look more like descriptive contextualists than functional contextualists. The mainstream of CBT is elementalistic and integrative (it is looking for an overall model of parts, relations and forces). The word for this kind of philosophy can create problems because it has negative connotations: mechanistic. Remember though that philosophy is not a metter of good and bad, or right and wrong. Philosophy is a matter of owning ones assumptions and assumptions are nothing to thump one’s chest over. Mechanism is a very powerful set of assumptions and it has done well in many areas of science. But it is different than the assumptions underlying ACT. If you think people think sort of like computers calculate, you will probably not like ACT. It will feel strange. Take things like the importance of values in ACT or the importance of cognitive defusion. The former is needed in order to specify the criteria for the application of workability, which is what a pragmatist takes to be ”true.” The later is what language looks like if you hold to that pragmatic assumption. If a person states an irrational thought, a traditional CBT person may want to know how it biases the facts – exactly what is demanded by the ontological assumption of mechanism – while an ACT person wants to know what saying that is in the service of and what functional role it plays due to history and context -- exactly what is demanded by the pragmatic assumptions of contextualism. 2. Basic Theory Nearly a decade and a half passed between the earliest randomized trials on ACT and those in the modern era. In that interval, the basic theory of human language and cognition underlying ACT, Relational Frame Theory was developed into a comprehensive basic experimental research program. RFT is not a basic theory of ACT. It is a basic theory of cognition. But if RFT is workable and if ACT makes sense, you have to be able to do a basic analysis of ACT using RFT – just as you would have to be able to do an analysis of any cognitive procedure using RFT. That is the aspiration – and if you know behavior analysis you will recognize that it is an entirely traditional aspiration for people who do work on behavioral principles – the difference is that now we now think we have an angle on human cognition that is empirically and conceptually workable. We are not fully there yet, of course, but we are now seeing the RFT studies of defusion, acceptance, values, and so on and the early data are tremendously exciting. According to RFT, the core of human language and cognition is the learned ability to arbitrarily relate events, mutually and in combination, and to change the functions of events based on these relations. For example, very young children will know that a nickel is larger than a dime by physical size, but not until later will the child understand that a nickel is smaller than a dime by social attribution. RFT researchers have shown that such relations as knowing that one event is “larger” than another arbitrarily can be trained as an operant and will alter the impact of other behavioral processes. We even have some new data seemingly showing that the symmetry of names and objects are trained as an operant in infants. There are neurobiological data showing that the brain lights up when performing RFT tasks much as it does when doing natural language tasks modeled by the theory. Virtually every component of ACT is connected conceptually to RFT, and several of these connections have been studied empirically. Among other applied implications of RFT, its primary implications in the area of psychopathology and psychotherapy can be summarized as follows 1. normal cognitive processes necessary for verbal problem solving and reasoning underlie psychopathology, thus these processes cannot be eliminated; 2. the content and impact of cognitive networks are controlled by distinct contextual features; 3. cognitive networks are historical and thus are elaborated over time. Much as extinction inhibits but does not eliminate learned responding, the logical idea that cognitive networks can be logically restricted or even eliminated is generally not psychologically sound; and, 4. direct change attempts focused on key nodes in cognitive networks, tend to elaborate the network in that area and increase its functional importance. ACT is based on these ideas. Most of traditional CBT is not. 3. Applied Theory From an ACT / RFT point of view, while psychological problems can emerge from the general absence of relational abilities (e.g., in the case of mental retardation), the primary source of psychopathology in most adults and language able children is the way that language and cognition interacts with direct contingencies to produce an inability to persist or change in the service of long term valued ends. This kind of psychological inflexibility is argued in ACT and RFT to emerge from weak or unhelpful contextual control over language processes themselves. The now vast literature on experiential avoidance is but one example of how this manifests itself. Other processes are cognitive fusion; the domination of temporal and evaluative relations over contact with the now; the effect of all of this on weak self-knowledge; attachment to a conceptualized self; unclear values or values based in looking good in the eyes of others or avoiding pain rather than self-congruent choices; and impulsivity or avoidant persistence. The contextual theory behind ACT situates all of these processes in context – it does not leave them “in the head.” These contexts can be directly changed and that is exactly what ACT tries to do. The functional contexts that tend to have such deleterious effects include excessive or poorly regulated contexts of literality, reason-giving, and emotional control, among others. In essence, the contexts that support verbal / cognitive functions are too widespread and are over applied. Acceptance and mindfulness are a prophylactic for that excess. 4. Clinical Methods ACT targets each of these core problems with the general goal of increasing psychological flexibility – the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends. The six targeted processes are acceptance, defusion, being present, a transcendent sense of self, values, and committed action. These core ACT processes are both overlapping and interrelated. Taken as a whole, each seems to support the other and all target psychological flexibility. They can be chunked into two groupings. Mindfulness and acceptance processes involve acceptance, defusion, contact with the present moment, and self as context. Indeed, these four processes provide a workable behavioral definition of mindfulness. Commitment and behavior change processes involve contact with the present moment, self as context, values, and committed action. Contact with the present moment and self as context occur in both groupings because all psychological activity of conscious human beings involves being in the now as known. You can draw lots of parallels to new developments in CBT, and even some in traditional CBT, but it is pretty obvious that these packages are not the same thing. I have trained several thousand therapists in ACT workshops of one day or more. I have literally never had a single CBT person do extensive training and come out saying “this is the same as traditional CBT.” If you want to pick one of the most salient differences, pick defusion (also known as deliteralization). In ACT, a troublesome thought might be watched dispassionately, repeated out loud until only its sound remains, or treated as an external observation by giving it a shape, size, color, speed, or form. A person could thank their mind for such an interesting thought, say it very slowly, or label the process of thinking (“I am having the thought that I am no good”). They might note how the back and forth of a mental argument is like a volley ball game and then literally play that out while watching from the sidelines. There are perhaps 100 defusion techniques that have been written about somewhere in the ACT literature. Not a one of them involves evaluating or disputing these thoughts. ACT is an approach to psychological intervention defined in terms of it philosophy, basic principles, and targeted theoretical processes. You can easily create and test protocols to test ACT with various disorders but it is not a specific technology anymore than, say, using candy contingently is “reinforcement.” In theoretical and process terms we can define ACT as a psychological intervention based on modern behavioral psychology, including Relational Frame Theory, which applies mindfulness and acceptance processes, and commitment and behavior change processes, to the creation of psychological flexibility.

Steven Hayes July 31, 2005 - 9:48am

Are there advantages of ACT as compared to traditional CBT?

Ultimately this is an empirical question. After considering that we can look at the possible advantages in a theoretical sense.

Right now there are a handful of studies that have looked directly and they tend to be medium to small. Only a few are published, and one of these barely mentions outcome because it was a piece on process of change. So we have a long way to go before this question will be answered empirically.

Here are the studies done so far:

Rob Zettle, who trained with Beck, did two very small randomized trials on ACT versus CT for depression – one using individual ACT and CT and the other using ACT and CT group therapy. A larger multi-site randomized trial is underway right now. In his two studies (see the ACT Handout) he found Cohen’s d’s at post between ACT and CT of 1.23 (individually delivered) and .53 (group) and at follow-up of .92 and .75. The N was very small though. The ACT group was only an N of 6 in the individual study and about 10 or so in the group study.

The 4 other studies are brand new and are not published yet. Ann Branstetter did a randomized trial with end stage cancer distress. Ann was trained in traditional CBT and she applied CBT procedures she thought would help (such as cognitive restructuring). There was not follow up because the patients were in end stage cancer but at week 12 ACT had a Cohen’s d of .9 compared to traditional CBT on distress over dying. You can email her for details – she is at Southwest Missouri State University.

Jennifer Block’s dissertation at Albany (she was just hired as a faculty member at LaSalle) compared ACT and CBGT in social phobia and found a Cohen’s d of .45 at post in favor of ACT compared to traditional CBT on the behavioral measure (standing up and speaking).

Carmen Luciano’s team at the University of Almeria just did a smoking trial comparing ACT and a CBT package used by a Spanish cancer society and found a Cohen’s d of .42 at a one year follow up on smoking cessation.

Raimo Lappalainen and his group at the University of Tampere has data in an effectiveness trial comparing ACT and traditional CBT (using CBT methods linked to functional analysis, such as skills training, or exposure) in a training clinic. Beginning student therapists were randomly assigned one ACT and one traditional CBT client (N = 14 each condition). Problems ranged across the usual outpatient spectrum but they were mostly anxiety and depression. On the SCL 90 the post Cohen’s d between ACT and CBT was .62. At follow up the effect was larger. Here is the reference: Lappalainen, R., Lehtonen, T., Skarp, E., Taubert, E., Ojanen, M., & Hayes, S. C. (2007). The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification, 31, 488-511. By thw ay at the process level there was greater acceptance for ACT patients; great self-confidence for CBT patients. Both correlated with outcomes, but when partial correlations are calculated, only acceptance still relates to outcome. The effect was accidentally not included in the publication but at follow up ACT was now significantly better than CBT in self-confidence.

Evan Foreman and James Herbert reported similar data from their clinic at Drexel University: Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D. & Geller, P. A. (2007). A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behavior Modification, 31(6), 772-799. In this study 101 heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned either to traditional CT or to ACT. 23 junior therapists were used. Participants receiving CT and ACT evidenced large and equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction and clinician-rated functioning. “Observing” and “describing” one’s experiences mediated outcomes for those in the CT group relative to those in the ACT group, whereas “experiential avoidance,” “acting with awareness” and “acceptance” mediated outcomes for those in the ACT group.

It is also known that ACT methods can empower behavioral methods (which are also part of the ACT model by the way ... so this finding is in essences a confirmation of the model itself). For example, consider this study: Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35, 747-766. In it acceptance methods (drawn directly from the ACT book) did a better job than control strategies in promoting successful exposure to CO2 gas in panic disordered patients.

A similar finding was reported in:

Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44, 1251-1263. As with the study above, brief acceptance methods led to lower heart rate during exposure to an aversive film and less negative affect during the post-film recovery period that did control strategies in individuals with anxiety and mood disorders.

So far it looks as though there might be a small advantage for ACT over traditional CBT methods in outcomes; there is a different set of change processes involved, and ACT methods may empower traditional behavioral methods.

Theoretically, the strengths of the ACT model as compared to CBT are these.

1. The model is easily scalable and broadly applicable. If you look at the whole outcome literature done so far (RCTs, controlled time series designs, and case studies) the problems targeted form a pretty broad list: PTSD, panic, depression, racist prejudice, burnout, epilepsy, smoking, OCD, pain, psychosis, cancer, diabetes, multiple sclerosis, sports psychology, attitudes against pharmacotherapy, skin picking, learning new procedures at work, heroin abuse, worksite stress, work innovation, marijuana abuse, and several others.

2. The putative processes of change are well specified with at least marginally adequate measures available in most areas. These change processes are a small set and they do not wildly vary from disorder to disorder.

3. The mediational analyses seem to be working. There are by our count already 16 successful formal mediational analyses published, or completed and coming. So far the data are very supportive. The processes successfully examined so far include acceptance, defusion, values, committed action, and psychological flexibility so most of the key ACT have some data in mediational trials.

4. Specific components seem to be working when inductively tested. There are at least 18 such studies. In every case ACT methods are impactful and work in a way that is theoretically coherent. These include all 6 points of the hexagon model.

5. The basic theory is intricately linked with the technology and itself seems to be working. For example, we are approaching 10 RFT studies linked to the three senses of self in ACT; RFT work on values is coming; and so on.

For those who believe only in RCTs of manuals, much of this answer will be dismissed. But the history of science shows that you cannot create a progressive science using only outcome studies. I (SCH) explained why in The Scientist-Practitioner (Hayes, Barlow, & Nelson-Gray, 1999). In a nutshell, though, it is this: without good theory, the technological development problem is based on common sense categories and it becomes empirically and practically overwhelming.

This should not be heard as “ACT adherents say RCTs are not important.” ACT folks have published nearly 30 RCTs of ACT methods. But they are not enough! Development in the areas of philosophy of science, basic principles, applied theory, specification of processes of change and effectiveness are just as important (and in the long run more important) than efficacy tests of technology.

The scientific game the ACT / RFT / Contextual psychology group is playing is this: to try to create a truly progressive science of psychology that can address the human condition in a more adequate way. Sure that is bold, but why not have bold goals? Is the ACT group willing to stand or fall on RCTs as a measure of success? Ultimately yes. But we want and demand another, even more difficult criteria: seeing a more truly useful psychology emerge as a result. That means concepts, theories, components, basic principles, effectiveness, training, dissemination and so on.

We think it is only fair to insist that ACT be measured against its own very difficult criteria when considering the progress of this effort. For example, examining ACT without examining RFT is like examining a cancer drug without looking at physiology.

Like the hare and the tortoise, ACT is following the slow and steady path. We think traditional CBT hopped ahead into a lay theory of cognition -- which produced quick progress but long term problems. We'd rather take the slow, one step at a time approach of contextual behavioral science. Which one will go farthest? Let's see. Let's be patient and see.

If there is an advantage of the ACT wing of CBT as compared to traditional CBT, this is where you are most likely to see it.

Steven Hayes July 31, 2005 - 9:52am

Are there any potential advantages of traditional CBT compared to ACT?

It is an empirical question, as was the previous one.

As for data so far, right now we have two studies showing a smaller effect size for ACT than for a traditional CBT procedure done outside of an ACT model. Zettle, 2003 found a smaller effect for ACT than for systematic desensitization with trait anxiety when treating a relatively minor problem (math anxiety). The effect was the same in the area of math anxiety per se.

The second study is Forman, E. M., Hoffman, K. L., McGrath, K. B., Herbert, J. D., Bradsma, L. L., & Lowe, M. R. (2007). A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study. Behaviour Research and Therapy, 45(10), 2372-2386. They compared ACT to a traditional CBT program for those who were impacted at different levels by food. 98 participants with chocolate cravings were exposed to a well known CBT-based protocol (Kelly Brownell’s LEARN program) and an ACT-based protocol or no instructions and required to carry chocolate with them of for two days. Those highly impacted by food related cues ate less and had fewer cravings in the ACT condition. But those not impacted by food, did worse in the ACT condition than in the CBT condition (and both did worse than doing nothing at all).

It may not make that much sense to use a procedure like ACT with minor problems because the issues it raises are so fundamental. This could be proven wrong with data. But note that in the Zettle study, ACT worked better with highly experientially avoidant subjects than with low avoidant subjects; desensitization did not show that relationship; in the Forman study those with high food impact were helped by ACT but not those with low food impact. It is not a comparison to CBT but another study [Masuda, A., Hayes, S. C., Fletcher, L. B., Seignourel, P. J., Bunting, K., Herbst, S. A., Twohig, M. P., & Lillis, J. (2007). The impact of Acceptance and Commitment Therapy versus education on stigma toward people with psychological disorders. Behaviour Research and Therapy, 45(11), 2764-2772 found that ACT was not better than education in reducing mental health stigma significantly among participants who were relatively flexible and non-avoidant to begin with. For experientially avoidant and inflexible participants, however, ACT was much better.

It seems possible based on this line of reasoning that CBT might actually work better than ACT in more confined and minor areas; in more severe or chronic areas ACT, might work a bit better ... and perhaps all of that because more avoidant and inflexible folks will be more dominant in severe areas. That is not a conclusion -- it is too early to say -- but it is a guess based on a few studies so far. And remember that ACT is part of CBT -- when we say "CBT" here we mean CBT methods placed into the context of a traditional CBT model that basically focuses on the idea that thoughts cause emotions and behavior.

It helps to keep in mind that ACT is a model not just a package. All of the behavioral methods and some of the cognitive ones can easily be put into ACT protocols. They are still ACT when that happens if they fit the model. That is especially true with behavioral methods -- which are a node on that hexagon model of ACT.

But ultimately we will have to show that, for example, exposure from an ACT perspective is better than (or at least works through a different process than) exposure from a traditional CBT perspective. We have a couple of small studies that indicate that might be true (e.g., see Jill Levitt’s dissertation in Behavior Therapy, 2004) but not large RCTs on the question. Some of these are underway right now (such as in Michelle Craske’s lab) so in a few years we will know.

Is there much in traditional CBT that is helpful? Yes, of course, and virtually all of what is known to work at the level of components fits with the ACT model so these procedures can be used from an ACT perspective. The things that contradict an ACT model are not known to work as components, such a cognitive restructuring. But even there you can modify it to be more a matter of cognitive flexiblity.

Is the ACT model a better place to put all of these procedures? Let’s see. The answer will probably not be “yes, always.” Presumably it is more likely to be “sometimes yes, sometimes no.” But both the yes and no answers will move us forward, and that is the whole point, not silly name brand struggles.

Steven Hayes July 31, 2005 - 9:53am

Why to skeptics argue that there is a quite limited support for ACT while advocates seem to say otherwise?

Some skeptics have not really read the whole literature and considered it carefully. Let's put these aside -- they are easy to detect and there is little to say about such criticism. What you then have left behind are two types. One are honest critics. These are very valuable and helpful people because they can light the way for additional research and development. The differences with honest critics so far seem to be in these areas.

Breadth of the criteria. The ACT / RFT community gives more weight to a model that is working than to RCTs alone. Mediational analyses, RFT progress, AAQ studies, component studies, experimental psychopathology, the like all weigh in very heavily. It is absolutely fair to let RCTs be the ultimate arbiter but if you pick them off one at a time with methodological worries, and focus only on DSM syndromes one at a time, even at ~120 RCTs you can see less support than people within the ACT / RFT community might believe is there. Over time, however, if the ACT / RFT community does its job, even that problem will be self-correcting because the development path being following includes randomized controlled trials as a centrally important area -- just not the only area.

The temporal measure of progress. Given the larger purpose of ACT / RFT, this harder set of criteria needs to be considered in terms of how hard the actual task is. The ACT / RFT community wants to be held to a high (amazingly high) standard, but this also means that judgments about accomplishment of such goals have to be made in the context of that stated purpose. This does mean that there is a certain prolonged sense of ambiguity. ACT / RFT research is more than 30 years old and critics can still doubt whether we are actually producing a more progressive psychology. That is fair, but then by the time the ACT / RFT community meets its goals to everyone's satisfaction, most folks in psychology and the behavioral sciences will know it, because these goals are so darned lofty.

Breadth of application. The ACT / RFT community think that the breadth of the model really matters, because the model itself claims to be about a deeper understanding of human cognition. In traditional syndromal treatment studies, the models are often quite narrow and breadth of application is not a fair test so when these folks look at ACT / RFT they don't quite know what to say. APA says we are over the bar only in chronic pain in terms of strong empirical support. Across the board the progress is more notable and the breadth of application is already pretty amazing but only now are good researchers in specific areas doing a deep dive -- modifying protocols and chasing process of change evidence. If the program succeeds there will be multiple studies of ACT / RFT applications within specific areas. Right now there are about 10 areas with at least 5 outcome studies, and nearly 20 areas with more that two (see the new book on "The ACT Research Journey" by Hooper and Larsson).

RCTs versus controlled time series designs. ACT comes from behavior analysis. If you eliminate time series designs in favor of only RCTs, the outcome data weaken, evne with nearly 120 RCTs and new RCTs now appearing every 2 weeks on average.

Quality of studies. Many ACT studies are put together by students and young faculty. Quite a number or from the developing world. Only a about 15 RCTs right now are funded. These early studies are often underpowered and the methodological bells and whistles are sometimes not there. Accord to a careful review by A-Tjak et al (in Psychotherapy and Psychosomatics, 2014) this is getting better, and we are starting to see replications with better controls. When you compare ACT to established CBT research from the best labs in the world, you are comparing research programs at two very different stages of development. We shall see what happens over time as funded ACT research becomes more common. However, average quality is a poor measure. A small study from, say, Iran is a wonderful thing to see ... how does any weaknesses pull down the more than 15 studies on ACT published in the Journal of Consulting and Clinical Psychology? You need to look to see if there are enough well done studies. You need to consider small studies that have specific weaknesses by looking at the whole literature. Knocking studies over one at a time means sturies with any flaws contribute nothing. That is, well, stupid. Average ratings means if you get students, or people without funding, or the developing world excited then you are necessarily weaker. That too is, well, stupid. Look at the whole literature and be responsible.

Published versus coming. ACT / RFT advocates often know about the data that are coming. We may know the researchers involved and feel that we can make some judgments. If you just look at publications (which an outside critic simply must do in order to be responsible) the picture looks different from the outside than it does from the inside. ACT / RFT research has been going on for 30 years, but it has only been visible for a few years, with the publication of the 1999 book on ACT and the 2001 book on RFT. About 75% of the outcome research is in the last 3 years. If the program is truly progressive, these differences will narrow over time however. If you want to get the recent meta-analyses and are a member go to the publications area. If you are not, then click here to join!

The reviews by Ost. Lar-Goran has been invited to ACT conferences many times to criticize the work. Some of his criticisms have been very useful. Others come from a different research tradition and don't have much appeal (e.g., the demand to focus only on syndromes; the insistance that only syndromal measure matter in outcomes). The other problem is that his two reviews have data problems. The first one (in 2008) attributed differences in methodological quality between ACT and CBT to the sloppiness of ACT studies. In fact, Brandon Gaudiano showed (see Gaudiano, 2009) that if you more collect data on funding the differences more carefully you see that all of these differences were due to funding. The study by Ost (in 2014) used ratings of methodological quality have not been replicated by others using the same scale (see the A-Tjak study; when Ost's rating were compared to this study on the same studies, Ost's were more against ACT and had an unacceptably low kappa of .35). The scale itself has several problems in my humble opinion but the A-Tjak study used a team approach for ratings that included ACT critics and ACT researchers, instead of using a single ACT critic and student raters. There were also over 80 factual or interpretive errors made in reading the ACT literature, which weaken the conclusions. A response article has been submitted to BRAT.

Bottom line. We think declaring that something is "evidence based" is a communitarian effort that should have the same open and agreed to standards that are carefully applied to all methods. APA has that ... and ACT is listed as evidence based in several areas. SAMHSA has that and ACT is listed in several areas there too. In the ACBS community we prefer to learn from our critics and keep on pursuing our vision and trying to get better.

Steven Hayes July 31, 2005 - 9:55am

Where is ACT and RFT going?

Everywhere that cognizing humans go. We want a theory of human behavior that allows us truly to make a difference in our homes, schools, workplace, and clinics. The ACT / RFT community wants it all: a technology that works, a theory that works, basic principles, AND a powerful linkage to our deepest human desires. But we can distinguish aspirations from data – and we have created a culture of openness and self-criticism that seems scientifically healthy. It is often that culture which seems most powerful when people first contact the ACT and RFT community. We are using ACT / RFT to create an ACT / RFT community that is open, non-hierarchical, diverse, committed, sharing, caring, and just plain fun. The vitality the young professionals and students as seen on this very website beg for the question: “what would happen if we worked together to create a community dedicated to the production of a psychology worthy of the human needs we are meant to address?” By appealing to the better nature of out clients (e.g., self-acceptance, mindfulness, values, commitment) we seem to be creating change in the clinic. Similarly, by raising our sites as professionals and creating a supportive, open, generous culture the same might happen in our training programs, clinics, and research teams. For those of us in the ACT / RFT / Contextual Psychology community we do not think that basic and applied science can safely stand apart. We seek the creation of a new empirical contextual psychology that carries forward and deepens our intellectual tradition, revitalizing basic psychology and linking our work to principles that help us address problems of human suffering and human growth. We want to see us create a psychology more adequate to the challenges of the human condition. This was part of the original vision of behavioral psychology and behavior therapy. Behavioral psychology lost its way over the issue of human cognition, and traditional CBT resulted, but perhaps we have found a way forward that will go beyond the excessively narrow goal of empirically evaluated technologies, to include also the two other aspects of our original tradition that were left behind: a firm link of application to basic principles, and an expansive vision of a form of psychology that can help create a better world in every area of human life. If we can do that, psychology itself may become more robust and useful. That is the vision.

- Posted 2005-07-31

Steven Hayes July 31, 2005 - 9:56am

How old is ACT?

ACT is more than 40 years old.

The personal insight that led to ACT is described by Steve Hayes in this TEDx talk: bit.ly/StevesFirstTED. By his best memory, that moment on the carpet (you will understand that phrase if you see the talk) was in the winter of 1980-81. But that was just a transformational moment. ACT began to form in Steve's lab soon after. The lab members at the time included Robert Zettle ("the Z"), Zamir Korn, and Irwin Rosenfarb. The lab was jointly run with the late Aaron Brownstein, a basic behavior analyst.

The first ACT protocol was written by Steve in 1981. ACT was called "Comprehensive Distancing" -- the lab nickname for it was "Big D." You can find the protocol in the "History of ACT" daughter page of the "About ACT" section of the website.

The first actual ACT study was done in 1981-1982 and was presented at ABCT (then called AABT) in 1982:

Hayes, S. C., Korn, Z., Zettle, R. D., Rosenfarb, I., & Cooper, L. (November 1982). Rule‑governed behavior and cognitive behavior therapy: The effects of comprehensive cognitive distancing on pain tolerance. Paper presented at the meeting of the Association for Advancement of Behavior Therapy, Los Angeles.

Steve held back on publishing it despite its success, thinking that the implications were too large and thus outcome studies should not be a focus (especially randomized outcome studies) until its model and methods were better understood and idiographically tested. That is why this very first study was published 17 years later: Hayes, S. C., Bissett, R., Korn, Z., Zettle, R. D., Rosenfarb, I., Cooper, L., & Grundt, A. (1999). The impact of acceptance versus control rationales on pain tolerance. The Psychological Record, 49, 33-47. The only randomized outcome study published directly from the lab in this era was Rob Zettle's dissertation which came out in 1986.

The first ACT training was in 1982: Hayes, S. C. (October 1982). Cognitive distancing and psychopathology. Presentation to Broughton Hospital, Morganton, NC.

"Comprehensive distancing" seamlessly morphed into ACT as we think of it today. The first time "acceptance and commitment therapy" was used in the title of a talk was in 1991: Wilson, K. G., Khorakiwala, D., & Hayes, S. C. (May 1991). Change in Acceptance and Commitment Therapy. Paper presented at the meeting of the Association for Behavior Analysis, Atlanta. The first time it appeared in the title of a journal article was Hayes, S. C. & Wilson, K.G. (1994). Acceptance and Commitment Therapy: Altering the verbal support for experiential avoidance. The Behavior Analyst, 17, 289-303.

Steven Hayes February 20, 2024 - 3:29pm

Is ACT based on behavior analysis?

In a word: yes. Long ago, behavior analysis was relied on by behavior therapists to provide a model of case conceptualization and intervention (e.g., Kanfer & Grimm, 1977; Kanfer & Saslow, 1969) but that idea fell away when clinicians came to believe that behavior analysis could not deal with the issue of cognition. ACT folks were behavior analysts but they agreed that behavior analysis needed to be developed before it could work in this area. ACT, RFT, functional contextualism, and a contextual behavioral science approach was the result of years of work to change that picture. It emerged from behavior analysis, but carries that tradition forward into the experimental analysis of cognitive processes, which extends the armamentarium of behavioral principles and alters many of the key concepts in traditional behavior analysis (e.g., see Barnes-Holmes, Hayes, & Roche, 2003). What has been created in the ACT/RFT/CBS tradition is a different stream of thought within behavior analysis and a different stream of thought within the CBT family of approaches. But it retains all of traditional behavior analysis as well. We are proud to see that as ACT/RFT/CBS has impacted clinical areas it is rekindling an interest in behavior analysis. That in itself is progressive we believe. In the modern era few clinical students are even exposed to a well-crafted course in behavioral principles, taught by a basic scientist knowledgeable in that tradition, which is a sad state of affairs given how robust these principles are. They are even more so when augmented with RFT, greater philosophical clarity, and a renewed development strategy (which is what contextual behavioral science refers to).

Steven Hayes June 7, 2008 - 10:52am

Is the linkage between ACT and RFT post hoc?

It has sometimes been said that the link between ACT and RFT is post hoc, but that is not the case. The basic, applied, and philosophical work co-evolved from the very beginning. In some areas of behavior analysis, applied work is based on animal work that is well worked out. Unfortunately, in the area of language and cognition the animal work never got there, so there was a more iterative process. RFT began from a clinical lab that was trying to fill a need for a better basic analysis. The work went back and forth from basic to applied constantly. Many of the publications come out years later, so understanding the sequence of events requires a closer look at the record. For example Steele and Hayes, 1991 if the first undeniably RFT experimental study, but it was designed and conducted in 1985-86 and was the cap of a six or seven year long process of both basic and applied development. Rob Zettle has written about this history. He was not just there but also created some of the key conceptual advances that lead to both ACT and RFT. The history is available in the publications area (search for Zettle, 2005). By the late 1970s we were getting frustrated with cognitive therapy / cognitive behavior therapy. We wrote a critical chapter on RET in 1979; we were doing conceptual work on rule-governance even that early. In 1981 a chapter interpreting CT from the point of view of rule-governed behavior was written -- it appeared in 1982. It too is on in the publications section (search for Zettle & Hayes, 1982). That chapter is concerned about rule-based insensitivity and undermining pliance; it breaks with Skinner on the definition of rules and do so in a way that demands RFT or something like it. In that same year we were already doing the basic studies on rule-based insensitivity that would publish in the mid-80s. So we were already testing how rule produce psychological inflexibility. Studies were being planned to try to learn how to undermine that effect. The earliest ACT (nee “Comprehensive Distancing”) manual was drafted in that same year and the earliest applied tests were begun Probably the easiest way to document this is to look at papers presented orally in 1981-1982, since oral presentations overcome most of the distortions due to publication lags. Here is part of that list: Hayes, S. C., Korn, Z., Zettle, R. D., Rosenfarb, I., & Cooper, L. (November 1982). Rule governed behavior and cognitive behavior therapy: The effects of comprehensive cognitive distancing on pain tolerance. AABT, Los Angeles. Hayes, S. C., Zettle, R. D., & Rosenfarb, I. (May 1982). An empirical taxonomy of rule governed behavior. ABA, Milwaukee. Hayes, S. C. (May 1982). Rule governed behavior and psychopathology. ABA, Milwaukee. Hayes, S. C., Rosenfarb, I., & Zettle, R. D. (May 1982). Rule governed behavior and sensitivity to changing contingencies. ABA, Milwaukee. Hayes, S. C. (May 1981). Rule governed behavior: Functional units of listener activity. ABA, Milwaukee. Rosenfarb, I., Hayes, S. C., & Zettle, R. (May 1981). Self reinforcement: A social commitment analysis. ABA, Milwaukee. Hayes, S. C. (November 1981). Running on empty: The ascendance of technical research. AABT, Toronto. Thus, you can see that the experimental rule-governed studies on insensitivity; studies on commitment; conceptual work on rules; conceptual work linking rules to sychopathology; criticisms of CBT; philosophical work on the need for theory; and the earliest studies on ACT all emerged iteratively at the same time. By 1984 the paper on Making Sense of Spirituality (Hayes, 1984 … you can find this in the publication list) makes it all clear what will come later. Self, deictic frames, defusion, flexibility and more are in there in one way or another. Shortly after that, the first RFT studies and the first ACT randomized trials began to appear. RFT is far broader than ACT ... but it has been an ACT-RFT effort from the very beginning. This does not mean that ACT processes are in a point to point correspondence with RFT processes. Over time this is happening more and more, but linkages in each direction were created on the fly. The bottom line is this: the record shows that ACT, RFT, and contextualism are all part of one research and conceptual program that emerged at the same time and that have co-evolved for 25 years. - S Steven C. Hayes

Steven Hayes February 14, 2006 - 12:46pm

What do I have to be to become certified as an ACT therapist?

The ACT community has agreed not to set up our own therapist certification. There is a process to recognize ACT trainers. ACT trainers sign a values statement agreeing to make their training protocols available for low cost or no cost and agreeing not to make proprietary claims or to certify therapists.

Why reject therapist certification? Two reasons: it ossifies the method, and creates a hierarchy that cannot be readily dismantled. Instead, the ACT community provides ways to increasing sophistication and ability; conducts studies on training methods; and encourages all ACT therapists to constantly improve. On the website, therapists can list themselves as ACT therapists whenever they choose, but are asked to list their training experiences.

Steven Hayes August 15, 2016 - 10:53pm

What is the role of intensive, experiential training in learning ACT?

ACT has a tradition of doing intensive, experiential training in addition to training in the core skills and competencies needed to do ACT. Why are these part of the ACT tradition? These trainings are not training in doing ACT per se -- they are more oriented toward learning what it feels like and how it works to adopt a defused, accepting, present-focused, mindful, values-based posture with regard to your own issues. These experiences are not meant to be therapy. Unlike other traditions, there is no belief that you have to somehow get fully analyzed (etc) and thus no longer be reactive in therapy in order to do good work. The point is not to be the world's most mindful or accepting human. The point is to learn to discriminate these states of mind to a degree that allows you to track what is happening during ACT intervention, and to have some skills in sitting with the painful space of sitting with another human being in pain. We hope that doing some experiential work with yourself will humanize and level ACT work because you learn how hard it is to do the things you are going to try to establish in others through ACT. There are curently no data showing that these kinds of trainings are needed to learn ACT, and even if you do them, they will not remove the need to learn ACT as a technical matter. This means you should not feel pushed to do them, especially if you are still just learning about ACT and your gut sense is that you might not respond well to such an approach. In that case, do more didactic training first and talk to others about their experiences and then decide. If you do such trainings remember this: you should never go beyond what you are willing to do. I always tell people to say and do only what they are willing to say and do, and to try to do the work of acceptance, defusion, mindfulness and so on with their own issues within themselves first, and to express that (if they choose) to others as an outward expression of that work, not as a substitute for it. The ACT model itself suggests that blurting out past pains (for example) can itself be traumatizing if it is not associated with acceptance, defusion, and mindfulness. Having said that, thousands of people have done more experiential training and the very subtitle of the ACT book says that it is an experiential approach. There seems to be something worthwhile in this type of training. Just don't allow yourself to feel forced into anything and don't mistake these experiences as a substitute for training in the technical skills involved in doing this work.

Steven Hayes August 1, 2005 - 5:03pm

What is the role of the eyes on exercise?

It has several functions but the bottom line is that it is the whole ACT model in one exercise Because it is uncomfortable but not dangerous it is a great context in which to practice defusion and acceptance. Its social nature heightens that part of it, since outright avoidance is relatively unlikely once people agree to do it. You can use psychological contact with the other as a metric of being present, so it gives feedback on the costs of fusion and avoidance. When these processes interfere the other person disappears Because self-as-context is social in origin, if the person running the exercise orients the participants to it you can contact the deictic basis of consciousness. The other person becomes somehow connected to you -- and yet you yourself contact a sense of transcendence in that social connection Because almost everyone values people, if you ask folks to use this as a physical metaphor for connection with others, it puts the mindfulness work (the work on acceptance, defusion, self, and the present) into a values context. You see how these processes support valued actions. It is a commitment exercise because you get agreement before hand; and again the social nature of it helps maintain the commitment And it is an exercise in psychological flexibility because it brings all of the other processes together in an unusual and repertoire expanding action It is the whole model in 10 minutes - Steve Hayes

Steven Hayes October 19, 2006 - 8:14pm

ACT for the Public

Welcome to the For the Public section of this site!

We hope that you will find the information provided here on Acceptance and Commitment Therapy (ACT) useful in your journey of understanding and/or applying ACT to your life.

What is ACT?

Acceptance and Commitment Therapy (ACT) has developed as a behavioral intervention to help people learn strategies to live life more in the present, more focused on important values and goals, and less focused on painful thoughts, feelings and experiences. ACT teaches people how to engage with and overcome painful thoughts and feelings through acceptance and mindfulness techniques, to develop self-compassion and flexibility, and to build life-enhancing patterns of behavior. ACT is not about overcoming pain or fighting emotions; it's about embracing life and feeling everything it has to offer. It offers a way out of suffering by choosing to live a life based on what matters most. ACT has developed within a scientific tradition, and there continues to be a thriving research community that examines the basic science underlying ACT and the effectiveness of applying ACT techniques to numerous life problems such as anxiety, depression, PTSD, substance abuse, chronic pain, psychosis, eating problems, and weight management, just to name a few. While the other sections of this site are geared to professionals, you may wish to read more about ACT and Relational Frame Theory RFT (the basic contextual behavioral science of language and cognition on which ACT is based) as you continue interacting with the material. Simply come back and browse through the rest of the site at your leisure!

Resources and Support: ACT for Personal Growth

Many people find that learning from and with others is a great way to enact important life changes. We suggest one or more of the following may best meet your needs:

Seeking a professional therapist with whom you feel comfortable
Attending a professionally run therapy group
Reading self-help books
Joining the free ACT for the Public email listserv
Finding others with whom to learn about and discuss applying ACT principles to your life
ACBS members are encouraged to join the ACT for Professionals email listserv because once on this listserv you can ask virtually any question, or raise virtually any issue, and thousands of ACBS members will read it and you will almost always get thoughtful and helpful responses.

The links at the bottom of the page will walk you through the ways to seek out all of these different types of resources -- most of them from within this website. We have compiled this information in the hopes that it will be useful in guiding you to the right resources for you.

PLEASE NOTE: While research suggests that self-help books and other resources can be helpful for many people, professional psychotherapeutic services are often more interactive and tailored to your individual needs and therefore may be in your best interest. If you are already seeing a therapist, it is best to share with your therapist that you plan to seek additional resources in this community, and to share what you learn in this community so that he or she can better support your growth.

admin October 28, 2009 - 3:11pm

Tips for Seeking an ACT Therapist

Looking for a therapist who uses ACT strategies in your area? There are more therapists joining ACBS and becoming listed here each day, so check back frequently. Here is a searchable list to Find an ACT Therapist from within this site. If it doesn’t show an ACT therapist in your area, you may still be able to find one by other means. Some suggestions:

Consult psychology, social work, and psychiatry departments at colleges or universities near you. Ask to speak to any members of the faculty or staff who are experts in behavior therapy, cognitive therapy, or clinical behavior analysis. Upon speaking to these experts, ask them if they have heard about ACT and know of any local ACT therapists.
In countries besides the U.S., you may be able to contact similar organizations to try the strategy described above.

You can seek therapists through these other venues as well:

The Association for Behavioral and Cognitive Therapies (ABCT) has a nation-wide database of PhD-level therapists, with searchable specialties (such as ACT) and by area. Visit www.abct.org and click "Find a Therapist".

The National Association of Social Workers (NASW) has a nation-wide database of therapists licensed at the master's level (specializing in marriage and family therapy, health and wellness, aging, and more). Visit www.helpstartshere.org and click "Find a Social Worker".

You may wish to contact therapists in your area from these lists (above) to see if they use mindfulness and/or acceptance-based methods in their practice. You may find many that do, but do not specifically list themselves as ACT therapists. Research across therapeutic orientations suggests that the therapeutic relationship is an important agent for change, so we recommend that you seek a therapist with whom you feel comfortable and who is comfortable working with you and the issues you are bringing to therapy.

admin January 8, 2010 - 8:41pm

Connecting with Others

There are two main ways to connect with others doing this work.

First, basic website use is free and open to anyone. ACBS members receive additional benefits.

Also, you may wish to join the For the Public email list. Here is a link to join. This email list is a general forum for public members reading ACT self-help books, working with an ACT therapist, or otherwise trying to apply ACT to their lives. Therapists, students and general members of the public all share their questions and personal experiences working with ACT principles on this list. It's free to join, and you can start posting questions right away as well as read older posts online. There are formal and informal groups formed through this email list who meet to discuss learning and applying ACT principles to their lives. These groups are not monitored or sponsored by ACBS, but they can be a great resource within which to learn and grow. You may wish to ask the Public listserv members for information about any groups in your area.

admin January 8, 2010 - 9:06pm

Self-Help Books

Self-Help Books in English

Click here to see a list of ACT Self Help books.

Self-Help Books in Non-English Languages

Also, there are several self-help books written in other languages, as well as translations of Get Out Of Your Mind And Into Your Life, The Happiness Trap, and ACT On Life Not On Anger. Please click here for more information.

admin January 8, 2010 - 9:17pm

Information on Commonly Used Titles

These two books listed below are the most commonly discussed on the ACT for the Public Listserv.

Get Out of Your Mind and Into Your Life offers a five-step plan for coping with painful emotions such as anxiety and depression. It teaches you how to learn life-enhancing behavior strategies that work to further the goals you value most. The realization that painful feelings cannot be controlled will open you to the possibility of fully emotional living. Once present, engaged, and aware, you can begin to build a new life for yourself filled with significance and meaning.

This self-help book was written for a general audience. If you or someone you love is struggling with getting out of your mind and onto a meaningful life path, this book is a great place to start.

Read this message from the author (Steve Hayes) regarding the use of Get Out of Your Mind and Into Your Life.

The Happiness Trap: How to Stop Struggling and Start Living is the second self-help resource written for a wide-ranging audience and many find that it presents the ACT concepts in a clear, concise manner. Too many of us are caught in the happiness trap: we think that we should be happy all or most of the time, and we believe that we can control the circumstances of our lives in order to avoid unpleasant experiences. Using the principles of Acceptance and Commitment Therapy, Harris offers key concepts and specific techniques for escaping the “happiness trap” to create a full, rich, and meaningful life.

There is also a companion website for this book maintained by the author, with additional resources you may find useful as you apply this approach to your life.

admin May 27, 2011 - 8:28pm

Free Practical Audio Exercises

Six ACT Conversations

These audio files are easy-to-understand, excellent resources for walking through the ACT model step-by-step and learning how to apply it to your life. Each segment consists of multiple parts, so you may wish to do a little bit of the exercises at a time.

Visit 6 ACT Conversations at RMIT University in Australia for more information. The audio files and accompanying worksheets are available for downloading.

Mindfulness Practice Exercises

There are several exercises recorded as mp3 or other audio files available for free download. You may wish to save them and listen to them on a computer or personal mp3 player.

15-minute Awareness exercise by Jason Luoma
Leaves on the Stream exercise by Jenna LeJeune
Observer Exercise from the 1999 ACT book recorded by Randy Burgess
Live Mindfully is a blog organized by Integrative Health Partners, a mindfulness and acceptance group practice, and provides over a dozen excellent mindfulness and ACT exercises to download for free.
Excercises in Spanish (Ejercicios en Español) de Fabian Maero
Free Audio Meditations with Dennis Tirch, Paul Gilbert or Laura Silberstein-Tirch

admin March 21, 2011 - 11:13am

Free Videos: Learning About and Applying ACT

There are many free videos that can help you learn about ACT and begin to apply it to your life. The videos listed here are by no means a comprehensive list, and different therapists and clients may use different ways to illustrate or apply ACT principles.

These videos span a wide range of topics, from how to use ACT principles to cope with common problems to animated ACT exercises you can practice at home. Most of the videos are developed by ACT therapists, but some are made by clients to illustrate how they've applied ACT principles to their lives.

These videos were not created for or by ACBS, but we have put some together here from various sources. We hope that you find some of them useful.

Simply click on the links below to browse. If you are looking for videos about RFT, check out this list. Also, don't forget about the many videos available to logged in ACBS members here.

If you find others on Youtube or elsewhere, please let us know by Adding a Comment and include the URL for the video and we'll get it up for you.

admin January 8, 2010 - 6:00am

Anger, Compassion, and What It Means To Be Strong | Russell Kolts | TEDxOlympia

While anger can feel powerful in our bodies, many of us use angry behavior to avoid dealing with things that make us uncomfortable. Compassion gives us a way to be strong that helps us courageously face the things that scare us—about the world, and about ourselves—and help make them better.

Russell is a licensed clinical psychologist and Professor of Psychology at Eastern Washington University, where he has taught for the past 16 years and has received numerous honors including twice being named the associated student body’s Faculty of the Year. Dr. Kolts has authored and coauthored numerous books and scholarly articles, including The Compassionate Mind Guide to Managing Your Anger, An Open Hearted Life: Transformative Lessons for Compassionate Living from a Clinical Psychologist and a Buddhist Nun (with Thubten Chodron), and the forthcoming Buddhist Psychology and CBT: A Practitioner’s Guide (with Dennis Tirch and Laura Silberstein). Dr. Kolts has pioneered the application of Compassion Focused Therapy (CFT) to the treatment of problematic anger and regularly conducts trainings and workshops on CFT.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Subtitles are available in: Arabic, Chinese, Italian, English, Japanese, and Serbian

Anonyme (not verified) October 4, 2016 - 11:45am

Chessboard Metaphor

This is a simple presentation of an ACT exercise commonly used in therapy that illustrates the difficulty with getting caught up in one's thoughts, as well as a way to change one's relationship to them.

Jen Plumb April 27, 2011 - 10:56pm

DJ Moran, Ph.D. - Psychotherapy Academy

Here are 4 videos from D.J. Moran, Ph.D. Transcripts are also available.

Community January 17, 2020 - 9:47am

Eva Adriana Wilson, MD: The Strong and Healthy Self

The following is a 5 minute video with animations that focuses on the utility of distress in guiding valued living.

Fredrick Chin October 29, 2015 - 1:25pm

Hank Robb, Ph.D.: Being Where You Are and Doing What's Important

Dr. Hank Robb conducts an easy-to-follow introductory treatment session he calls "Being Where You Are and Doing What's Important" for this television series.

This is an excellent for a simple introduction on how ACT can be applied to your life.

Part 1

Our Psychological Landscape: Part 1 from Emily Rodrigues on Vimeo.

Part 2

Our Psychological Landscape: Part 2 from Emily Rodrigues on Vimeo.

Part 3

Our Psychological Landscape: Part 3 from Emily Rodrigues on Vimeo.

admin April 27, 2011 - 10:29pm

How do you turn the corner with anxiety?

This is an episode of a national television program in Australia called "Insight". This episode aired on November 6, 2018, on the topic of "Beating Anxiety".

Clients suffering with anxiety talk about the experiences and struggles with anxiety as well as different therapies they have tried.

Traditional CBT and ACT are featured centrally. Steven C. Hayes is a guest on this episode.

https://www.sbs.com.au/news/insight/tvepisode/beating-anxiety

ACBS staff November 9, 2018 - 10:17am

Jason Luoma & Jenna LeJeune: The ACT Therapist

The poem was created by Jason Luoma (http://www.drluoma.com) and Jenna LeJeune (http://www.portlandpsychotherapyclinic.com) as part of an Acceptance and Commitment Therapy conference in Australia. If you like the poem, come to an ACBS conference!

ACBS staff March 28, 2013 - 9:27am

Joe Oliver: Demons on the Boat

This is a simple, animated ACT metaphor for identifying and coping with difficult experiences. Animation by Joe Oliver.

admin April 27, 2011 - 10:39pm

Joe Oliver: The Unwanted Party Guest

This is another simple animated metaphor that illustrates one way to cope with difficult or unwanted experiences. Animation by Joe Oliver.

admin April 27, 2011 - 10:41pm

Jonathan Bricker: The willingness to crave

Jonathan Bricker: The willingness to crave Anonyme (not verified) January 5, 2015 - 1:01pm

Learning ACT - Skills and Comptencies for Clinicians

These videos are from the Learning ACT DVD and expand upon excises and content covered in the book.

The first video serves as an introduction to the rest.

Brandon Sanford October 22, 2013 - 10:54pm

Living Well When You Don’t Feel Well - Joe Trunzo

Living Well When You Don’t Feel Well: Overcoming Lyme Disease and Illness | Joe Trunzo | TEDxBryantU
Published on 5 Mar 2018

Trunzo highlights a different way of thinking and coping with diseases (and life), specifically Lyme. Dr. Trunzo earned his undergraduate degree in 1993 from Marywood University in Scranton PA and completed his graduate work in 2000 at Drexel University in Philadelphia, PA. He completed his pre-doctoral internship at the University of Vermont and his post-doctoral fellowship at the Centers for Behavioral & Preventive Medicine at Brown University Medical School in Providence, RI.

He is a Professor of Psychology and Chair of the Department of Applied Psychology at Bryant University. He is also a licensed, practicing clinical psychologist with expertise in the psychological management of chronic medical illnesses such as cancer and Lyme disease, as well as the treatment of mood and anxiety disorders, especially obsessive compulsive disorder.

He serves on several professional committees and belongs to a number of professional organizations. In his spare time, he enjoys being with his family, live music, running, and mountain climbing. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

Joe R March 13, 2018 - 9:07am

Louise Gardner - Your ACT Auntie Series

ACT Videos

Mindful Moment Videos

Community November 1, 2019 - 11:05am

Matthieu Villatte - Self as Context (Flexible Self)

This video illustrates how to use hierarchical framing to build a sense of self as a context or container of all psychological experiences. The client feels split among the different roles of his life at the moment (new job, baby)

Brandon Sanford October 22, 2013 - 10:10pm

Mental Brakes to Avoid Mental Breaks | Steven Hayes | TEDxDavidsonAcademy

How can we best deal with difficult or negative thoughts? Dr. Steven Hayes discusses language, cognition, and the science behind putting on the mental brakes.

Steven C. Hayes is Nevada Foundation Professor at the Department of Psychology at the University of Nevada. An author of 41 books and more than 575 scientific articles, he has shown in his research how language and thought leads to human suffering, and has developed "Acceptance and Commitment Therapy" a powerful therapy method that is useful in a wide variety of areas. His popular book "Get Out of Your Mind and Into Your Life" was featured in Time Magazine among several other major media outlets and for a time was the number one best selling self-help book in the United States. Dr. Hayes has been President of several scientific societies and has received several national awards, such as the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapy.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Subtitles available in English and Italian

Anonyme (not verified) October 3, 2016 - 10:57am

Mindfulness for Two - Experiential Role Plays

The following are a series of experiential Role-Plays which accompany Kelly Wilson & Troy DuFrene's Mindfulness for Two.

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Brandon Sanford October 22, 2013 - 11:10pm

Oliver, Christodoulou, & Whitfield: Passengers on the Bus -- metaphor animation

Joesph Oliver and colleagues, Vaso Christodoulou and Henry Whitfield worked alongside a youth media charity, Exposure, to develop this animation. This was done with the assistance of a grant from the British Association for Behavioural and Cognitive Psychotherapies (BABCP) ACT SIG. Exposure was set up to help kids who have had mental health problems get experience and find work within the media industry.

The animation is an allegory, telling the story of a bus driver, Tom, and his struggles with various passengers on his bus, as he heads his bus towards a life of meaning and vitality.

Enjoy!

Douglas Long February 15, 2013 - 3:03am

Our Common Fate video - by Rikke Kjelgaard

This video demonstrates our common humanity.

That every one of us experience unwanted thoughts and feelings.

Through processes of openness, awareness and engagement we can learn to hold these experiences lightly. We can learn to show ourselves, our inner and outer world both compassion and kindness while engaging in patterns of meaningful and vital behaviours.

This video is made with much appreciated contributions by trainers and trainees in Acceptance and Commitment Therapy (ACT).

***

The rejection of our common fate makes us strangers to each other.
The election of that fate, in love, reveals us as one body.

Sebastian Moore

***

Thank you Robyn Walser and Kelly Wilson for your inspiration and contribution to ACT and to my life and practice and to this movie.
-Rikke Kjelgaard

***

Music by Coldplay

office_1 May 6, 2020 - 11:25am

Pain Management Programmes 2017 Glasgow Conference: Plenary Session 3 - The Great ACT Debate

Pain Management Programme 2017 Glasgow Conference
16th Biennial National Conference

Glasgow Caledonian University, Glasgow, Scotland
14th and 15th September 2017
Plenary Session 3 - The Great ACT Debate - "ACT: best thing since sliced bread or the Emperor’s new clothes?"
David Gillanders and James Coyne

https://vimeo.com/album/5023441

Joe R March 6, 2018 - 1:07pm

Psychological flexibility: How love turns pain into purpose | Steven Hayes | TEDxUniversityofNevada

What can we do to prosper when facing pain and suffering in our lives? More than a thousand studies suggest that a major part of the answer is learning psychological flexibility. Steven C. Hayes is one of the researchers who first identified that process and put it into action in the form of a popular acceptance and mindfulness method called Acceptance and Commitment Therapy. In this emotional talk, Hayes distills the essence of psychological flexibility down into a few easy to understand sentences. He takes viewers through a harrowing journey into his own panic disorder, to the very moment in his life when he made this life changing choice: I will not run from me. Hayes shows how making that choice allows us to connect with our own deep sense of meaning and purpose, arguing that taking a loving stance to your own pain allows you to bring love and contribution into the world.

Steven C. Hayes is Nevada Foundation Professor at the Department of Psychology at the University of Nevada. An author of 38 books and more than 540 scientific articles, he has shown in his research how language and thought leads to human suffering, and has developed “Acceptance and Commitment Therapy” a powerful therapy method that is useful in a wide variety of areas. His popular book “Get Out of Your Mind and Into Your Life” was featured in Time Magazine among several other major media outlets and for a time was the number one best selling self-help book in the United States. Dr. Hayes has been President of several scientific societies and has received several national awards, such as the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapy.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Subtitles available in Dutch, English, Finnish, German, Greek, Italian, Japanese, Persian, Polish, Portuguese, Romanian, Russian, Spanish, and Swedish

Anonyme (not verified) October 3, 2016 - 11:08am

Rich Blonna, Ph.D.: A Brief Introduction to ACT

This very brief introduction to ACT spells out the different components of the ACT work.

Jen Plumb April 27, 2011 - 11:14pm

Russ Harris, MD: About ACT in simple terms

In this 30 minute interview with Australian motivational speaker Zara, Dr. Harris discusses ACT in simple terms and how he's applied it in his own life.

admin April 27, 2011 - 10:01pm

Self-Help Plus - Stress Management

World Health Organization's Self Help Plus (SH+) program - shown in 3 RCTs not only to reduce PTSD and depression, but also to prevent the onset of mental illness in those at risk.

- SH+ manual and audio files in English

Self-Help Plus (SH+) is WHO’s 5-session stress management course for large groups of up to 30 people. It is delivered by supervised, non-specialist facilitators who complete a short training course and use pre-recorded audio and an illustrated guide (Doing What Matters in Times of Stress - available in over 20 different languages) to teach stress management skills. The course is suitable for adults who experiences stress, wherever they live and whatever their circumstances. It has been shown to reduce psychological distress and prevent the onset of mental disorders. The format of SH+ makes it well-suited for use alongside other mental health interventions, as a first step in a stepped care programme, or as a community intervention delivered alongside broader community programming.

Check out this free webinar of WHO's Self Help PlusACT protocol for refugees presented by: Russ Harris and Claudette Foley. They answer Frequently Asked Questions about the protocol – AKA “Self-help Plus” - and explore how to implement it.

office_1 August 4, 2022 - 1:43pm

Shamash Alidina ACT Training Videos

Mr. Shamash Alidina has shared some videos on Acceptance and Commitment Training.

Here's the link: https://youtube.com/playlist?list=PLFqEhpJvR7lfJfhGFXSPQmRxfHI_mb9ba

office_1 October 13, 2021 - 2:16pm

The ACT Matrix 101 Videos by Kevin Polk, Ph.D.

Kevin Polk August 29, 2015 - 11:31pm

The OCD Mind and Uncertainty | ACT

A brief introductory video to help clients with OCD who are struggling with uncertainty and the urges OCD can bring about.

Submitted by Annabella Hagen

Community November 8, 2017 - 10:40am

The secret to self control | Jonathan Bricker | TEDxRainier

Jonathan Bricker's work has uncoved a scientifically sound approach to behavior change that is twice as effective as most currently practiced methods. His new methods are driving new norms and new apps for how people quit smoking and decrease obesity, saving many people from an early death.

Jonathan Bricker is an internationally recognized scientific leader in a bold approach called acceptance and commitment therapy. A Stanford researcher called his use of the approach “a breakthrough in behavioral research [that] has major public health implications for the major causes of preventable death.” Bricker and his team, having received $10 million in total federal research grants to study this topic, are rigorously testing this intervention on multiple platforms, including smartphone apps, websites, and telephone coaching. His SmartQuit app for quitting smoking was recently launched and is now in distribution worldwide.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Subtitles available in English, French, German, Italian, Japanese, Korean, and Spanish

Anonyme (not verified) October 3, 2016 - 11:01am

Thoughts on the future of ACBS and contextual psychology - 2016 - Steven Hayes & Barbara Gil-Luciano

Steven Hayes, University of Nevada, & Bárbara Gil-Luciano, Madrid Institute of Contextual Psychology

Some thoughts on the future of ACBS and contextual science from Steven Hayes. (recorded June 2016)

¿Cuál es el futuro de la CBS (Contextual Behavioral Science - Ciencia Contextual) y hacia dónde crees que se dirige la Psicología Contextual? Entrevista a Steven Hayes

subtitulado en español

admin July 15, 2016 - 1:08pm

Tom Lavin, MFT, LCADC, ACATA: : When Life Hurts - Meaning Can Provide Strength and Direction

When Life Hurts: Meaning can Provide Strength and Direction
Acceptance and Commitment Therapy/Logotherapy Perspective

Presented by Tom Lavin, MFT, LCADC, ACATA
Psychotherapist

Tom Lavin April 30, 2012 - 6:21pm

Tom Lavin, MFT, LCADC, ACATA: Live Better Psychoeducation Series

ACT: Live Better Psychoeducation Series

The intention of the “Live Better Series” is to provide life perspectives and life enhancement skills to encourage and support people in living vital and meaningful lives.

The “Live Better Series” examines and explores what Dr. Salvatore R. Maddi found to be three essential life attitudes in developing stress hardiness-resiliency:
1. Commitment Attitude: strive to be engaged rather than isolated

2. Control Attitude: be engaged in influencing outcomes, rather than lapse into passivity and powerlessness
3. Challenge Attitude: view stressful situations as opportunities to learn and grow and live one’s values

In cultivating these three resiliency fostering attitudes, the psychoeducation series is based on the core principles of Dr. Steven C. Hayes’ Acceptance and Commitment Therapy:
1. Acceptance of what is
2. Identifying and then choosing and committing to personally meaningful values
3. Taking action on living a life based on one’s identified core values

Complimentary to the core principles of ACT, the series integrates the three essential elements of Dr. Viktor Frankl’s Logotherapy, a therapy based on the fundamental human desire to live a meaningful life:
1. Creative Values: identifying and manifesting one’s talents and gifts to contribute to life
2. Experiential Values: actively engaging with those elements of life that inspire and nurture one’s spirit
3. Attitudinal Values: adopt a self-transcendent attitude: responding with grace , courage , and wisdom in the face of inescapable suffering

Tom Lavin MFT, LCADC, ACATA, the recipient of the 2014 IMPACT AWARD of the Association for Contextual Behavioral Science, is the primary instructor.

Co-presenters for the series include Drs. Steven C. Hayes, Kelly Wilson, Victoria Follette, and Nicole Pavlatos.

****Worksheets that accompany each class are available here.

Tom Lavin May 20, 2014 - 3:40am

Tom Lavin, MFT, LCADC, ACATA: New Skills for Living - Experts on using ACT in daily life

Tom Lavin, MFT, LCADC has hosted the local ABC affliate television show in Reno, NV titled New Skills for Living, a health and wellness series, since 1995 in an effort to help people learn skills to live vital and meaningful lives.

Tom is the recipient of the 2014 IMPACT AWARD of the Association for Contextual Behavioral Science.

You can see expert ACT therapists discuss how ACT principles can be applied to so many aspects of your life!

Topics: ACT in Daily Life, Anxiety, Addiction, Chronic Illness, PTSD, Eating Disorders, Mindfulness for College Students, Families and Addiction Recovery, Smoking Cessation, Valued-Based Living, Happy Couples, Autism, Meaningful Living, etc.

Each of the videos are approximately 20-30 minutes in length.

Visit easeap.com for more information.

"ACT in Daily Life", Steven C. Hayes, PhD

"ACT: Anxiety" Steven C. Hayes, PhD

"ACT: Addressing Addiction" Steven C. Hayes, PhD

"ACT Addressing Chronic Illness" Steven C Hayes, PhD

"Mindfulness for College Students" Jacqueline Pistorello, PhD

"ACT: PTSD" Jacqueline Pistorello, PhD

"ACT: Anxiety" Kelly G. Wilson, PhD

"ACT: PTSD Treatment" Victoria Follette, PhD

"Stop Smoking" Jonathan Bricker, PhD

"Happy Couples" Robyn D. Walser, PhD

"Living Values Makes a Difference" Jennifer C. Plumb, MA

"Effective Psychotherapy" Tom Lavin, MFT, LADC

"Help for People with Eating Disorders" Jason Lillis, PhD

"ACT Therapy for Substance Abuse and Disordered Eating" Lindsay B. Fletcher, MA

"Principles of Vital Living" Tom Lavin, MFT, LADC

"How Families Can Deal with Financial and Relationship Stress" Tom Lavin, MFT, LADC

"Addiction and Family Recovery" Tom Lavin, MFT, LADC

"ACT: Autism" Nanni Presti, MD, PhD

"Addiction Recovery" Barbara Kohlenberg, PhD

"When Life Hurts: ACT and Logotherapy" Tom Lavin, MFT LADC

Tom Lavin August 5, 2013 - 4:21am

Resources for Learning More about ACT

First check out the Resources for Learning About ACT.

See the list of ACT books.

To understand more of the ACT langauge and concepts, check out the ACT Glossary of Terms.

To gain a deeper understanding about ACT and it's intellectual foundations, you may wish to browse through this section of the site: www.contextualscience.org/basic_foundations. The topics presented here are written with professionals in mind, but it is a good starting place for learning more about the roots of ACT.

admin January 8, 2010 - 9:53pm

A Note on the Research Supporting ACT

You may be wondering about how effective ACT is when studied carefully. The Get Out of Your Mind and Into Your Life book has been studied and shown to be helpful in reducing stress and increasing quality of life. Other studies on self-help books or using self-help books in conjunction with therapy are on-going.

It takes quite a lot to become what is called an "empirically supported treatment"; meaning that a number of rigorous research studies indicate that the treatment has been shown to be effective for helping people cope with a particular problem.

In the U.S., ACT was listed in 2011 as an empirically supported treatment for numerous problems by SAMHSA's National Registry of Evidence Based Programs and Practices (SAMHSA is the Substance Abuse and Mental Health Services Administration, a division of the Department of Health and Human Services).

There has been at least one and in many cases several carefully controlled studies on ACT for substance abuse and smoking, anxiety problems (including OCD, generalized anxiety disorder, and social phobia), chronic pain, psychosis, borderline personality disorder, and coping with chronic disease such as diabetes, epilepsy, or cancer.

ACT has also been shown to be helpful for people who struggle with severe mental illness or have more than one disorder or problem (e.g., anxiety and depression); many ACT studies treat people who have the problem of interest as well as other diagnoses. It's also been used with success for reducing worksite stress, and reducing stigma and prejudice.

Researchers have done a considerable amount of research that shows that the individual processes within ACT can be helpful across problems, and researchers care about ensuring that the treatment you get is likely to be helpful for the particular problem(s) for which you seek help.

As of December 2019, there are over 300 ACT Randomized Controlled Trials and over 45 peer reviewed assessments of the ACT evidence base.

admin April 5, 2010 - 7:02pm

ACT TEDTalks

ACT TEDTalks Emanuele Rossi March 25, 2020 - 1:22pm

Direct Links to International Subtitles

Arabic

TED Olympia _ الغضب والتعاطف ومعنى أن تكون قوياً _ راسل كولتز
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=ar

السر وراء التحكم فى النفس | جوناثان بريكر | TEDxRainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=ar

خلق تواصل إستثنائي- ماڤيس تساي TEDxEverett
https://www.youtube.com/embed/B9kg1UdzDvw?cc_load_policy=1&cc_lang_pref=ar

TED _ موهبة الشجاعة العاطفية وتأثيرها _ سوزان ديفد
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=ar

لماذا من الصعب أن نكون بشرا | جون فورسيث | TEDxUnionCollege
https://www.youtube.com/embed/zo-CaG0A1Xs?cc_load_policy=1&cc_lang_pref=ar

قوة الصغر | اشلينغ ليونارد كورتين | TEDxBallyroanLibrary
https://www.youtube.com/embed/w4WpBax7rJU?cc_load_policy=1&cc_lang_pref=ar

Bulgarian

Дарбата и силата на емоционалния кураж
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=bg

Chinese Simplified

避免精神崩溃的精神刹车 | Steven Hayes | TEDxDavidsonAcademy
https://www.youtube.com/embed/GnSHpBRLJrQ?cc_load_policy=1&cc_lang_pref=zh-CN

愤怒，同情，以及它意味着什么是强 | Russell Kolts | TEDxOlympia
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=zh-CN

情感勇气的礼物和力量 | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=zh-CN

为什么做人那么难？| 约翰 · 福赛斯 | TEDxUnionCollege
https://www.youtube.com/embed/zo-CaG0A1Xs?cc_load_policy=1&cc_lang_pref=zh-CN

Chinese Traditional

情感勇氣的禮物和力量 | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=zh-TW

為什麼做人那麼難 | 約翰．福賽斯（ John Forsyth） | TEDxUnionCollege
https://www.youtube.com/embed/zo-CaG0A1Xs?cc_load_policy=1&cc_lang_pref=zh-TW

Danish

Modet til at føle | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=da

Dutch

Psychologische flexibiliteit: je pijn wijst je de weg | Steven Hayes | TEDx University of Nevada
http://bit.ly/SteveTED1-cc-Nederlands

De gave en kracht van emotionele moed | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=nl

English

Psychological flexibility: How love turns pain into purpose | Steven Hayes | TEDxUniversityofNevada
http://bit.ly/SteveTED1-cc-English

Mental Brakes to Avoid Mental Breaks | Steven Hayes | TEDxDavidsonAcademy
http://bit.ly/SteveTED2-cc-English

The secret to self control | Jonathan Bricker | TEDxRainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=en

Anger, Compassion, and What It Means To Be Strong | Russell Kolts | TEDxOlympia
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=en

Create Extraordinary Interactions | Mavis Tsai | TEDxEverett
https://www.youtube.com/embed/B9kg1UdzDvw?cc_load_policy=1&cc_lang_pref=en

The gift and power of emotional courage | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=en

Why it's hard being human | John Forsyth | TEDxUnionCollege
https://www.youtube.com/embed/zo-CaG0A1Xs?cc_load_policy=1&cc_lang_pref=en

Living Well When You Don’t Feel Well: Overcoming Lyme Disease and Illness | Joe Trunzo | TEDxBryantU
https://www.youtube.com/embed/keC6R-Qtb_M?cc_load_policy=1&cc_lang_pref=en

The Power of Small | Aisling Leonard-Curtin | TEDxBallyroanLibrary
https://www.youtube.com/embed/w4WpBax7rJU?cc_load_policy=1&cc_lang_pref=en

Finnish

Psykologinen joustavuus: Kuinka rakkaus kääntää tuskan tarkoitukseksi | Steven Hayes | TEDx University of Nevada
http://bit.ly/SteveTED1-cc-Suomalainen

French

La flexibilité psychologique : comment l'amour fait de la douleur une raison d'être | Steven Hayes | TEDx University of Nevada
https://www.youtube.com/embed/o79_gmO5ppg?cc_load_policy=1&cc_lang_pref=fr

Le secret de la maitrise de soi | Jonathan Bricker | TEDx Rainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=fr

Le don et le pouvoir du courage émotionnel | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=fr

Pourquoi est-ce si difficile d'être un être humain | John Forsyth | TEDxUnionCollege
https://www.youtube.com/embed/zo-CaG0A1Xs?cc_load_policy=1&cc_lang_pref=fr

German

Psychologische Flexibilität: Wie Liebe Schmerz in existenzielle Bestimmung verwandelt | Steven Hayes | TEDxUniversityofNevada
http://bit.ly/SteveTED1-cc-Deutsch

Mentale Bremsen verhindern mentale Zusammenbrüche | Steven Hayes | TEDx Davidson Academy
http://bit.ly/SteveTED2-cc-Deutsch

Das Geheimnis der Selbstkontrolle | Jonathan Bricker | TEDx Rainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=de

Ärger, Mitgefühl und was es bedeutet, stark zu sein | Russell Kolts | TEDxOlympia
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=de

Die Gabe und Kraft gefühlsbestimmten Mutes | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=de

Greek

Ψυχολογική ευελιξία: Πώς η αγάπη μετατρέπει τον πόνο σε σκοπό | Στίβεν Χέιζ | TEDx University of Nevada
http://bit.ly/SteveTED1-cc-ελληνικά

Θυμός, συμπόνια και τι σημαίνει να είσαι δυνατός | Russell Kolts | TEDxOlympia
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=el

Δημιουργήστε εξαιρετικές αλληλεπιδράσεις | Mavis Tsai | TEDxEverett
https://www.youtube.com/embed/B9kg1UdzDvw?cc_load_policy=1&cc_lang_pref=el

Το δώρο και η δύναμη του συναισθηματικού κουράγιου
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=el

Hebrew

המתנה והכח של אומץ רגשי | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=iw

Hungarian

Pszichénk rugalmassága : Hogyan változtathatja a szeretet, a fájdalmat motivációvá? | Steven Hayes | TEDx University of Nevada
https://www.youtube.com/embed/o79_gmO5ppg?cc_load_policy=1&cc_lang_pref=hu

Az érzelmi bátorság adománya és hatalma | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=hu

Italian

Flessibilità Psicologica: come l'amore dà senso alla sofferenza | Steven Hayes | TEDx University of Nevada
http://bit.ly/SteveTED1-cc-Italiano

Freni mentali per evitare crolli mentali | Steven Hayes | TEDx Davidson Academy
http://bit.ly/SteveTED2-cc-Italiano

Il segreto dell'autocontrollo | Jonathan Bricker | TEDx Rainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=it

Rabbia, compassione e cosa significa essere forti | Russell Kolts | TEDx Olympia
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=it

Il dono e la forza del coraggio emozionale | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=it

Il potere delle piccole cose | Aisling Leonard Curtin | TEDxBallyroanLibrary
https://www.youtube.com/embed/w4WpBax7rJU?cc_load_policy=1&cc_lang_pref=it

Japanese

心理的柔軟性: 愛がどうやって痛みを目的に変えるか | スティーブンヘイズ | TEDx University of Nevada（ネバダ大学）
http://bit.ly/SteveTED1-cc-日本語

ネガティブな感情をスローダウンする方法｜スティーヴン·ヘイズ｜TEDxDavidsonAcademy（デビットソン·アカデミー）
http://bit.ly/SteveTED2-cc-日本語

セルフコントロールの秘訣 | ジョナサン·ブリッカー | TED× Rainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=ja

怒りと思いやり、そして強くなることの意味 | ラッセル·コルツ | TEDx Olympia
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=ja

感情に向き合う勇気の力と素晴らしさ | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=ja

Korean

자기 통제의 비밀 | 조나단 브릭커 (Jonathan Bricker ) | TEDx Rainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=ko

특별한 교감 나누기 | 마비스 차이(Mavis Tsai) | TEDxEverett
https://www.youtube.com/embed/B9kg1UdzDvw?cc_load_policy=1&cc_lang_pref=ko

자신의 감정을 마주할 수 있는 용기 (Susan David) | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=ko

작은 것의 힘 | 애슐링 레오나르드 커틴(Aisling Leonard-Curtin) | TEDxBallyroanLibrary
https://www.youtube.com/embed/w4WpBax7rJU?cc_load_policy=1&cc_lang_pref=ko

Macedonian

Mental Brakes to Avoid Mental Breaks | Steven Hayes | TEDxDavidsonAcademy
http://bit.ly/SteveTED2-cc-македонски

Дарот и моќта на храброста | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=mk

Marathi

भावनिक धैर्य: एक ताकद, तशीच देणगीही. | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=mr

Persian

انعطاف پذیری روانشناختی : چگونه عشق، درد انسان را به هدف و معنا سوق میدهد
http://bit.ly/SteveTED1-cc-فارسی

ترمزهای ذهنی برای دوری از درهم شکستن روانی | استیو هیز | TEDxDavidsonAcademy
http://bit.ly/SteveTED2-cc-فارسی

موهبت و قدرت شهامت عاطفی | سوزان دیوید | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=fa

Polish

Elastyczność psychologiczna: Jak miłość zmienia ból w powołanie| Steven Hayes | TEDx University of Nevada
http://bit.ly/SteveTED1-cc-Polskie

Dar i moc emocjonalnej odwagi | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=pl

Portuguese

O dom e o poder da coragem emocional | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=pt-PT

Portuguese, Brazilian

Flexibilidade psicológica: como o amor transforma a dor em propósito | Steven Hayes | TEDx Universidade de Nevada
http://bit.ly/SteveTED1-cc-Portugues
https://www.youtube.com/embed/o79_gmO5ppg?cc_load_policy=1&cc_lang_pref=pt-BR

Raiva, compaixão e o que significa ser forte | Russell Kolts | TEDxOlympia
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=pt-BR

O segredo do autocontrole | Jonathan Bricker | TEDxRainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=pt-BR

Create Extraordinary Interactions | Mavis Tsai | TEDxEverett
https://www.youtube.com/embed/B9kg1UdzDvw?cc_load_policy=1&cc_lang_pref=pt-BR

O dom e o poder da coragem emocional | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=pt-BR

O poder do pequeno | Aisling Leonard-Curtin | TEDxBallyroanLibrary
https://www.youtube.com/embed/w4WpBax7rJU?cc_load_policy=1&cc_lang_pref=pt-BR

Romanian

Flexibilitatea psihologică. Cum iubirea transformă durerea în scop | Steven Hayes | TEDx University of Nevada
http://bit.ly/SteveTED1-cc-Română

Darul și puterea curajului emoțional | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=ro

Russian

Психологическая гибкость: Как боль превращается в цель благодаря любви | Steven Hayes | TEDxUniversityofNevada
http://bit.ly/SteveTED1-cc-русский

Секрет самоконтроля | Джонатан Брикер | TEDxRainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=ru

Создание экстраординарных взаимодействий | Мавис Цай | TEDxEverett
https://www.youtube.com/embed/B9kg1UdzDvw?cc_load_policy=1&cc_lang_pref=ru

Дар и сила эмоциональной смелости | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=ru

Гнев, сострадание и что значит быть сильным | Рассел Колтс | TEDxOlympia
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=ru

Serbian

Bes, saosećajnost i šta znači biti jak | Rasel Kolts (Russell Kolts) | TEDx Olympia
https://www.youtube.com/embed/QG4Z185MBJE?cc_load_policy=1&cc_lang_pref=sr

Dar i snaga emocionalne hrabrosti | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=sr

Spanish

Flexibilidad psicológica: Como el amor convierte el dolor en propósito | Steven Hayes | TEDx University of Nevada
http://bit.ly/SteveTED1-cc-Español

Frenos mentales para evitar daños mentales | Steven Hayes | TEDx Davidson Academy
http://bit.ly/SteveTED2-cc-Español

El secreto del autocontrol | Jonathan Bricker | TEDx Rainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=es

Create Extraordinary Interactions | Mavis Tsai | TEDxEverett
https://www.youtube.com/embed/B9kg1UdzDvw?cc_load_policy=1&cc_lang_pref=es

El don y el poder del coraje emocional | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=es

Por qué es difícil ser humano | John Forsyth | TEDxUnionCollege
https://www.youtube.com/embed/zo-CaG0A1Xs?cc_load_policy=1&cc_lang_pref=es

Swedish

Psykologisk flexibilitet: Hur kärlek förvandlar smärta till mening | Steven Hayes | TEDxUniversityofNevada
http://bit.ly/SteveTED1-cc-Svenska

Turkish

Psikolojik esneklik: Aşk acıyı nasıl amaca dönüştürür? | Steven Hayes | TEDx University of Nevada
https://www.youtube.com/embed/o79_gmO5ppg?cc_load_policy=1&cc_lang_pref=tr

Kendini kontrol etmenin sırrı | Jonathan Bricker | TEDxRainier
https://www.youtube.com/embed/tTb3d5cjSFI?cc_load_policy=1&cc_lang_pref=tr

Duygusal cesaret yetenek ve gücü | Susan David | TED
https://www.youtube.com/embed/NDQ1Mi5I4rg?cc_load_policy=1&cc_lang_pref=tr

Vietnamese

Cách tạo nên những mối liên kết kỳ diệu - Mavis Tsai | TEDxEverett
https://www.youtube.com/embed/B9kg1UdzDvw?cc_load_policy=1&cc_lang_pref=vi

Emanuele Rossi April 7, 2020 - 1:26pm

Anger, Compassion, and What It Means To Be Strong | Russell Kolts

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Emanuele Rossi April 7, 2020 - 10:38am

Create Extraordinary Interactions | Mavis Tsai

Our ability to form close connections is not only at the core of our mental health, but interpersonal closeness helps us live longer. Mavis Tsai presents the components of an extraordinary interaction and six powerful questions you can share with others to create unforgettable conversations.

Mavis Tsai, Ph.D., is a clinical psychologist/research scientist and Associate Director of University of Washington’s Center for Science of Social Connection. She has gained a world-wide following as the co-creator of Functional Analytic Psychotherapy (FAP), a contextual behavioral and relational therapy that harnesses the power of the therapeutic relationship to transform clients’ lives. She is the co-author/editor of five text books on FAP (some of which have been translated into Portuguese, Spanish, Japanese and Italian) and over 60 articles and book chapters. She received Washington State Psychological Association’s 2014 Distinguished Psychologist Award in recognition of outstanding contributions to knowledge in clinical psychology. Her most recent and passionate work is in training volunteers in five continents to launch Live with Awareness, Courage and Love Meetups, which address the need for people to connect more authentically with themselves and with others, and to spread the

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Emanuele Rossi April 7, 2020 - 10:53am

Living Well When You Don’t Feel Well: Overcoming Lyme Disease and Illness | Joe Trunzo

Trunzo highlights a different way of thinking and coping with diseases (and life), specifically Lyme.

Dr. Trunzo earned his undergraduate degree in 1993 from Marywood University in Scranton PA and completed his graduate work in 2000 at Drexel University in Philadelphia, PA. He completed his pre-doctoral internship at the University of Vermont and his post-doctoral fellowship at the Centers for Behavioral & Preventive Medicine at Brown University Medical School in Providence, RI.

Emanuele Rossi April 7, 2020 - 11:06am

Mental Brakes to Avoid Mental Breaks | Steven Hayes

How can we best deal with difficult or negative thoughts? Dr. Steven Hayes discusses language, cognition, and the science behind putting on the mental brakes.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Emanuele Rossi March 25, 2020 - 1:26pm

Psychological flexibility: How love turns pain into purpose | Steven Hayes

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Emanuele Rossi March 25, 2020 - 1:24pm

The Power of Small | Aisling Leonard-Curtin

Aisling Leonard-Curtin, M.Sc., C.Psychol., Ps.S.I., is a chartered counselling psychologist who lives with her wife Trish in Dublin. She is co-director of Act Now Purposeful Living, has a private practice, and deliver acceptance/mindfulness workshops. She has over a decades experience in a wide range of settings including adult psychiatry, psycho-oncology, educational, health and community. Aisling’s hobbies include writing fiction, performing improve comedy and hanging out with her pets. Aisling Leonard-Curtin, M.Sc., C.Psychol., Ps.S.I., is a chartered counselling psychologist who lives with her wife Trish in Dublin. She is co-director of Act Now Purposeful Living, has a private practice, and deliver acceptance/mindfulness workshops. She has over a decades experience in a wide range of settings including adult psychiatry, psycho-oncology, educational, health and community. Aisling’s hobbies include writing fiction, performing improve comedy and hanging out with her pets. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

Emanuele Rossi April 7, 2020 - 2:03pm

The gift and power of emotional courage | Susan David

Psychologist Susan David shares how the way we deal with our emotions shapes everything that matters: our actions, careers, relationships, health and happiness. In this deeply moving, humorous and potentially life-changing talk, she challenges a culture that prizes positivity over emotional truth and discusses the powerful strategies of emotional agility. A talk to share.

Susan David, Ph.D. is one of the world’s leading management thinkers and an award winning Harvard Medical School psychologist. Her new #1 Wall Street Journal bestselling book, Emotional Agility based on the concept Harvard Business Review heralded as a Management Idea of the Year and winner of the Thinkers50 Breakthrough Idea Award, describes the psychological skills critical to thriving in times of complexity and change. She is a frequent contributor to the Harvard Business Review, New York Times, Washington Post, Wall Street Journal, and guest on national radio and television. Named on the Thinkers50 global list of the top management thinkers, Susan is a sought-after keynote speaker and consultant, with clients that include the World Economic Forum, EY, United Nations, Google, Microsoft, NASDAQ, and many other national and multinational organizations. Her focus is on defining and executing effective strategy, especially in the areas of engagement, high-performance leadership, and culture change. Susan is the CEO of Evidence Based Psychology, on the faculty at Harvard Medical School, a Cofounder of the Institute of Coaching (a Harvard Medical School/McLean affiliate), and on the Scientific Advisory Boards of Thrive Global and Virgin Pulse. Susan is also core faculty of the global Homeward Bound, an all-women leadership program that culminates in an expedition to Antarctica and aims at increasing the influence and impact of women in the sciences.

Emanuele Rossi April 7, 2020 - 10:56am

The secret to self control | Jonathan Bricker

Jonathan Bricker's work has uncovered a scientifically sound approach to behavior change that is twice as effective as most currently practiced methods. His new methods are driving new norms and new apps for how people quit smoking and decrease obesity, saving many people from an early death.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Emanuele Rossi March 25, 2020 - 1:26pm

Why It's Hard Being Human | John Forsyth

John devoted most of his adult life to writing, speaking, teaching, doing research, and training mental health professionals and the public in the use of Acceptance and Commitment Therapy (ACT) and practices that cultivate mindfulness, loving kindness, and self-compassion. He is also a Professor of Psychology and Director the Anxiety Disorders Research Program at the University at Albany, SUNY in Upstate New York. This is a job that he absolutely love. But he also wear many other hats. He’s a licensed clinical psychologist in New York, with expertise in the use and application of Acceptance and Commitment Therapy (ACT) for several forms of psychological and emotional suffering. He is also an active researcher, teacher, and consultant and serve as a senior editor of the ACT book series with New Harbinger Publications. His talk is a narration of why it is hard to be human in today's advanced world. John devoted most of his adult life to writing, speaking, teaching, doing research, and training mental health professionals and the public in the use of Acceptance and Commitment Therapy (ACT) and practices that cultivate mindfulness, loving kindness, and self-compassion. He has been at this for over 20 years, and have seen the enormous impact that ACT can have in the lives of many, including my life too.
He is a Professor of Psychology and Director the Anxiety Disorders Research Program at the University at Albany, SUNY in Upstate New York. This is a job that he absolutely love. But he also wear many other hats. He’s a licensed clinical psychologist in New York, with expertise in the use and application of Acceptance and Commitment Therapy (ACT) for several forms of psychological and emotional suffering. He is also an active researcher, teacher, and consultant and serve as a senior editor of the ACT book series with New Harbinger Publications. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

Emanuele Rossi April 7, 2020 - 12:58pm

Η αξία της ζωής | Maria Karekla

Η Δρ. Μαρία Καρεκλά είναι κάτοχος διδακτορικού στην Κλινική Ψυχολογία, με ειδικότητα στις Αγχώδεις Διαταραχές και στην Ψυχολογία της Υγείας. Είναι Επίκουρη Καθηγήτρια στο Τμήμα Ψυχολογίας του Πανεπιστημίου Κύπρου και υπεύθυνη του εργαστηρίου ACThealthy: Εργαστήρι Κλινικής Ψυχολογίας και Συμπεριφορικής Ιατρικής, καθώς συντονίζει την επιτροπή του διδακτορικού προγράμματος στην κλινική ψυχολογία. Επίσης προεδρεύει της Επιτροπής Βιοηθικής Κύπρου για βιοϊατρικές μελέτες και είναι μέλος του Συμβουλίου Εγγραφής Ψυχολόγων.
Ανάμεσα στις ερευνητικές της δραστηριότητες συμπεριλαμβάνονται έργα στο θέμα της θαλασσαιμίας, του διαβήτη, των διατροφικών διαταραχών, του άσθματος, του καπνίσματος και των χρόνιων πόνων. Οι έρευνες της έχουν λάβει επιχορήγηση από Εθνικούς, Ευρωπαϊκούς και άλλους φορείς και έχουν βραβευτεί από οργανισμούς όπως η Ευρωπαϊκή επιτροπή και το Pompidou group, το Association for the Advancement of Behavior Therapy και το Society of Behavioral Medicine. Έχει στο βιογραφικό της πέραν των 50 δημοσιεύσεων σε επιστημονικά περιοδικά. Επίσης εκπροσωπεί το Πανεπιστήμιο Κύπρου και την Κύπρο σε διάφορες επιτροπές που άπτονται του επαγγέλματος της.

Dr. Maria Karekla holds a doctorate degree in Clinical Psychology from the University at Albany, SUNY with a specialisation in Anxiety Disorders and Health Psychology. Currently holds the position of Assistant Professor for Clinical Psychology at the University of Cyprus and she is responsible for the ACTHealthy lab: Laboratory of Clinical Psychology and Behavioral Medicine, while she is a key member in the development of the doctoral level clinical psychology program. She actively and systematically participates in psychological research projects that have received awards by (among others) the European council and Pompidou’s group, and the Association for the Advancement of Behavior Therapy. Her research focuses on areas of health promotion and the investigation of individual difference factors (especially experiential avoidance) as they relate to the development and maintenance of various forms of psychopathology (especially anxiety disorders and health related problems). She is a member of the clinical psychology and school psychology program development committees at the University of Cyprus. Maria is currently a member of the European Awarding Committee for the specialization of psychotherapy of EFPA and has served as a liaison of the Cyprus Psychologists Association to numerous subcommittees and task forces of EFPA. A number of her research projects have received local, EU and other funding. Dr. Karekla’s “ACTHealthy: Anxiety disorders and Health Psychology” research laboratory has cooperated with other institutions, business and bodies both in Cyprus and abroad on numerous project.

Emanuele Rossi April 7, 2020 - 1:58pm

More CBS TEDxTalks

Community January 12, 2022 - 1:22pm

Free ACT Articles, Podcasts, and Interviews

There are several articles that have appeared in magazines and popular news outlets, as well as interviews with ACT experts on the radio, the internet, and podcasts. Click on the following links to peruse these articles: ACT in Popular Media and also Podcasts.

Joel Guarna January 15, 2009 - 5:21pm

ACT in Popular Media

The links below are to articles that have appeared in popular media outlets, interviews with ACT therapists in online or radio sources, and other links of interest to you.

ACBS Members: Please note that this section of the site is intended for members of the public. Therefore, whenever possible, please copy the text of an article or interview onto the site and/or post links to the original media source directly (e.g., hyperlinks) when you add to this section.

Joel Guarna June 4, 2009 - 3:55pm

Podcasts

ACBS Podcasts

Podcast: Voices & Values - DEI SIG (ACBS 2021)

15 in 15 - the ACBS World Conference 15 Podcast (ACBS 2017)

ACT in Context: The Acceptance and Commitment Therapy Podcast (ACBS 2011)

Other Podcasts

Psychologists Off the Clock (2021)

Research Matters (Jason Luoma 2021)

ACT: Root to Fruit (Marcel Tassara 2021)

Metaphors for Life (2018)

Functionally Speaking: A 21st Century Behavior Therapy (DJ Moran 2016)

ACT: Taking Hurt to Hope (Joanne Dahl 2014)

More Podcasts

Community March 5, 2021 - 9:34am

The Times of India - Therapy for the desi mind (2022)

Therapy for the desi mind

Acceptance and commitment therapy teaches people to acknowledge their negative feelings instead of trying to resist or wrestle with them

By Saranya Chakrapani / TNN / May 22, 2022

“I began taking a deep dive into Indian spiritual texts like the Upanishads and Buddhist philosophies and found a whole lot of metaphors that could be used to convey the idea of self-empowerment through the ACT modality to someone struggling with anxiety or depression,” says Dr Balaji.

Read the article at The Times of India

Community May 25, 2022 - 1:46pm

Washington Post: "A meaningful life is possible amid suffering, some therapists say" (2022)

A meaningful life is possible amid suffering, some therapists say

Acceptance and commitment therapy teaches people to acknowledge their negative feelings instead of trying to resist or wrestle with them

By Katherine Kam February 19, 2022

Emily Sandoz, a psychologist in Louisiana, has witnessed clients’ grueling struggles during the pandemic. Many said they felt trapped and deprived of their usual ways of coping. Others began therapy for the first time after the pause in their busy lives forced some existential questions: “Do any of these things that I used to put all this energy into even matter? Does my job even matter? Do my relationships matter?”

Then, she said, her clients felt guilty.
“I know that this has been stressful for everyone, but . . .”
“I just feel like I should be able to handle this.”
“I know what I need to do, but I’m just not doing it.”

It’s natural to feel distress during such a harrowing time, Sandoz tells them, but even in the midst of inevitable pain and hardship, people can still live meaningful lives aligned with their highest values.

Sandoz provides a form of behavioral therapy called acceptance and commitment therapy, or ACT. Psychologists consider it a third-wave therapy after traditional behavior therapy and cognitive behavioral therapy. Infused with mindfulness concepts, ACT acknowledges that suffering is part of the human condition and guides people in becoming “psychologically flexible” to navigate life’s ups and downs and keep moving forward.

Read the article at washingtonpost.com

Community February 19, 2022 - 8:24pm

Wall Street Journal: "How to Deal With Stress in Your Life: Embrace It" (2021)

How to Deal With Stress in Your Life: Embrace It

By Elizabeth Bernstein August 28, 2021

When frustration, anxiety and fear start to cloud the mind, psychologists recommend an approach called acceptance that helps people deal clearheadedly with tough situations.

Read the article at https://www.wsj.com/articles/how-to-deal-with-stress-in-your-life-embrace-it-11630152000

Community August 28, 2021 - 7:35pm

BBC: "Fibromyalgia and Pain" (2021)

Fibromyalgia and pain: 'How cooking gave me my family back'

By Bryony Hopkins April 6, 2021

Ian spent years "existing" until the NHS referred him to the pain management programme at the Bath Centre for Pain Services. The programme focuses on a psychological model called acceptance and commitment therapy, which looks at finding ways to move forward with things that can't be shifted. Read more about Ian's story at https://www.bbc.com/news/disability-56536589

Community April 15, 2021 - 3:24pm

Wall Street Journal "How to Live With the Pain of Loss, Without Going Numb" (2018)

How to Live With the Pain of Loss, Without Going Numb

People often try to deny their feelings, but that doesn’t work. Here are some healthier techniques.

August 20, 2018 Interview with Steven C. Hayes

https://www.wsj.com/articles/how-to-live-with-the-pain-of-loss-without-going-numb-1534772199

Community March 6, 2021 - 10:09pm

ACT in Popular Media Archives (2001 - 2017)

ACT in Popular Media Archives (2001 - 2017) Community January 5, 2021 - 9:40am

Lauren Porosoff Articles - Using ACT and RFT in the Classroom (2017)

Solution Tree - flexible context sensitivity and functional coherence (2018)

Kappan - conditional vs. hierarchical framing (2017)

Teaching Tolerance - defusion (2014)

Lauren Porosoff October 15, 2018 - 4:37pm

Brian Goff talks ACT - 101.9 FM, Portland (2016)

Hear radio host Sheila Hamilton interview Evergreen Clinical’s Brian Goff about ACT on KINK’s Speaking Freely (101.9 FM Portland, OR).

Click here to hear the interview.

Community May 8, 2018 - 10:10am

The Self-Acceptance Project (2013)

In this free online video event series, Tami Simon speaks with several contemporary luminaries in the fields of spirituality, psychology, and creativity. Together they explore the questions around self-acceptance—and investigate how we can overcome the difficulties of embracing who we are. Where do our self-critical voices come from? Can we silence them, or is there a better way to deal with them? Can we be motivated to change and excel while still accepting ourselves as we are? Why is it often so much easier to feel compassion and forgiveness towards others than towards ourselves?

http://live.soundstrue.com/selfacceptance/

Douglas Long May 28, 2013 - 1:32am

Russ Harris Interview (May 2012)

3 day workshop with Russ Harris in Copenhagen: Interview with Russ Harris on the 15th of May 2012

Interview by Maria Krøl and Ole Taggaard Nielsen

I: What was it that brought you to ACT?

R: I thought it was a very realistic look at the human condition. It starts with the premise that life involves lots of pain. No matter how good your life gets there’s going to be plenty of pain that goes with it. I found that to be very realistic. We’re all gonna have lots of painful feelings, we’re all gonna have lots of negative thoughts. So how do we learn to live with that? How can we still live a rich, full and meaningful life, even with the pain? So it was very realistic, and it really resonated with my experience. And I liked that there was a lightness and playfulness about the model; it had a sense of humor. I also love the creativity of it; the way that it frees you up to design your own metaphors and your own interventions. It gave me a lot of freedom as a therapist; there are just so many different ways I can do it. I love that I can be creative and playful. And I love the compassion and the self-compassion that’s built into the model. And I think more than anything, I loved the training: how it was about working with my own issues, and applying the approach to my own stuck-points in life; to help with my own pain and suffering. It just really resonated with me.

I: You mentionend that you used to do traditional CBT. When did you move in the ACT direction?

R: I started working as a GP (family doctor) in 1991 and I became increasingly interested in the psychology of health and wellbeing. And as I started spending more and more of my time looking at the role of stress in the lives of my patients. My consultations would average to 20-30 minutes, which was unusually long for a GP. 5 minutes at the end of the session would be about the medical problem, and 25 minutes would be about what’s happening in your life: the stresses and difficulties. And I started to realize that I was really in the wrong profession.

So I wanted to train in therapy and the first model I trained in was traditional CBT. And I liked it. It’s a very effective model. I think I started formally doing sessions of therapy as opposed to GP counselling, in about 1994. And from that point, until 2003, I mainly did traditional CBT. However, at the same time that I was doing CBT, I kept training in other models, I was always looking for other things because even though CBT had some really good stuff, it didn’t, for example, have much to say about finding meaning and purpose in life. Also, I was very interested in mindfulness. There’s a whole branch of medicine called Psychoneuroimmunology, which is about the connection between the mind and the body, and there was some very interesting research coming out, about the benefits of mindfulness meditation for the immune system. So I was very interested in mindfulness, but it was very hard to get my clients to meditate.

As for traditional CBT, I really liked the behavioral elements: the skills-training, exosure, scheduling, and goal-setting etc, and I also liked the distancing components, where you become more aware of your thinking processes; but I didn’t like the components that were about challenging thoughts, because it didn’t actually work for me. I could challenge my thoughts all day long, but they’d just keep coming back, again and again. And I liked the mindfulness stuff, but I wasn’t overly keen on meditating. And I wanted to explore meaning and purpose with my clients, but I wasn’t quite sure how to do it. So I was trying for many years to bring these elements together: behavioural activation, mindfulness, cognitive distancing, meaning and purpose. I didn’t know anything about ACT, but it’s what I was intuitively trying to do. So when I finally discovered ACT in 2003, it was like ”WOW, this is fantastic!” A friend told me about it, I went to the book store, I looked at the book and it was love at first sight. ”Oh My God, this is fantastic.” I just fell head over heels in love with it. I became obsessed with it, and I instantly moved all my clients from traditional CBT to ACT. It was a bit confusing for them initially. I would say, ”No, no we don’t need to challenge those thoughts anymore”. They would say, ”Really?”

I: What is the goal of ACT, and how is it different from traditional CBT?

R: The aim of ACT is to create a rich, full and meaningful life while accepting the pain that inevitably goes with it. You might get some CBT people to say that’s the aim of CBT too - but words like ”rich, full, meaningful”, well, I didn’t encounter that emphasis in my own CBT training. More technically the aim of ACT is to increase psychological flexibility. And that’s definitely not the aim of CBT. Psychological flexibility is your capacity to be in the present moment, open fully to your experience and act in line with your values: to ”Be present, open up and do what matters”. That’s the outcome we’re looking for.

I: Could you tell me a little bit about the therapeutic stance in ACT?

R: The therapeutic stance is that ”We’re both in the same boat”. There’s no real difference between client and therapist; it’s just who’s sitting in that chair on that day. This metaphor that we like to share on the first session is the ”two mountains metaphor”. I say to clients: you come along to therapy, and it’s easy to get the idea that therapists have their life sorted out, that they don’t have any issues, no major problems. And I don’t want you to leave this room buying into that illusion. I want to shatter that myth right now. What’s it like is, you’re climbing your mountain over there and I am climbing my mountain over here. From where I am on my mountain I can see stuff on your mountain that you can’t see. For example, I might be able to see an alternative pathway that’s easier, or you’re using your pickaxe incorrectly, or there’s an avalanche about to happen. But I’d hate you to think that I’m sitting on the top of my mountain, no problems, no issues, just sitting back and enjoying life. I’m climbing my own mountain, over here. And we’re all climbing our mountain till the day we die. But what we can learn to do here is to climb more effectively, climb more efficiently; learn how to enjoy the climbing. Learn how to take a break and have a good rest and take in the view and appreciate how far we’ve come. That’s what this is about. So it’s a stance of commonality and equality: we’re both in the same boat; we’re dealing with the human condition. It’s not like some people have got a mental illness and some don’t; this is the human condition.

I: What is ”happiness” in ACT?

R: In ACT we stay away from the word ”happiness” because most people think that happiness means ”feeling good”. So in ACT rather than using the term happiness we use the term ”vitality”: a sense of embracing this moment of life, living this moment of life to the fullest. Steve Hayes has a saying: ”There’s as much life in a moment of pain as a moment of joy”. So the question is: ”Can I embrace this moment of life, whether it’s a very painful moment or whether it’s a joyful moment?” I say to clients all the time: ”If you’re going to live a full human life you’re going to feel the full range of human emotions”. So if you pushed me hard to define happiness in terms of the ACT model I would say ”Happiness means living a rich, full and meaningful life in which we feel the full range of human emotions - both the painful ones and the pleasent ones - without a struggle.”

I: How can you as a therapist help a client to identify personal values?

R: Many different ways. You can often identify them by asking questions: What matters to you? What’s important to you? A question I ask every client on the first session is: ”If the work that we do in this room could make a difference in one relationship, which relationship would that be? How would you behave differently in that relationship as a result of the work that we do?” Other useful questions are ”What do you want to stand for in life?”; ”When you look back at your life from your deathbed, what do you want to say that life was about?”; ”If you could be the ’ideal you’, how would you treat your body, how would you treat your children, how would you treat your job, how would you treat the environment, how would you treat your loved ones?”. You can think of vaues as how you would treat your relationship with anyone or anything; what are the qualities that you would bring to it? For many people these questions are useful. However, some people just go blank when you ask them such questions; in which case, we would do experiental exercises, of which there are many. One of the best is Kelly Wilson’s ”sweet spot” exercise, where you ask someone to get in touch with a very rich sweet memory, one of life’s ”sweet spots”. So it could be a memory of a time of love, a time of creativity, a connection with nature, a moment of achievement or pride or having fun, or a simple pleasure. We help them to relive the memory, and then we ask them questions to tease values from it: What does this memory tell you about what matters to you? What qualities were you embodying in the memory? What does this tell you about the way you want to behvae or the things you want to do more of, moving forwards? In this memory what were you ”in relationship with”? Was it a relationship with nature, or with your body, or with a loved one, or with an activity? In that relationship, what personal qualities were you embodying? There are many experiemental exercises, but the sweet spot is a particularly good one.

I: What are your thoughts on medication as a treatment for depression and other psychological problems?

R: The ACT stance on medication is like the ACT stand on everything else. The ACT model rest on the concept of ”workability”: is it working to give you a rich, full and meaningful life. If it is, keep doing it. If it’s not, do something different. This would be the ACT stance for any medication; not just psychiatric medication, but also medication for diabetes or cancer. For example some people with cancer choose not to have chemotherapy. They figure ”The chemotherapy won’t cure me, it will just give me six extra months of life- and the quality of life will be so low, I’d rather not do that.” So the ACT stance on medication is neither for it, nor against it; it’s all about workability. And there are quite a few published ACT studies where clients were on medication as well as doing ACT.

I: Do you have clients that choose to be on medication?
R: Sure, and if they do, I’ll work with them. I ask clients on antidepressants: ”What difference do they make?” The most common answer I’ll get is: ”I felt a bit better initially but now I don’t know if they’re doing anything” or I’ll get: ”I’m not feeling as much pain, but I’m not feeling as much of anything”. Most therapists don’t ask, but if you ask clients on antidepressants if they have sexual problems, about 70% of clients will say ”yes”. The incidence is much higher than the drug companies acknowledge. It’s a big problem. If a client considers the costs of being on medication outweigh the benefits - as many of them do - I will work in conjunction with a psychiatrist to help them get off it. I personally don’t want to play the role of prescribing medication or monitoring medication; I’m not interested in that. Basicly since I started doing therapy, I’ve said, ”I’m here to work with you as a therapist, if you want medication, you go see a gp or a psychiatrist, they can monitor all of that.”

I: You seem to use a lot of your own experiences in your book, in presentations and in therapy; what is the purpose of that?

R: ACT is a model that is in favor of self-disclosure from the therapist. ACT doesn’t insist on self-disclosure, but it’s very much in favor of it. If you read the literature you’ll certainly find studies and papers warning you about the dangers of self-disclosure, but you’ll also find plenty about the enormous therapeutic benefits of self disclosure. ACT is in favor of self-disclosure as long as it is done mindfully and judiciously: to model ACT for the client, or validate their experience, or normalize their experience, or build therapeutic rapport in a useful way.

I: Today when you did tell your own story, I think people got very emotional and touched by it. Are you purposefully aiming to bring up emotionality in the client?

R: What we are aim to do in ACT is to model and instigate and reinforce ACT processes. So I can model the ACT processes, I can instigate them, and if I see them happening in the room, I can reinforce them. One way of modelling them is through self-disclosure. We want to have an intimate therapeutic relationship. Kelly Wilson uses the term ”values and vulnerabilities”. If you know nothing about my values and vulnerabilities, we don’t have an intimate relationship.
Now ACT doesn’t insist on this. You can do ACT and be closed off, without sharing any of your personal thoughts or feelings; but it’s very different when you open up and self-disclose. It helps to break the illusion that the therapist has their life sorted out and doesn’t struggle with this stuff. Many of our clients are fused with the idea that ”everyone else is happy and has a wonderful life except for me”. When the therapist says, ”I get anxious too” or ”My mind is saying that I’m not good enough”, the client goes, ”Oh woww, you too!”

I: What are you occupied with at the moment in ACT concerns?

R: I’m writing four books. I’m writing with Louise McHugh – co-authoring a textbook, trying to make RFT really simple and understandable, and link it to ACT. RFT is the theory of language and cognition that underlies ACT, and many people find it really hard - so we’re trying to make it really simple.
I’m also writing a self-help book with Joe Ciarrochi and Ann Bailey on the use of ACT for weight loss. There are five or six published studies now on ACT with weight loss. That book is called ”The weight escape”, and it should be out in late 2013. I’m nearing completion of an advanced-level textbook called ”Getting Unstuck in ACT” for people who already know the basics of ACT. It’s about the most common ways therapists get stuck, and how to get unstuck again. That should be out in early 2013. And I’m writing a humorous book on mindfulness called ”The Way of The Sloth”. The sloth is an animal in South America. It hangs upside down from the trees with these hugh long claws, and it’s really slow moving. It’s the slowest mammal in the world. In English, the word ”sloth” means ”laziness”. ”Sloth” is one of the ”seven deadly sins” in the bible. Everyone thinks that this animal, the sloth, is really lazy - but what we’re saying in this book is that it’s a master of mindfulness. It doesn’t waste any energy; it’s this mindful creature; the zen master of the forest. So it’s a humorous book, where everyone gathers in the forrest to ask the sloth questions about life, the universe and everything.

I: Do you still have clients?
R: Not many, these days. Just a handful. I’d like to see more but I just don’t have the time; I’m always travelling and teaching.

I: Would you like to tell us a bit about your new book ”The reality slap”? It will published in Danish soon?

R: A ”Reality Slap” is when life just slaps you in the face, knocks you around, turns your world upside down. So ”The Reality Slap” is a book for anyone who goes through a major stressful life event; in particular, it’s about loss and grief. Death of a loved one, bankruptcy, divorce, major illness, a serious accident, a disability: any of these big life events. How do we cope with these events? There are 4 basic principles.

First principle: Hold yourself kindly. This is about self-compassion: Can I be kind to myself? There’s a massive gap here between what I want and what I’ve got; there’s a huge amount of pain showing up: so can I be kind to myself? Many of us don’t know how to do that. We stuff our face with drugs or alcohol or food, or we beat ourselves up, or withdraw from life: this is not really being kind to ourselves. So what are simple ways that I can be kind and caringand supportive to myself, in the midst of my pain?

The second principle, I call ”Dropping an anchor”. All these painful emotions, thoughts, feelings: it’s like an emotional storm. And if I get swept away by the storm, there’s nothing effective I can do. So how do I drop an anchor? Basically, I use mindfulness to ground myself in the present moment, and let those thoughts and feelings flow through me, without carrying me away.

The third principle is ”Take a stand”. What do I want to stand for in the face of this? What do I want to be about in the face of this challenge, in the face of this loss, in the face of this tragedy or crisis? I don’t have to give up on life. I can still stand for something, even if what I’m going through is horrendous. Even if the person I loved most has died, I can still stand for something in the face of that. I can give up on life, or I can stand for something that makes it meaningful. So it’s really about values, and committed action.

The fourth and last principle is ”Find the treasure”. Even in the midst of great pain and suffering, there are things that we can treasure and appreciate. For example, when we’re at the funeral of a loved one, we experience great pain - but in the midst of that pain, people reach out to us with love and kindness and caring; so can we appreciate and treasure those moments?

This principle has to come last, only once the other three are in place. The danger is that many people will try to ”find the treasure” as a first line response. They’ll say things like ”Well, every cloud has a silver lining” or ”What does not kill me makes me stronger”. But if that’s the first thing that you say to someone in great pain, they will experience it as completely invalidating. So ”Find the treasure” comes after everything else. And we’re not trying to pretend that the pain is not there. There is pain here AND there are things here that I can appreciate. But principles one to three have to come first.

Douglas Long August 28, 2012 - 1:47am

Dealing with Fear -- Radio interview with Steven Hayes and phone-in questions (October 2011)

In this episode of the Regina Brett show, ACT psychologist Steven Hayes discusses the psychology of fear, and how ACT can help. He then offers advice to individuals who call in with questions.

Or, if you are logged in, you can download the mp3 file which is attached to this page.

Douglas Long December 1, 2011 - 1:35am

Psychology Today: How Analyzing Your Problems May Be Counterproductive (February, 2010)

How Analyzing Your Problems May Be Counterproductive
Published on February 13, 2010
By Ray B. Williams

When you're upset or depressed, should you analyze your feelings to figure out what's wrong? Or should you just forget about it and move on? New research and theories suggests if you do want to think about your problems, do so from a detached perspective, rather than reliving the experience.

This answer is related to a psychological paradox: Processing emotions is supposed to help you facilitate coping, but attempts to understand painful feelings often backfire and perpetuate or strengthen negative moods and emotions. The solution seems to be neither denial or distraction, according to research conducted by University of Michigan psychologist Ethan Kross, who says the best way to move forward emotionally is to examine one's feelings from a distance or detached perspective.

Kross, along with University of California colleague Ozelm Ayduk, conducted a series of studies that provide the first experimental evidence of the benefits of taking a detached perspective on your problems. Kross says, "reviewing our mistakes over and over, re-experiencing the same negative emotions we felt the first time, tends to keep us stuck in negativity." Their study, published in the July, 2008 issue of Personality and Social Psychology, described how they randomly assigned 141 participants to groups that required them to focus (or not to focus) on their feelings using different strategies in a guided imagery exercise that led them to recall an experience that made them feel overwhelmed by sadness or depression. In the immersed-analysis condition, participants were told to go back to the time and place of the experience and relive it as if it were happening to them over again, and try to understand the emotions they felt, along with the underlying causes. In the detached-analysis condition, the subjects were told to go back the time and place of the experience, take a few steps back and move away from the experience, and watch it unfold as though it was happening to them from a distance, and try to understand what they felt and the reasons for the feelings-- what lessons are to be learned.

The results of the experiment? Immediately after the exercise the distanced-analysis approach subjects reported lower levels of anxiety, depression and sadness compared to those subjects who used the immersed-analysis strategy. One week later the participants were questioned. Those that had used the distanced-analysis strategy continued to show lower levels of depression, anxiety and sadness. In a related study, Ayduk and Kross showed that participants who adopted a self-distanced perspective while thinking about their problems related to anger, showed reductions in blood pressure.

Kross' and Ayduk's research supports the work done by psychotherapist Dr. Steven Hayes. Traditional cognitive psychotherapy may not be the best intervention according to Dr. Steven Hayes, a renowned psychotherapist, and author of Getting Out of Your Mind and Into Your Life. Hayes has been setting the world of psychotherapy on its ear by advocating a totally different approach.

Hayes and researchers Marsha Linehan and Robert Kohlenberg at the University of Washington, and Zindel Segal at the University of Toronto, what we could call "Third Wave Psychologists" are focusing less on how to manipulate the content of our thoughts (a focus on cognitive psychotherapy) and more on how to change their context--to modify the way we see thoughts and feelings so they can't control our behavior. Whereas cognitive therapists speak of "cognitive errors" and "distorted interpretation," Hayes and his colleagues encourage mindfulness, the meditation-inspired practice of observing thoughts without getting entangled by them--imagine the thoughts being a leaf or canoe floating down the stream.

These Third Wave Psychologists would argue that trying to correct negative thoughts can paradoxically actually intensify them. As NLP trained coaches would say, telling someone to "not think about a blue tree," actually focuses their mind on a blue tree. The Third Wave Psychologists methodology is called ACT (Acceptance and Commitment Therapy), which says that we should acknowledge that negative thoughts recur throughout our life and instead of challenging or fighting with them, we should concentrate on identifying and committing to our values in life. Hayes would argue that once we are willing to feel our negative emotions, we'll find it easier to commit ourselves to what we want in life.

This approach may come as a surprise to many, because the traditional cognitive model permeates our culture and the media as reflected in the Dr. Phil show. The essence of the conflict between traditional cognitive psychologists and psychotherapists is to engage in a process of analyzing your way out your problems, or the Third Wave approach which says, accept that you have negative beliefs, thinking and problems and focus on what you want. Third Wave psychologists acknowledge that we have pain, but rather than trying to push it away, they say trying to push it away or deny it just gives it more energy and strength.

Third Wave Psychologists focus on acceptance and commitment comes with a variety of strategies to help people including such things as writing your epitaph (what's going to be your legacy), clarifying your values and committing your behavior to them.

It's interesting that that The Third Wave Psychologists approach comes along at a time when more and more people are looking for answer outside of the traditional medical model (which psychiatry and traditional psychotherapy represent). Just look at a 2002 study in Prevention and Treatment, which found that 80% people tested who took the six most popular antidepressants of the 1990's got the same results when they took a sugar pill placebo.

The Third Wave Psychologists approaches are very consistent with much of the training and approach that many life coaches receive, inclusive of Neuro-Linguistic Programming (NLP), and many spiritual approaches to behavioral changes reflected in ancient Buddhist teachings and the more modern version exemplified by Eckhart Tolle (The Power of Now and A New Earth). The focus of those approaches reinforces the concepts of acceptance of negative emotions and thoughts, and rather than giving them energy and fighting with them, focus on mindfulness, and a commitment to an alignment of values and behavior.

What's fascinating is how brain science and psychological research is supporting ancient spiritual practices. Perhaps now the East and the West, science and spirituality, are coming together.

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Ray Williams is Co-Founder of Success IQ University and President of Ray Williams Associates, Inc., providing leadership development, personal growth, and executive coaching services.
accessed from psychologytoday.com

Jen Plumb February 15, 2010 - 7:18pm

Russ Harris Interviewed on RadioNZ (2010)

Russ Harris on RadioNZ

Jen Plumb August 5, 2010 - 6:59pm

BigThink.com Interview with Steve Hayes (2009)

Topics discussed in the interview:

What Keeps Steven Hayes Up at Night?

The Tolerating Cure

How to Deal With a Panic Attack

Happiness Is an Empty Promise

The Catch-All Nature of Acceptance and Commitment Therapy

Finding a Career by Way of a Panic Attack

Full Interview Transcript:

Question: What led you to explore this field of psychology?

Steven Hayes: Well, I'm in psychology probably the way a lot of people get into psychology: you're interested in why there's so much pain and suffering around you. And I certainly saw that at home, just growing up, and decided early on that it was a place to put my science interests and also just my humanitarian interests, and you could put those two together in one field. After I was a psychologist I developed a panic disorder, and that changed a lot of -- what kind of work I do, because I was trained as a behavior therapist and as a cognitive behavior therapist. And when I applied the methods that I would apply with others when they had panic disorder, it didn't really fully hit what I thought was needed for me.

And I turned back towards several things that were sort of in my experience from more eastern traditions, human potential traditions, and then tried to marry that up -- I'm a child of the '60s and grew up in California, so was exposed to the kind of garden variety eastern thinking that most folks in my generation were exposed to, and I actually found more in mindfulness and acceptance methods that were directly of benefit to me than in the traditions I was nominally part of.

So that really changed my thinking, and it caused me to set out on about a 30-year journey as to how dig down to the essence of what's inside some of our deepest clinical traditions, but also our spiritual and religious traditions, particularly these eastern traditions. But not just that; all of the mystical wings of the major spiritual and religious traditions have methods that are designed to change how you interact with your logical, analytical, linear thinking. And I didn't want to leave that just intact; I didn't want to simply be a meditation teacher or something. I wanted to understand it, and we spend a lot of time kind of pulling at its joints and trying to understand why these things might be helpful to people, I think particularly helpful to people in the modern world who are exposed through the media and the kind of chattering world that we've created to a lot of horror, a lot of pain, a lot of judgment, a lot of words, and need to find a place to go that is more peaceful and more empowering, being able to lives their lives in an intimate, committed, effective way. So that's kind of how I came there, or I ended up where I ended up.

Question: What is ACT and how does it differ from traditional forms of cognitive therapy?

Steven Hayes: Sure. Well, the empirical clinical traditions, especially in the cognitive behavioral tradition, early on they were trying to apply behavioral principles mostly developed with animal models directly to people. And there's a lot of benefit that happened there; it's still relevant today. You can do a lot of good things for people who suffer with anxiety, depression and so on using those methods. I'm old enough to have seen all three of these steps, and somewhere in the late '70s and mid-'80s people realized that you had to have a better way of dealing with cognition, and they couldn't find it in the animal models. So they went to more commonsense clinical models where they would sort of divide thinking styles up into rational and irrational processes, making cognitive errors and so forth. And they thought if we could just get people to think more rationally and focus on the evidence and take some of those over-expansive thoughts that are creating difficulty for them and change them, then they'd do better. And some of it was -- the techniques were helpful, but the theory didn't work very well.

Increasingly over time we learned that the components that theory tells you to put in and the processes that should change didn't really explain the outcomes and add to the outcomes. And it had this potential for a downside: people can get even more self-focused, even more caught up in their own thinking. And we're part of a newer sort of third generation of tradition that is using acceptance and mindfulness practices and values, commitment, behavior change practices and marrying them up. So the difference between traditional CBT and the acceptance and commitment therapy, or ACT -- but not just ACT; also mindfulness-based cognitive therapy, dialectical behavior therapy, a number of the other more kind of modern acceptance and mindfulness approaches -- instead of teaching people to detect, to challenge, to dispute and change their thinking, we teach people to notice what they're thinking and to notice what they're feeling, what their body is doing, learn from it, but then focus also on their values and getting their feet moving towards the kinds of lives that they want to produce to have a life worth living.

And it turns out that that's, we think, a quicker and more direct way, a more certain way, to moving ahead in your life than first trying to get the cognitive ecology inside this skull of ours all lined up with an ability to detect our logical errors and correct them and so forth. Meanwhile, the clock is ticking. There's relationships to have, children to be raised, work to be done, contributions to be made, and you're waiting to get the world within all lined up. We think it's more effective to find a way to back up from that a little bit; notice it, see what's there, learn from it, and move ahead directly towards the kind of lives that you want to produce. And it turns out those processes are not just in therapy, but in this office, in your home, in the schools and organizations. And so the ACT work has very quickly expanded out from psychotherapy into behavioral medicine, and from that even into organizational work and now into prevention work and into communities and schools. So it's kind of exciting to see psychology touching people where they are, in the streets, in a way that is empowering and sort of simplifies what it is that people need to learn to be more effective and happy, successful, vital in their lives.

Question: How can a therapist help someone realize their values?

Steven Hayes: You know, a couple of things: if someone watching this were to focus on what pains them the most, and then would take the time to look inside -- what do I care about such that that's particularly painful? -- they're probably going to find a significant area that they value. I'll give an example: most people are hurt deeply by betrayals in relationships. And what your mind tells you to do is, don't be so vulnerable; don’t be so silly; don't open yourself up; don't be so trusting; you can be betrayed. In fact, the reason why you hurt so much is that you want relationships that are loving, committed, intimate; you want trust. And what your mind's telling you to do in a way is, don't care about that so much so that you won't be hurt so much. It might be better to really get up against and sort of contact that caring, and maybe take a more loving stance even with your own pain, and keep your feet moving towards what you really want, because the cost in terms of intimacy and connection and caring that comes when you try not to be vulnerable, when you're constantly looking out for betrayals of trust, is too great. It makes it very hard to have relationships of the kind that you really want. So there's an example. One, look where the pain is. Flip it over; you'll find that's where the values are.

Another one is just to think of the times that you've felt most with yourself, most connected, most vital, most energized, most flowing, natural. And if you take some of these specific memories and you walk inside them, you're going to find that there's things in there that you care about. There's things in there that, when it's really working well, are kind of a lighthouse, like a beacon in the distance, that you can move towards. You never fully reach these things. I mean, I'll give you an example. There are times when you felt especially important to another person, or cared about or loved or accepted. Well, loving relationships aren't something you can have like a precious little jewel you put in a box and then put on your shelf. It's something you walk towards. And there's always difficulties; there's always pain in relationships. But you can keep walking towards that beacon in the distance. That process, that journey, is called life. And if you're moving towards the things that you value, life is more vital, flowing; it's more empowering. And so that's another way: go inside the sweetness of life, catch the places where you genuinely were moved by or connected with life, and you'll find in there kind of a light that can direct you when the cacophony gets very noisy and you get confused and lost, that can direct you towards what you care about.

Question: How does the role of an ACT therapist differ from the role of traditional psychologists?

Steven Hayes: It might be a little bit, because this psychology is a psychology of the normal. A lot of the psychologies that are out there are built on the psychology of the abnormal. We have all these syndromal boxes that we can put people in and so forth. The actual evidence on syndromes is not very good. I mean, there's no specific biological marker, for example, for any of the things that you see talked about in the media. Even things like schizophrenia -- there's no specific and sensitive biological markers for these things. So yeah, there may be some abnormal processes involved in some of them, but vastly more of human suffering comes from normal processes that run away from us. Like normal processes of problem-solving work great on the world without; when it's applied within, you too easily get into a mode of mind where you can start living when the problem of your history is solved.

But your history's not going to go away; it isn't the same thing as dirt on the floor or paint peeling off the walls; it's not going to be solved in that way. It's more like learning how to carry it, to contact it, to see it. Because it's based on the psychology of the normal, the therapist is part of that too. And so when the therapist gets in there and is working on acceptance and mindfulness and values, they too are working with those very same processes. And so it requires a therapist not to be a master at it -- you don't even have to be good at it -- but just to see the value of it and to be willing to look at their own difficult emotions and thoughts and find a way to carry them gently in the service of the clients that they're serving.

So for example, if a therapist is feeling insecure in therapy, a lot of therapists will try to sort of push that aside to try to do the therapy. Instead, we would ask people to get with that feeling of insecurity, because after all, the client is being asked to do the same thing. So it tends to be relatively intense, interactive, horizontal. It's not one up; the therapist is in the same soup. And it has a kind of a quality of two human beings in the same situation, really, working through these psychological processes. And yeah, I'm working for you; you hired me; I'm working for you as a therapist. But I'm not up here and you're down there. And what you're struggling with, at other times and with other areas I'm struggling with.

Question: Why can ACT treat everything from schizophrenia to prejudice?

Steven Hayes: Well, and even more than that. I mean, I've mentioned even in this office the same processes are there. We've done research showing that ACT and the processes that underlie it can help things like can secretaries learn new software? Can therapists learn new methods? What about stigma and prejudice between people? So it isn't just in the psychotherapy areas. And why that would be, as an empirical fact there's a pretty enormous breadth to these methods. And why that would be -- because everywhere that a human mind goes, these processes of avoiding the world within in order to try to regulate your behavior, or becoming entangled in your thoughts interfering with your ability to take advantage of what's around you, or losing contact with your values for fear that you'll know more about the places where you hurt -- those kinds of processes are just normal psychological processes that are built into language and cognition itself. They're built into problem-solving. And so if you take the mode of mind that works great in 95 percent of your life and apply it within, it then implodes. It starts creating barriers, and that's true at work, it's true in organizations, it's true in our culture, true in our politics. And yeah, it's true in our consulting rooms.

So we're going -- the reason why it spreads out -- we have pretty good evidence for this; I know it sounds a little grandiose -- but the mental cognitive processes that we're targeting are ones that narrow human beings' repertoire and make it harder for them to learn to be more flexible, to take advantage of the opportunities in front of them. And we think that's something we can have something to say about, something to help with in all of these different areas, maybe even in areas like child development or organizations and schools, or maybe even things like prevention or how peoples interact with each other, one to the other. So we've taken the work, for example, into things like prejudice and stigma, because in the modern world, if we can't solve that we have planes flying into buildings. And then we have planes flying over countries. The amount of hate and objectification and dehumanization that's on the planet isn't something we can tolerate any more in a world that's coming of suitcase bombs and the ability to amplify that hate out into harm towards each other. So it applies broadly because anywhere that a human mind goes these processes go.

Question: What is happiness?

Steven Hayes: You know, there's many different definitions of it. I think one dangerous definition of it is to think of happiness as kind of a warm, joyful, **** feeling in your heart that you have to pursue and grab and hold onto for fear that it'll go away. I mean, it's fun when you have those feelings, but we know, and the evidence shows, them more intent you are on having those feelings and chasing those feelings, that's a butterfly that flies away the more you chase it. A better way to think about happiness that actually is something that I think you can reach towards is, it's living in accord with your values and in a way that is more open and accepting of your history as it echoes into the present, that's more self-affirming, self-validating and values-based. The Greeks had a word for it; they called it eudaimonia, and it's not a bad definition. And I think that definition of happiness is something that will empower human lives.

The definition that we have that gets very hedonistic and emotion-oriented -- the problem is that there's too many quick and dirty ways to chase that in ways that end up being unhelpful to people. If you avoid the feelings of betrayal and the sense of insecurity that comes in relationships that aren't working by running into detuned relationships, by sexuality that isn't connected to intimacy, et cetera. Yeah, you might feel good, but it doesn't live well. If you just have another martini or even more severe forms of substance use, yeah, it might feel good, but it doesn't live well. And if you escape into kind of a materialism -- the right car, the right woman, the right house, the right trip, the right place, the right job, the right praise -- you know, these things -- all of the folks who are wise in our culture, over the history of our culture, have written about the dangers of trying to define a meaningful life that way. But commercial culture and our media is constantly encouraging us to think that if we feel good we live well. And then we're only too happy, thank you very much, to sell you goods and services from the dancing oivoids and the pill you can take, or the trips or the cars or the clothes or the women that you can get with -- whatever that is that will give you the quick route to that.

And it's an empty promise. I think young people know it's empty, but they're not quite sure what to do. And I kind of look at what's on the T-shirts and I see another solution, which also worries me. I see "Just do it." "No fear." -- this kind of suppressive response to the treacle that the culture tries to define for us as a meaningful life also blows up on you. "No fear" is not something that you should put on your shirt. How about "I can hold my fear and still connect with you"? Put that on your shirt. "It’s okay to be me, with all of my history." Put that on your shirt. So there's a middle path. There was a guy who sat under a tree a long time ago who is important to a pretty big chunk of the human population that called it The Middle Path. There is a middle path between indulgence and suppression, but the culture has overwhelmed that in the cacophony that has been created in the modern world and the commercial encouragement of avoidance and indulgence on the one hand, or suppression and "just do it," treating yourself as an object on the other. We've got to find a way that's more compassionate, softer, that allows us to move forward towards the kind of lives that we really want to live.

Question: Are Americans striving too much for happiness?

Steven Hayes: I think the commercial culture, and also science and technology after all, which gives us greater ease but also makes it harder for us to sit with the small amounts of distress that come just by living itself, is probably -- the combination of the commercial culture and the media culture and the science and technology has probably made it more difficult in American culture. But I think it's built into language and cognition. It was only given some counterweights -- the major institutions that are there are our spiritual and religious traditions, which emerged very early on, at the point at which human language grew and written language created kind of the problem that we can have now with language kind of running away from us. And those traditions have weakened too in our culture, and they've changed. So we probably do -- it isn't that we're chasing happiness; I think we have the wrong model of happiness. I mean, defined as eudaimonia, defined as a values-based life of integrity and fidelity to yourself and what you most deeply want to stand for, that definition of happiness -- man, that's the kind of life I want to live and I think that will support people and sustain people.

But this cheap-thrill version, this sort of ease definition, the feel-good definition of happiness is an empty promise. And the culture in the West I think has done a particularly bad job of indulgence in that vision of what happiness is and encouraging people to chase it. And I think we can see in the growing amount of problems that we have in the developed world that it's an empty promise. And I'll give you an example, not from the U.S., but in Scandinavia probably the most worker-supportive part of the planet, they have the highest rate of chronic pain and the greatest rate of worker-related disability. So right inside this idea that any kind of pain and difficulty is so much unwelcome that if you say that you're in pain, we're going to come in guns a-blazing and even pay you full salary to quit work because you're burned out, or to -- inside that what you're going to create is gigantic amounts of chronic pain syndrome. Scandinavians spend 15 percent of their gross national product on disability. Fifty percent of the public health nurses are on disability. I mean, and that's where we're headed in the U.S. too, because unless we get wiser as to how to carry the difficulties of life in a way that's self-compassionate and empowering, we can create this kind of world in which we'd rather sort of plug into the matrix with whatever pills or escapist tendencies we can think of instead of walking through a process of living that's going to include loss. It's going to include limitations on function. It's going to include some significant difficulties. We need to learn and teach our children how to do that. And the West is just doing a terrible job of that right now.

Question: Do you believe in medicating depression and other forms of mental illness?

Steven Hayes: Medication -- I want good science, and big pharma is only too happy to give us bad science, because the way the FDA is set up and what the requirements are -- I mean, these are geek topics, and the normal person wouldn't really know how to evaluate it. But you only require a certain number of randomized trials. You don't have to have the proper control groups. You can have the blind be penetrated; people can know that they're on the medication, which we know there's a big placebo effect inside medications. So the science is often inadequate. The best science that's out there, then I want to -- then that's fine; let's go there. And there's decent science.

Let's take something like antidepressant medications. There's decent science saying it has an effect, but it's shockingly small after you control for penetration of the blind, people knowing that they're getting the active pills versus sugar pills, if you use an active control. It's probably only a few points. Like in depression, on the 56-point scale, the estimate is it probably accounts for about two points difference. But it's a multi, multibillion-dollar industry. And by the way, has huge side effects. And some of these medications, 40 percent of the people taking them have significant sexual side effects, for example. And that's just one. The level -- a single antidepressant medication can be worth a billion dollars to a company.

So I want good science, and I want it to be realistically marketed. I wouldn't like -- I think all these commercials that we have -- only two countries on the planet that allow pharmaceutical companies to market directly to people, New Zealand and the United States -- it's a bad idea, in my opinion. I think it ought to be better regulated. And when it's presented to people, it ought to be presented in a way that's realistic. For example, often people will prescribe these medications, and we'll say, you have a brain disease; you'll have to be on these medications permanently. It's because you have a brain disease. Well, brain disease -- there would be a specific biological marker for the so-called disease. There is no biological marker for depression. It's not true that we know that it's a brain disease. Is the brain involved in depression? Yes, the brain is involved with what you and I are doing right now. If neither one of us had a brain, we wouldn't be having a conversation. But that doesn't mean it's a brain disease.

And so the prescribers very often overstate, oversell, and the detail people are only too happy to tell them to do that. This idea that there's something wrong with your brain, and because of that you're permanently -- by the way, almost never are these medications evaluated with what will happen if you're on them for three, four, five, 10, 15 years. Sometimes some of the side effects that come up come up only later, and sometimes they're very severe, even irreversible side effects. So I would like it to be more like yes, these medications might be helpful to a degree, but what they do in areas like depression or antipsychotics is, they give you a little more distance between the things that cause you to get entangled with thoughts and feelings. And so they might be of some help, open up a little window. Now can we go in there and learn some of these methods directly to do that?

For example, antidepressant medications, you still have some depressive thoughts. Antipsychotic medications, you still have some psychotic symptoms for the vast majority of the people taking them. But it gives them a little separation, and it doesn't control his behavior as much when you have a sad feeling, difficult thought, an odd perceptual experience. We can teach people those exact skills in therapy, and so evidence is pretty good if you use it as just a window to get in there and teach these skills, you get longer-term benefits and without the side effects. So don't be sold just because a commercial interest wants to sell you things. The government ought to help out, because the average citizen can't go out and be doing reviews of the scientific literature. And focus on the processes that have low side effects and good long-term outcomes. Right now you're going to find those in the psychosocial area, in the therapy area, in the empirically supported treatments such as ACT or cognitive behavior therapy, behavior therapy. And go there first rather than going to the pill bottle as if it's going to be the end of your journey, that it's going to solve the problem. Very often it's only going to help, and even only to a minor degree, and more is going to be needed.

Question: What’s your advice to someone dealing with a panic attack?

Steven Hayes: Well, the advice I'd give if you were my patient would be a little different because we'd have a little more time. But if I can distill it down to the essence of what we do in a course of therapy, the person with panic -- I can say this from the inside out since you're looking at a panic-disordered person in recovery -- has adopted a posture with regard to the world within in which their own anxiety is their enemy. And they think that if they can just get the anxiety to go down, go away, not occur as much or not occur with such intensity, or at least not occur here, or there, in that situation, that then things would be better. In fact, all of that is not the solution to the problem; it is the problem. Holding anxiety as your own enemy, and that it has to go down, diminish it, go away and not happen here is a kind of self-invalidating, interiorly focused process that would get you even more entangled with these processes. Instead, what we're going to need to learn to do is to allow your history to bring into the present thoughts and feelings and memories, and to sort of hold them mindfully and self-compassionately, and then focus on what you do and bring them along for that journey.

So -- feelings are only your history being occasioned by the present moment. If that's your enemy, then your history is your enemy. If sensations are your enemy, your body is your enemy. And if memory is your enemy, you'd better have a way of controlling your mind in such a way that you never are reminded of things that are painful from the past. Well, there is no such thing like that that's healthy. And most of the things that people do that are called psychopathology are the unhealthy things people do when they try to accomplish that agenda. If you avoid people, avoid having your buttons pushed, avoid going to places that might occasion anxiety; if you're hammering down drugs and alcohol; these are all methods of trying to mount that unhealthy agenda.

So I would say, could we instead take this anxiety to be something that may be of importance, may even be meaningful? And it says something about your history, and could we learn to sort of hold it in a way that's more compassionate, to sort of bring the frightened part of you close and treat it with some dignity, and keep focused -- instead of making that go away -- focused instead on what kind of life you want to live connected to what kind of meaning and purpose. That's going to be a quicker, more self-compassionate and more certain journey forward than this kind of "out with the anxiety, in with the relaxation," "out with the self-doubt, in with the confidence" kind of -- "let's just snap out of it" kind of harsh and non-compassionate place that we stand with ourselves inside things like panic disorder.

Question: Why don’t some psychologists believe in the effectiveness of ACT?

Steven Hayes: It's an argument about theory and processes, but the processes, and the ones we've been talking about, inform what we think of ourselves and what we should encourage in our children and what we should try to put into the culture. And I think really we've been through a time when we thought we could think our way out of this, and kind of think clearly and that would solve the problem, and detect logical errors and that would solve the problem. We thought of suffering as a problem of sort of dysfunctional cognitions. I think we're coming into a time instead where it has to do with how you stand in relationship to your own world within and in relationship to those around you in the world without. And I believe these are the things that we need to put into our schools, education, into our psychotherapy and into our culture more, finding a way to not be so harsh and judgmental, so objectifying and dehumanizing, constantly focused within and trying to get these difficult thoughts and feelings to go away; or focused without and objectifying and dehumanizing others. So the core of the controversy is, is it more powerful to take an acceptance and mindfulness-based approach compared to a cognitive and emotional change approach when we're dealing with these problems? I think the evidence is more in our favor, especially the process evidence.

And I think if you look at where the culture is going, there's a reason why Eckhart Tolle is on Oprah. There's a reason why The Purpose-Driven Life is a best seller, quite apart from appealing to evangelicals and the Christianity that's in it. It's also -- there's a yearning for meaning, for values and for mindfulness and acceptance, because we've created a modern world where our children are exposed to 10, 20, 30 times the number of words that our great-grandfathers were exposed to. And we're exposed in a single day or two to more horror on our Internet Web pages than our great-grandfathers were exposed to in decades of living. And we have not created modern minds for that modern world. Science and technology has just dumped it on us. And I think people yearn for it. I think you see it in what's popular. And why are people wanting to learn about meditation, and why are they going on mindfulness retreats? And why are they talking about a purpose-driven life? It's because they know more is needed in the modern world.

And that's the core of the controversy. I think it's pretty clear in how things are moving in empirically supported treatments that we're going to be speaking to the culture in a different voice. It's not going to be the loosey-goosey voice of the '60s, but it's going to have some echoes of some of the deeper clinical and spiritual and religious traditions that had wisdom in it. If we're not going to get there through religious means and things of that kind, which greatly has weakened in the West, we're going to have to find a way to put it in the culture in a different way, because we need something right now other than yet another cable shoutcast or yet another Internet Web page showing us the cellulite on the actress's rear end. I mean, the amount of sort of judgment and harshness that's in our culture -- we need something that's prophylactic for that, and I think that's what's inside these new methods.

Question: What keeps you up at night?

Steven Hayes: What keeps me up at night in a positive way is the possibility that we might contribute to the development of human culture in a way that, years from now, people who will never know our names may be able to live more empowered lives. And if you ask like what is the name of your great-great-great-grandfather, you probably don't even know if you get three or four greats out. So it's not that we're immortal; we're going to die very, very soon. It's not that what we produce is going to live on; it will not. But the changes that we can make in the culture can be there for people that we will never meet, that will never know us, and that's what keeps me up at night. It's what excites me about science, that we can learn ways of being with each other. And the behavioral sciences have not been enough of a part of cultural development. The physical sciences have; the behavioral sciences have not. And I would like to see if we can bring some things into human culture that would humanize and soften and empower people.

What keeps me up at night in a negative way is, if we don’t solve these problems of the human heart and of the human head, of human psychology, there is no technological solution so great that it can prevent the world that is coming, and a world of suitcase bombs or of the ability to pollute the planet in a way that it cannot recover, of global warming and the rest. We've created through science and technology a different world that has frightening sides to it, and psychology and behavioral science has to be part of this, because if you take something like the so-called war on terrorism, if we go out another 20 years and it isn't just planes into buildings, but it's a suitcase bomb in the middle of New York, there's not enough soldiers and there's not enough bullets to kill enough people to make us safe. I think we're going to have to find a way to humanize the culture itself.

And it isn't just them; it's us. When we fly planes over countries, dropping bombs on the evil ones, I think we're doing something very similar to what's being done when the infidels are getting their comeuppance with planes going into buildings. So it's gotten to the point where if we are not healthy psychologically as a human society, we will not have a planet to live on. And that's what keeps me up at night, when I see so little focus on the behavioral side of these problems, and the idea that just politics, or just physical science, is going to solve this. Or just the military; it's not true. We have to solve this, and we've got to solve it in our own heads and in our own hearts, one at a time. And I think psychotherapy actually tells us a little bit about what we might need to do to soften the culture and make it more possible for us to live together as human beings on this planet.

Jen Plumb December 19, 2009 - 3:48pm

Time Magazine: Self-Help Through Negative Thinking (2009)

Cloud, J. (July 2009). Yes, I suck: Self-help through negative thinking. Time Magazine. Time, Inc.: New York, NY.

In the past 50 years, people with mental problems have spent untold millions of hours in therapists' offices, and millions more reading self-help books, trying to turn negative thoughts like "I never do anything right" into positive ones like "I can succeed." For many people — including well-educated, highly trained therapists, for whom "cognitive restructuring" is a central goal — the very definition of psychotherapy is the process of changing self-defeating attitudes into constructive ones.

But was Norman Vincent Peale right? Is there power in positive thinking? A study just published in the journal Psychological Science says trying to get people to think more positively can actually have the opposite effect: it can simply highlight how unhappy they are.

The study's authors, Joanne Wood and John Lee of the University of Waterloo and Elaine Perunovic of the University of New Brunswick, begin with a common-sense proposition: when people hear something they don't believe, they are not only often skeptical but adhere even more strongly to their original position. A great deal of psychological research has shown this, but you need look no further than any late-night bar debate you've had with friends: when someone asserts that Sarah Palin is brilliant, or that the Yankees are the best team in baseball, or that Michael Jackson was not a freak, others not only argue the opposing position, but do so with more conviction than they actually hold. We are an argumentative species.

And so we constantly argue with ourselves. Many of us are reluctant to revise our self-judgment, especially for the better. In 1994, the Journal of Personality and Social Psychology published a paper. showing that when people get feedback that they believe is overly positive, they actually feel worse, not better. If you try to tell your dim friend that he has the potential of an Einstein, he won't think he's any smarter; he will probably just disbelieve your contradictory theory, hew more closely to his own self-assessment and, in the end, feel even dumber. In one fascinating 1990s experiment demonstrating this effect — called cognitive dissonance in official terms — a team including psychologist Joel Cooper of Princeton asked participants to write hard-hearted essays opposing funding for the disabled. When these participants were later told they were compassionate, they felt even worse about what they had written.

For the new paper, Wood, Lee and Perunovic measured 68 students on their self-esteem. The students were then asked to write down their thoughts and feelings for four minutes. Every 15 seconds during those four minutes, one randomly assigned group of the students heard a bell. When they heard it, they were supposed to tell themselves, "I am a lovable person."

Those with low self-esteem — precisely the kind of people who do not respond well to positive feedback but tend to read self-help books or attend therapy sessions encouraging positive thinking — didn't feel better after those 16 bursts of self-affirmation. In fact, their self-evaluations and moods were significantly more negative than those of the people not asked to remind themselves of their lovability.

This effect can also occur when experiments are more open-ended. The authors cite a 1991 study in which participants were asked to recall either six or 12 examples of instances when they behaved assertively. "Paradoxically," the authors write, "those in the 12-example condition rated themselves as less assertive than did those in the six-example condition. Participants apparently inferred from their difficulty retrieving 12 examples that they must not be very assertive after all."

Wood, Lee and Perunovic conclude that unfavorable thoughts about ourselves intrude very easily, especially among those of us with low self-esteem — so easily and so persistently that even when a positive alternative is presented, it just underlines how awful we believe we are.

The paper provides support for newer forms of psychotherapy that urge people to accept their negative thoughts and feelings rather than try to reject and fight them. In the fighting, we not only often fail but can also make things worse. Mindfulness and meditation techniques, in contrast, can teach people to put their shortcomings into a larger, more realistic perspective. Call it the power of negative thinking.

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View this original article online here.

Also click our link to access the 2006 Time article by John Cloud referenced in the above article.

ACBS Professional/Student Members: Once you are logged in, you can view the original Woods, et al (2009) article here.

Jen Plumb September 23, 2009 - 2:48pm

ACT Articles in Veja Magazine in Portugese (2006)

Articles on ACT have appeared in Brazil, following a long piece in "Veja" in March 2006.

Steven Hayes March 28, 2006 - 1:43pm

An Overview of ACT; Psychotherapy Australia Magazine (2006)

Embracing Your Demons: an Overview of Acceptance and Commitment Therapy By Russ Harris

This a simplified overview of ACT, written deliberately in a non-technical manner, so that therapists and counsellors of all backgrounds can appreciate it.

Russ Harris August 27, 2006 - 6:52am

Martha Beck's story in O Magazine (2006)

This is Martha Beck's column in "O":

MELANIE'S LIFE WAS SHRINKING LIKE A CHEAP BLOUSE in an overheated dryer. At 30 she'd developed a fear of flying that ended her dream of world travel. Within a year, her phobia had grown to include—or rather, exclude— driving. After the World Trade Center attacks, Melanie became terrified to enter the downtown area of any city. She quit her job as an office manager (the potential for mail-based terrorism was too big) and called me hoping I could help her devise a way of earning money from home.

"Everybody tells me my fears aren't realistic," she said. "But I think I'm the most realistic person I know. It's a dangerous world— I just want to be safe."

There was only one thing for which Melanie would leave her apartment. Once a month, she walked to a rundown neighborhood to meet her drug dealer, who sold her Xanax and OxyContin of questionable purity. I insisted that Melanie see a psychiatrist before I'd work with her, and the worried shrink called me before the impression of Melanie's posterior had faded from his visitor chair. "She's taking enough medication to kill a moose," he told me. "If she slipped in the shower and knocked herself out, withdrawal could kill her before she regained consciousness."

Ironic, n'est-ce pas? Safety-obsessed Melanie was positively devil-may-care when it came to better living through chemistry. This made no sense to me—until I realized that Melanie's objective wasn't really to avoid danger but to prevent the feeling of fear.

Melanie was using a strategy psychologist Steven Hayes, PhD, calls experiential avoidance, dodging external experiences in an effort to ward off distressing emotions. It wasn't working. It never does. In fact, to keep her tactics from destroying her, she would have to learn the antidote for experiential avoidance—and so must the rest of us, if we want our lives to grow larger and more interesting, rather than smaller and more disappointing.

Why Experiential Avoidance Seems Like a Good Idea

Most of us do this kind of emotional side step, at least occasionally. Maybe, like Melanie, you feel skittish on airplanes, so you take the train instead. In the realm of physical objects, dodging situations associated with pain is a wonderfully effective strategy; it keeps us from pawing hot stovetops, swallowing tacks, and so on. Shouldn't the same logic apply to psychological suffering? According to Hayes, it doesn't. Experiential avoidance usually increases the hurt it is meant to eliminate.

Consider Melanie, who, quite understandably, wanted to steer clear of the awful sensation of being afraid. Every time she withdrew from a scary activity, she got a short-term hit of relief. But the calm didn't last. Soon fear would invade the place to which Melanie had retreated—for example, she felt much better driving than flying for a little while, but it wasn't long before she was as petrified in cars as airplanes. Drugs calmed her at first, but soon she became terrified of losing her supply. By the time we met, her determination to bypass anything scary had trapped her in a life completely shaped by fear.

The reason this happens, according to Hayes and other devotees of relational frame theory, is that Melanie's brain works through forming connections and associations. So does yours. Your verbal mind is one big connection generator. Try this: Pick two unrelated objects that happen to be near you. Next answer this question: How are they alike? For instance, if the objects are a book and a shoe, you might say they're alike because they both helpedyou get a job (by being educated and dressing well). Ta-da! Your book, your shoe, and your job are linked by a new neural con¬nection in your brain. Now you're more likely to think of all these things when you think of any given one.

This means that every time you avoid an event or activity because it's painful, you automatically connect the discomfort with whatever you do instead. Suppose I'm having a terrible hair day, and to not feel that shame, I cancel a meeting with a client. Just thinking about that client brings on a pang of shame. If I watch a movie to distract myself, I may be hit with an unpleasant twinge just hearing the name of that movie. This happens with every form of psychological suffering we try to outrun. Your true love dumps you, and to stave off grief, you avoid everything you once shared —your favorite song, the beach, mocha lattes. Now you're bereft not only of your ex but also of music, seascapes, and a fabulous beverage. Your losses are greater, as is your grief. So you go on a hike to cheer yourself up, and what do you think as you gaze at the lovely scenery? Well, duh. You wish your ex were seeing it with you, and you're sadder than ever. When we run from our feelings, they follow us. Everywhere.

The Willingness Factor

In Hayes's book Get Out of Tour Mind & into Your Life, he suggests that we picture our minds as electronic gadgets with dials, like old-fashioned radios. One dial is labeled Emotional Suffering (Hayes actually calls it Discomfort). Naturally, we do everything we can to turn that dial to zero. Some people do this all their lives, without ever noticing that it never works. The hard truth is that we have no ultimate control over our own heartaches.

There's another dial on the unit, but it doesn't look very enticing. This one Hayes calls Willingness, though I think of it as Willingness to Suffer. It's safe to assume that we start life with that dial set at zero, and we rarely see any reason to change it. Increasing our availability to pain, we think, is just a recipe for anguish souffle. Well, yes...except life, as Melanie so astutely commented, is dangerous. It'll upset you every few minutes or so, sometimes mildly, sometimes apocalyptically. Since desperately twisting down the Emotional Suffering dial only makes things worse, Hayes suggests that we try something radical: Leave that dial alone—abandon all attempts to skirt unpleasant emotions—and focus completely on turning up our Willingness to Suffer.

What this means, in real-world terms, is that we stop avoiding experiences because we're afraid of the unpleasant feelings that might come with them. We don't seek suffering or take pride in it; we just stop letting it dictate any of our choices. People who've been through hell are often forced to learn this, which is why activist, cancer patient, and poet Audre Lorde wrote, "When I dare to be powerful—to use my strength in the service of my vision, then it becomes less and less important whether I am afraid."

Once we're willing to confront our emotional suffering, we begin making choices based on attraction instead of aversion, love instead of fear. Where we used to think about what was "safe," we now become interested in doing what seems right or fun or meaningful or ripe with possibilities. Ask yourself this: What would I do if I stopped trying to avoid emotional pain? Think of at least three answers (though 30 would be great and 300 even better). Write them here:

Stick with this exercise until you get a glimmer of what life without avoidance would be like. To paraphrase Dr. Seuss, Oh, the places you'd go! Oh, the people you'd meet, the food you'd eat, the jokes you'd tell, the clothes you'd wear, the changes you'd spark in the world!

One thing none of us will ever be able to calculate is how much we've lost by not having these experiences—something Hayes calls the pain of absence. Being unwilling to suffer robs us of incalculable joy—and the awful punch line is that we still get all the anguish we tried to escape (and then some).

The Consequences of Willingness

What happens when we're willing to feel bad is that, sure enough, we often feel bad—but without the stress of futile avoidance. Emotional discomfort, when accepted, rises, crests, and falls in a series of waves. Each wave washes parts of us away and deposits treasures we never imagined. Out goes naivete, in comes wisdom; out goes anger, in comes discernment; out goes despair, in comes kindness. No one would call it easy, but the rhythm of emotional pain that we learn to tolerate is natural, constructive, and expansive. It's different from unwilling suffering the way the sting of disinfectant is different from the sting of decay; the pain leaves you healthier than it found you.

It took Melanie a huge leap of faith to accept this. She finally decided to turn up her Willingness to Suffer dial, simply because her Emotional Suffering levels were manifestly out of her control. She started by joining a yoga class, though the thought of it scared her witless. She found that her anxiety spiked, fluctuated, and gradually declined. Over the ensuing months, she entered therapy, traded her street-drug habit for prescribed medication, and found a new job. Melanie's worry isn't completely gone; it probably never will be. But that doesn't matter much. She is willing to accept discomfort in the pur¬suit of happiness, and that means she'll never be a slave to fear again.

To the extent that we reject anything we love solely because of what we fear, we're all like Melanie. Find a place in your life where you're practicing experientialavoidance, an absence where you wish there were something wonderful. Then commit to the process of getting it, including any inherent anxiety or sadness. Get on an airplane not because you're convinced it won't crash, but because meeting your baby niece is worth a few hours of terror. Sit on the beach with your mocha latte, humming the song you shared with your ex, and let grief wash through you until your memories are more sweet than bitter. Pursue your dreams not because you're immune to heartbreak but because your real life, your whole life, is worth getting your heart broken a few thousand times.

When fear makes your choices for you, no security measures on earth will keep the things you dread from finding you. But if you can avoid avoidance — if you can choose to embrace experiences out of passion, enthusiasm, and a readiness to feel whatever arises—then nothing, nothing in all this dangerous world, can keep you from being safe.

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Martha Beck is the author of Leaving the Saints and The Joy Diet (both Crown).

Steven Hayes January 15, 2006 - 8:29pm

New Harbinger's interview with Steve Hayes (2006)

Interview with Steven Hayes on Get Out of Your Mind and Into Your Life

New Harbinger Publications: In Get Out of Your Mind and Into Your Life, you contradict some of the most central tenets of psychology. You say for example that, “accepting your pain is a step toward ridding yourself of your suffering,” and “we assume that...suffering is normal and it’s the unusual person who learns how to create peace of mind.” How did you come to adopt ideas that are so contrary to earlier models of psychological thought?

Steven C. Hayes: Actually the idea that human suffering is pervasive is hardly new. Most of our spiritual and religious traditions begin there, for example. And our scientifically based therapy traditions inadvertently do too, though they don’t seem to realize it. Every professional writing a grant or pitching the need for a new treatment program begins with a section documenting how pervasive a given problem is in the community. And you see that work being written up in the popular media all the time with stories about the unbelievably large numbers of people who have, say, been abused, or have an addiction problem, or struggle with relationships, or have a mental disorder, or who are just stressed at work.

To see the truth of the claim I make in this new book, all you have to do is stop and say, “Hey, wait a minute. What if we added up all of these problems? How many people would fail to be in one ‘abnormal’ grouping or another?” When you craft the question properly the answer hits you in the face: it’s pain and struggle that is normal, not happiness. Most people I know have the personal information needed to reach the same conclusion. Just ask yourself this: How many people do you know really well who don’t struggle at times—or even often—in their lives?

There is almost this conspiracy of silence. Because we’re told that happiness is normal we tend to keep silent about our struggles—it means we’re abnormal. But because most people have the same secret, we walk around feeling isolated and alone. That doesn’t mean you can’t be happy. You can. But you have to learn how to avoid the traps our minds lay for us. The reason why suffering is so pervasive is because we’re so bad at doing anything about it.

The natural, rational thing to do when we face a problem is to figure out how to get rid of it and then actually get rid of it. In the external world, our ability to do just that is what allowed us to take over this planet. But that only works in the world outside of our skin. We don’t at first realize that and so we deal with our own psychological struggles by trying to get rid of our painful feelings, difficult memories, or worrisome thoughts—as if then we’ll be happy. But it doesn’t work.

Modern science is fairly clear that this is one of the surest ways to prevent happiness from ever arriving. Said another way, suffering is so pervasive because our attempts to solve it actually make it persist. We are caught in a trap of our own making. As for how I got there, my position came from three sources. The traditional model didn’t work for me; it didn’t work for my patients; and as I began to research it, I figured out why that was. And our research showed that doing some very counterintuitive things instead did work.

NHP: Can you give us a layperson’s primer on acceptance and commitment therapy (ACT)?

SCH: ACT is based on the idea that psychological suffering is usually caused by running away from difficult private experiences, by becoming entangled in your own thoughts, and as a result of all of that failing to get your feet moving in accord with your chosen core values. ACT is based on a new and extensive basic research program on language and cognition, relational frame theory (RFT), which explains why pain occurs so readily in people and is so hard to solve. Fortunately it also suggests new, powerful alternatives such as acceptance, mindfulness, values, and committed action.

ACT—and this new book—helps people acquire these new skills. They can be learned fairly quickly, and they seem to apply to an amazingly wide range of human difficulties. We teach clients how to back up from thoughts and the world structured by thought and instead to focus on the process of thinking itself: how to feel feelings as feelings, fully and without needless defense, even when we don’t like them; how to show up in the present moment as a conscious human being; and how to begin to act in accord with chosen values. In short, we teach people how to be more flexible in moving toward what they really want and less automatic, programmed, and self-defeating. Get Out of Your Mind and Into Your Life explains how to do just that.

NHP: You claim these ideas apply to almost every psychological problem people face. Can you talk about some of the problems ACT can be applied to?

SCH: Research is showing that ACT methods are beneficial for a broad range of clients. There is almost nothing you can mention that doesn’t have at least some supportive data on the role of acceptance, mindfulness, and values, or negative data on the impact of avoiding your own experiences and failing to act in accord with your values in that same area. ACT teaches people fairly quickly how to alter their relationship to difficult private experiences and how to get behavior change going NOW, rather than waiting to have difficult emotions or thoughts go away before acting.

This empowering message has been shown to help clients cope with a wide variety of clinical problems, including depression, anxiety, stress, burnout, substance abuse, prejudice, smoking, adjusting to chronic disease, and even psychotic symptoms. In the area of anxiety and panic, avoiding your own negative private experiences is one of the strongest predictors of bad outcomes.

Conversely, we now know from research with a variety of anxiety disorders that when you let go of the struggle with anxiety, you’re on the road to a healthier life. This doesn’t necessarily mean that anxiety will go away—it means that its role in your life will diminish, sometimes quickly. If you think about it, you can see why. Suppose I could tell if you were the tiniest bit anxious. You could not fool me. And suppose I then held a gun to your head and said, “Relax completely or I’ll shoot.”

Almost no one would pass such a test. Yet that is the exact situation a panic disordered person has put himself or herself in. Instead of being shot, what is threatened is loss of self-esteem or loss of the view that a good life is possible, but that is pretty much the same thing—and the outcomes are equally predictable. We have several studies now showing that ACT can be helpful with anxiety problems.

Depression is sometimes spoken of as a feeling, but it’s more than that. It’s also an agenda: the agenda of not feeling bad. When you are depressed you are less able or willing to feel, and because of that you are less able or willing to act. Here is one way to put it: depression is what you feel when you are not willing to feel something else. ACT undermines that whole game, and instead focuses on what it is that you really, really want in life, while feeling and thinking whatever you feel and think. It turns out that these feelings won’t be just depression, but perhaps anger, fear, sadness, or loss, among others. If depression has to first go away before a person can move forward, you have an unsolvable problem. But when we learn how to just notice our depressive thoughts, and feel our feelings as feelings, deliberately and fully—it turns out that we can begin to live again, right now, even with depressed feelings or depressogenic thoughts.

And when we do that, we start to move. We’re able to contribute to others. To make a difference. That breaks the back of depression. There are three small controlled studies on ACT and depression, and it makes a big difference. This work is still young, but so far it appears that ACT may actually be more effective than the best current psychological treatment for depression. We will know when bigger studies are done. In science that is the key: replication by others.

Chronic pain leads people to spend their lives trying to find a way to get rid of it, but research shows that this approach to pain makes it more central, more dominant, and more disruptive to people’s lives. Meanwhile there is even a bigger tragedy happening than the pain itself—a life is being lost. It turns out that ACT can greatly improve functioning by helping the chronic pain patient focus on his or her own chosen values and, while being aware of the pain when it’s present, begin to live again.

ACT helps the person with chronic pain step back from the chatter that says he or she can’t live until pain goes away, and without arguing back, simply begin to move forward. I personally don’t have chronic pain. But I do have tinnitus—my ears are screaming 24/7. And do you know what the literature says? Any attempt to cope with it is harmful. What you need to do is to let go of it and focus on living. I now sometimes go an entire day without noticing tinnitus even once—but every time I check, wow! Is it noisy! Chronic pain is like that.

We need to learn to live with it. We are not talking about living with it like putting up with it or tolerating it. We are talking about LIVING with it. It appears that ACT can make a difference in chronic pain quickly. In one study with people just starting to become chronic pain patients, four hours of ACT reduced sick- leave due to pain almost to zero levels; in another with patients who have been in pain for over a decade, three weeks of ACT improved their functioning 20 to 40 percent, depending on the area. So we know we can make a difference with chronic pain.

Most addiction seems to be in large part driven by avoidance and cognitive entanglement. When you use, you are trying to feel only good. Drugs are sometimes called a fix. Fixing means repairing what is broken but it also means to hold something in place. Drug and alcohol abusers are trying to hold “feeling good” in place by chemical means. When you abandon that attempt you will sometimes feel good and sometimes feel bad. If you can do that and focus instead on changing your behaviors, you have a way forward.

We now have controlled ACT studies with several kinds of substance abuse including marijuana and heroin, and they show good effects. ACT has an agenda sort of like that serenity prayer from AA: accept what you can’t change, change what you can. In the prayer, clients ask for the wisdom to know the difference—ACT theory specifies that difference. It’s good to change your behavior; it’s harmful to try to change the automatic results of your history. There are now three randomized trials on ACT for smoking and so far it beats the patch, Zyban, and traditional cognitive behavior therapy.

We also know this: Urges to smoke don’t predict whether or not you can quit. Most people are surprised by that, because urges seem important. But what is missing is the context in which these urges occur. What predicts quitting or not quitting is how much you first have to not feel urges before you can stop. Said another way, the task in smoking cessation is to learn to let the urges and emotions and thoughts just wash over you, while doing nothing at all about them other then noticing them as they are … and to do all of that while not reaching for that cigarette. You do that and you are on the way to quitting smoking for good.

ACT is used in several trauma centers nationwide such as the National Center for PTSD in Palo Alto, CA, or the trauma and substance abuse program at the Baltimore, MA, VA hospital. Entire units are organized around ACT. So the providers in this area see value in what we are doing. Both the basic studies on the psychological process that underlies trauma and early treatment studies show the same thing: it’s not pain that predicts trauma. It’s the unwillingness to feel pain that predicts trauma.

This is an important insight for us all in the modern era because the media has made it possible for all of us to be exposed regularly to horror. We see the bombings in Iraq. We all saw those dots that were not dots coming out of the top floors of skyscrapers on 9/11. World wide we are exposed to amazing levels of painful events every day if we just turn on our televisions. 9/11 is just the clearest example. Now, a few years later, we are learning who was traumatized by those events. It was not those most horrified. It was those most unwilling to feel horrified. And no wonder. If you are unwilling to feel what you already did in fact feel, where do you go? How can you run fast enough? Here is the formula: Pain + unwillingness to feel pain = trauma. The implication of this equation is not mere exposure. We know that poorly timed exposure sometimes actually makes folks worse.

What ACT does is give people the skills they need to willingly carry the pain they have and integrate it into a valued life. You need to learn how to back up from your thoughts and see them as they are; to show up in the moment; to commit to your values. That, plus exposure, will move you ahead.

This is a relatively new area for us but there are now already four studies on compulsions or related phenomena such as skin picking, and ACT appears to be working quite well on these so far. Suppose you have the thought, like Howard Hughes in The Aviator, “aphids are dirty and flowers with these bugs will contaminate you.” That weird thought will produce very unpleasant feelings. So the obsessive person undoes the feeling by throwing out the flowers, by washing his hands, or by other rituals. It produces relief, but it also just feeds the compulsion beast, and it comes back bigger than ever.

ACT cuts that vicious cycle. If you have the thought “aphids are dirty and flowers will contaminate you,” you don’t need to argue with it or make it go away. You need to defuse from that thought. Notice it come and go. Watch it like you’d watch a leaf float by. Do nothing about it, except to think it as a thought. And accept the feelings it produces. Feel them the way you would reach out and feel fabric. And then get back to valued living. You do that and you’ve broken the back of an obsessive cycle. It’s amazing to me that we give people so little help in rising to the psychological challenges of chronic disease.

Take diabetes. Every time a diabetic tests for blood glucose, the implications of this chronic disease become present: it’s a disease that can blind you, lead to loss of limbs, or even kill you. That is a psychologically hard thing to do. And the numbers that come back as you test your blood glucose can be very upsetting—they can be high even when you think they should be low. And each high number once again reminds you that you have a disease that can blind you, lead to loss of limbs, or even kill you.

My wife and I just walked through her gestational diabetes, and it was a roller coaster. We both came away amazed at how hard it was and what a burden people who will deal with this their whole lives must be carrying. We have shown in our lab that just three hours of ACT can double the number of diabetics who are in control of their blood glucose three months later. If that continues, we would reduce loss of limb or blindness by more than half—for only a tiny three-hour intervention.

People are so hungry for help, and the “feel goodism” of the culture just is no help at all. If you can help patients learn to carry their fears, watch their scary thoughts, and focus on valued actions, you are giving them the tools they need to manage their illness. It’s not just a problem of information; it’s a problem of psychological flexibility.

The epilepsy data are even more dramatic. In one recent study a nine-hour ACT program plus medication reduced seizures by over 90 percent at a one-year follow up compared to medication alone. Ninety percent! It seems that the combination of acceptance, mindfulness, and values stopped the self-amplifying loop that kept the stress up, quality of life down, and seizures continuing unabated.

The larger message here is that you have to teach people how to step up to the psychological challenge of physical disease. But you don’t do that by helping people win a war with their insides—you do it my helping them step out of that war and focus of what concrete actions they need to take to live the kind of life that want to live.

ACT is showing good results with stress. Stress is not just the negative results of anxiety or worry—it’s also the effect of control being applied where it doesn’t belong. It’s also the effect of getting lost inside our own minds. In one recent study, we showed that just a few hours of ACT reduced stress several months later, and it did it because people learned acceptance and mindfulness skills.

Burnout is just a more specific type of stress-related result, but it seems especially sensitive to cognitive entanglement. In one of our studies the tendency to take negative thoughts about work literally predicted burnout higher than stress itself. So when you have, say, that judgmental thought about your boss, being able just to notice that thought and focus on your work values can mean the difference between quitting and succeeding in that workplace.

It’s beginning to appear that even the most horrifying private experiences fit with this idea. Medications don’t completely remove hallucinations and delusions for most people with a psychosis. Yet in this country very little else is provided to these patients to help them cope with these frightening and disruptive experiences.

This lack of help is terribly inhumane—there is much we can do. If you have ever seen the movie A Beautiful Mind you understand the basics of what we try to teach in an ACT approach. We teach patients to just watch their hallucinations, to notice their own delusional thoughts, to focus on their values, and to keep their overt behaviors going. That package works. In two separate studies it has been shown that just two to five hours of ACT will reduce rehospitalization by 38 to 50 percent over the next four months. Who knows what we will be able to do with more extensive packages.

Prejudice is probably the single most important problem on the planet. The “War on Terrorism” should not just be a war on terrorism—it needs to be a war on intolerance since that is a big part of where terrorism comes from. Whether it’s killing the infidels, or the Catholics, or the Tutsis, it’s all a form of prejudice. But in the modern era, prejudice has enormously powerful tools at its disposal: bombs, chemicals, biological weapons. And we are not yet up to the worst of the list.

Let me ask you this. If there was a big red button in every home on the planet and if an adult pushed it the world would end, how long would the planet last? Not long. But once we have freely available suitcase bombs…and are we not close to that very situation? And how long before we have those bombs. Ten years? Twenty? Well, whatever your answer, that is how long we have to figure this out because that is the day we have a big red button in everyone’s house.

When a terrorist attacks an innocent human being he or she is revealing the end stage of a process of objectifying and dehumanizing others. But to some degree this same process underlies more usual phenomena such as prejudice based on ethnicity or gender or stigma associated with illness or appearance. Most approaches to stigma and prejudice are either educational—in one way or another telling others what to believe and do—or experiential, learning through direct contact with stigmatized groups. Unfortunately the effects of both are weak and unreliable. In one recent study done in a prison, education about racial differences actually increased racial conflict.

And these methods are not mindful of the issues we have been talking about. If you try to suppress a prejudiced thought you will increase its strength and psychological impact, not decrease it. We need another way forward. Yet we all have prejudiced programming—ethnic and gender biased jokes, for example. Even if our values are not racist or sexist, our minds sometimes are. It doesn’t matter your race or gender; we’re all swimming in this stream.

ACT shows another way forward. We have found that acceptance of prejudicial thoughts (as thoughts) and learning to just notice them mindfully while connecting with our values will increase people’s willingness to engage in non-prejudiced behaviors. We have shown it with prejudice toward substance abusers in recovery, ethnic prejudice, bias toward the mentally ill, and bias against science-based treatments. We will see how far it can go.

Shame and prejudice are really the same thing; one is just inwardly focused. Buying into “I’m bad” is really not different from buying into “you’re bad.” And it turns out that the same methods that help with prejudice and stigma also help with shame and self-stigma. ACT can help people increase job performance, too. Have you ever worked with someone who comes up with excuses anytime he or she needs to learn something new—a new telephone system, a new budgeting process, and so forth?

We’re learning that the same experiential avoidance process that ACT targets is part of this resistance. It’s obvious if you think about it. How did you feel when you first started to learn to dance, when you first skied, when you first put on ice skates, and so forth? Didn’t you feel a bit foolish and awkward? If you can’t allow that, how can you learn? We’ve found that our measures of experiential avoidance can predict what office workers will do at work: Our short questionnaires correlate with keystroke errors a year later because people who are high avoiders don’t learn the software well.

Why? Because they’re never willing to feel stupid or uncomfortable. ACT has been shown to undermine this avoidance, and as a result people are more willing and able to learn. In one recent study we showed that workers who had just been through an ACT workshop were then more willing and able to learn things that had nothing to do with ACT (in this study it was therapists learning to using certain medications in their work). And therapists were using these new methods more at a three-month follow up.

NHP: Some of this work is said to have come from your own battles with anxiety and panic. How did these ideas apply to your own struggles?

SCH: I had a panic disorder. At the height of it, my life shrank until I could not travel, get on an elevator, drive, go to a movie, get on a plane, or even talk on the phone without a tremendous struggle. It was clear to me that I had a choice: I could either lose my life as I knew it or I could learn to step forward into my fear. I went back into my behavioral training, my science training, my eastern training, my human potential training. ACT in some ways is my personal journey—it’s how I faced anxiety. But it’s not just me. Other major ACT researchers and writers are chronic depressives, heroin addicts, or social phobics, and they have poured these experiences into the work. That’s not by accident. When life has beaten you up, the uncommon sense in ACT begins to have appeal.

Sometimes people are just by their nature ready for this approach even when they’re young, but most of us start out thinking we can win the war with our minds and our history. And you might even get away with that view if nothing bad ever happens. When it does, though, you need to take a different path. When futility sets in you have a chance to do something new. I began to learn how to abandon the war with my mind and history.

I personally do ACT everyday. I do acceptance, defusion, mindfulness, and values work continuously. I know right now I might have anxiety attack. It’s been ten years since the last, but I know I can’t control that. It’s not up to me—it’s up to my history and my current situation. But what I can control and what only I can control is whether I will back up from my own experience. My pledge to myself is that I will stand with myself, regardless. If that means I get so anxious I can’t talk, right here, right now, that will be a problem—but if I stay true to my commitment, it will be your problem, not mine.

NHP: A lot of what you’re describing sounds Buddhist-inspired. How does ACT differ from Buddhism, both in theory and in the practice it requires?

SCH: Buddhism has a lot of wisdom in it, as do all of the major spiritual and religious traditions, but it emerged from pre-scientific times. Some of its specific ideas show that lineage; some of its methods require weeks, months, and years to work. ACT is in the same general psychological space, but it’s driven by a scientific theory, and its methods are designed to be quicker and more focused. I find it very encouraging that the two overlap because ACT did not come from Buddhism or any specific religious or spiritual tradition. It came from modern contextual psychology. If things from very different starting points overlap in their end points, to my mind this increases the chance that they’re both on to something.

NHP: How does ACT differentiate between pain and suffering?

SCH: Pain is just pain. We all have it—all the time if you just look. For example, we all know we will die. There is some pain in that knowledge, and you can contact that knowledge anytime, anywhere. But that alone is not suffering. If you add in unwillingness to feel pain, entanglement with your thoughts about pain, and loss of your valued actions—now you’ve amplified pain into suffering. I’ve seen that exact thing happen with thoughts about death, for example. But YOU did it. The pain didn’t do it. You see this in area after area: Anxiety + unwillingness to feel anxiety and keep moving in a valued direction = panic. Sadness, loss, anxiety, or anger + unwillingness to feel sadness, loss, anxiety, or anger while moving in a valued direction = depression. Pain + unwillingness to feel pain = trauma.

NHP: You’re a language researcher and chapter two of Get Out of Your Mind and Into Your Life is called “Why Language Leads to Suffering.” Can you tell us why you suggest that language is a source of human suffering?

SCH: We’ve learned four important things in our research. Human language and cognition is bidirectional, arbitrary, historical, and controlled by a functional context. Because language is bidirectional, words pull the events they’re related to into the present. Anywhere you go you can remember painful things. Just think of them. That is totally new on the planet, so far as we know. No other creature seems to do it. So it means we have orders of magnitude more pain than other creatures. And it’s arbitrary—what we relate isn’t dictated by form. Kick a dog and he’ll yelp—it’s dictated by form.

Show a person a beautiful sunset who has just had someone very near and dear die and that person may cry, wishing the lost loved one could be here to see it. The crying is not dictated by form—even beauty can create sadness. That means we can’t solve our problem with pain situationally. But because language is historical, we can’t win by changing the content of our cognitions. A person who thinks “I’m bad” and who then changes it to “I’m good” is now a person who thinks “I’m bad, no I’m good.” Where you start from is never fully erased—because you are a historical creature. Your mind is psychological, not logical. We make all of this so much worse by deliberate attempts to get rid of our history and its echoes—the automatic thoughts and feelings that emerge from our past. Because we’re historical creatures, these efforts elaborate whatever we’re trying to get rid of. Because human cognition is bidirectional, it mocks our attempts to change thoughts and feelings.

For example, suppose we need to get rid of anxiety because if we don’t bad things will happen. Anxiety is the natural response to bad things … so our efforts will tend to evoke anxiety, defeating our purpose. Fortunately, our work on cognition shows that the events that cause us to relate one thing to another are different than the events that give these relations functional properties. We take advantage of that in ACT. We change the functions of thoughts and feelings, not their form, and that makes all the difference.

NHP: You also say that research suggests many of the tools we use to solve problems lead us into the traps that create suffering. What does this mean?

SCH: Here’s how we solve problems: We use verbal processes to enable categories, time, and evaluation. “If I did that then this would happen, which would be good.” Notice all three are there: the categories and names of things and their features; time and contingency (if … then); and evaluation (this is better than that). This is great for problem solving. We see an imaginary future and evaluate it—all through the use of arbitrary symbols. It’s because of this ability that we took over the planet. Yet this alone is plenty enough to create psychological problems. “If I go to the mall, I will feel anxious, which is really bad.” Same processes: categories, time, and evaluation. “If my lover leaves me I won’t be able to function.” Same thing. “If I kill myself I will stop hurting.” Same thing. This is why you can’t weed out the processes that cause suffering—these same processes are at the root of our achievements as a species.

We need to learn how to use these processes when they’re helpful and let them lie dormant when they’re not. It’s very hard to do—like the delusions that follow Russell Crowe in the movie A Beautiful Mind— most of our most difficult experiences are there night and day begging us to taken them literally. But once we do we are lost. It’s hard to learn how to do nothing even when it’s only nothing that will do. Humans are terrible at that. We are terrible at letting go.

NHP: One of the premises of ACT is that avoidance of difficult emotions leads to suffering, which is highly counterintuitive. First, why do you say this and second, what do you say to someone who says that avoidance of pain is ingrained and automatic?

SCH: Let me take the last part first. The avoidance of pain is indeed ingrained and automatic. That is the point. So, sure, it’s absolutely normal to needlessly avoid pain. And there is nothing wrong with avoiding many forms of situational pain. There is no need to put your hand on a hot stove, for example. But historical pain is something else. If you have a painful memory, you’ll always have it and avoiding it will only distort your life because memories don’t go away. If you have a thought you don’t like, trying to make it go away is like trying not to think of a piece of chocolate cake … in the effort deliberately not to think it, you just did.

Here is why avoiding that kind of pain is problematic: First, the painful event doesn’t truly go away, it’s just avoided, and the next time it’s contacted it’s bigger and stronger and even more likely to control behavior. Second, it makes us attend all the more to this very pain. Like a noise in the background, as soon as it’s important that it go away, it’s now in the foreground and far, far worse that it was only moments before. Third, the very basis of avoiding painful thoughts or feelings is that the reaction is really bad—but that means that as we deliberately try to avoid things, we’re building them into more and more powerful events because we start this process with the embraced belief that they truly are dangerous.

We literally make our nightmares come true because the real damage is done the moment we take them literally. At that point they transform themselves from mere historical events—mere processes of the mind worth noting—into things that can control our lives. After all if they’re controlling efforts at avoidance they’re already controlling our lives.

NHP: You talk a lot about values in your book, and the “commitment” in acceptance and commitment therapy refers to making a commitment to living a values-based life. What does it mean to live a values-based life and how does it help reduce suffering?

SCH: Values are like directions on a compass. They’re never achieved, but in each and every step they influence the quality of the journey. Values dignify and make more coherent our life course—and they put pain in a proper context. It’s now about something. Let me go back to that movie A Beautiful Mind. It’s only when the hero has to decide between what he values and entanglement with insanity that it’s possible and sensible to accept the delusions; to notice them; and to abandon trying to control them—all in the service of being a husband, father, and a mathematician.

In the same way, we only put down our avoidance, addictions, and mental wars because it’s costing us something dear, whatever it is that we want our lives to be about. Without that cost we would be lost. It’s amazing how often people have never really thought about what they want in their lives. They’ve been fighting a mental war, waiting for life to start, and have never really asked or answered the question of what kind of a life they’re waiting to live.

The joyful vision of ACT is that you can start living that very life NOW, with your thoughts, feelings, memories, and sensations. You start that journey by asking what it is that you really want your life to be about. That is the point on the compass.

NHP: What kinds of techniques do you try to teach in ACT? Can you walk us through an ACT exercise?

SCH: Okay. First think of a painful thought, a self-critical thought, one of those nagging deep down familiar bits of negativity. Do you have one? ACT has scores of techniques that are designed to help you catch the word machine in flight rather than getting caught up in the world seemingly structured by it. These “defusion” techniques help us notice the process of thinking, not just their products.

So let’s try a few with that very thought. I’ll do them in rapid fire, but in the book we present all of this in more detail, and you can take the time you need to explore them properly.

First say that thought very fast over and over again, feeling your mouth as you say it and noticing how odd it sounds when said fast. Now say it slowly, one word on the inbreath and the next on the outbreath until it’s all said. Now sing the thought out loud. Be careful not to ridicule, satirize, or criticize your thoughts. Rather just notice as you sing that these are thoughts. Now say them in the voice of a politician from the opposite political party as you. Be careful not to ridicule, satirize, or criticize your thoughts. Rather just notice as you hear these words that these words are thoughts. You don’t have to do anything about them. Just thank your mind for the thought and notice what shows up.

These are four of literally hundreds of techniques ACT therapists have developed to liberate humans from the grip of their own cognition and emotion—but all without making the cognition or emotion go away. Once you’re on to it, you can come up with your own methods. In this new book we actually walk readers through that process. Once you see the model and its purpose it’s not hard. You can literally create your own methods to get out of your mind and into your life. So the book is not a new belief system. It’s a new context for living with that word machine we call our minds, without turning our lives over to it.

Joel Guarna January 15, 2006 - 7:44pm

Salon.com Interview with Steven Hayes (February, 2006)

Below you will find a link to the Salon.com interview with Steve.

https://www.salon.com/2006/02/25/happiness_4/

More likely, you will need to go to http://www.salon.com and search for "Steven Hayes" -- the first article should be this one.

admin February 21, 2020 - 2:22pm

Sunday Telegraph in the UK: Human Pain and Human Vitality (March, 2006)

Here is a column that appeared in the March 5, 2006 Sunday Telegraph Human Pain and Human Vitality Nearly 30 years ago I had my first panic attack. A productive and reasonably successful young academic, I soon found myself struggling to give a lecture, to speak on the phone, or to ride in an elevator. From the outside I appeared calm – but on the inside I felt I was dying. Literally. Sitting still on a park bench my heart beat 165 times a minute as I fought a battle, not with a physical challenge requiring such blood flow, but with the word machine between my ears. Some of my experiences at the height of this struggle now seem so alien that it is only with difficulty that I can imagine the mindset that produced them. I’ll share one, knowing for many it may simply seem incomprehensible. An airline attendant stood at the front of a plane and described how to use the passenger seatbelts. I watched with a sense of amazement and incredulity, as one might gaze at an impossibly athletic feat during the Olympics. I remember thinking “how can she do that without being terrified?! She has to say all of those specific words, and they have to be right, and do it in front of a plane full of people!” Each of us compares our insides to others’ outsides, and our picture of the human condition is ever distorted as a result. That difference makes it believable that it is our birthright to be psychologically healthy, happy, and carefree – and that feeling good is the measure of a life well lived. Commercial interests are only too pleased to feed this vision, assuring us that we will approach it readily through the right car, home, or vacation. The pharmaceutical industry will provide the right pill; the media the latest “feel good” therapy; and the local bar both the ideal beer, and the setting to find the right romantic partner. It is seemingly only the abnormal person who suffers. The outsides of others provide superficial evidence of the validity of this vision. But what if everyone has a secret? And what if the joke is that we all have the same one? The fact is that almost all people are in pain somewhere in their lives much of the time. It is hard to be fully human. Almost all will struggle and suffer, and find that easy methods of feeling good bear little relationship to living a meaningful, valued, vital life. Anyone who reads the popular media, never mind the voluminous scientific literature on this topic, probably realizes that human problems are pervasive in the developed world. Few, however, seem to face the implications of such statistics considered as a whole. Over 30% of the population will have a psychiatric disorder sometime in their lives. Nearly 50% will struggle with thoughts of suicide for two weeks or more. Divorce rates reach similar levels; second marriages are no better; and the relationships that remain are often restricted or empty. If we add in the rates of emotional or physical abuse, sexual concerns, loneliness, burnout, problems with children, or 100 other such problems we need to consider the possibility that it is human pain is that is nearly universal. In effect it is abnormal to be “normal.” The treacle of modern “feel goodism” is simply false. That was my starting point, 25 years ago. Unable to control my anxiety, and sinking ever deeper into panic disorder as I tried to do so, I began to explore what it would be like to approach what I was struggling so mightily to avoid. I began to research whether it was the emotional and cognitive objects of my struggle that were my enemy, or struggle itself. We now know that one of the most pathological things a human being can do is to attempt to avoid their own thoughts and feelings, and to link their overt actions to this attempt. Researchers such as Frank Bond (University of London) have discovered that the psychological inflexibility that results from this effort produces bad outcomes almost everywhere you look. It predicts more anxiety, depression, worry, and trauma. It undermines your ability to learn new things, enjoy your job, be intimate with others, or rise to the challenges of physical disease. Lance McCracken (University of Bath) has shown that these processes predict far more disability due to chronic pain than the amount of pain or injury itself. Turned outward, the human mind is highly effective. We can predict the future and remember the past; we can evaluate outcomes based on imagined courses of action. It is these symbolic problem-solving abilities that have lead us to dominate the planet, despite being weak, slow, and vulnerable. But these same abilities also entangle us needlessly in a struggle with our own thoughts and feelings. If we don’t like dirt on the floor we can vacuum it up and the dirt will be gone. Conversely, if we don’t like a painful memory and try not to think it –we will make it more of a focus, more frequent, and more impactful. If we fear a future lack of food we can grow plants that will later nourish us. But if we fear the harm produced by future panic and thus try to avoid it, we will have brought that imagined harm into the present and amplified its role in our lives. The human mind has in effect been turned on its owner, merely by allowing it to do what it normally does, but in the wrong domains. It turns out that this is not necessary. We have developed methods to train people in a healthy alternative: accept feelings and be mindful of thoughts without arguing, coming instead into the present moment more consciously and fully, focusing on values and taking actions that move in their direction. For example, if the thought “I’m bad” is present, trying to change it only confirms that there is something unacceptable about you. In our approach we might instead say “bad” 100 times aloud, or sing the thought, or print it on a T-shirt and wear it, or say it in the voice of one’s least favored politician. Like the movie A Beautiful Mind, this defanged thought is then willingly brought along into valued actions, such as being a loving person, or contributing to others. Controlled research shows this these methods are helpful in areas as diverse as anxiety, burnout, diabetes management, smoking, pain, and depression among several others. I walk through these concepts and techniques in Get Out of Your Mind and Into Your Life (New Harbinger; 2005) which was the number one self-help book last week in the United States on Amazon. The basic and applied psychological science behind these methods will be presented for students, therapists, and researchers at a week-long “world conference” July 22-28 at the University of London (see www.contextualscience.org). For the first time in human history, we are trying to raise an entire generation on the message that feeling good equals living well. It is not true. It has never been true. And now we are seeing the sad results in our homes and on our streets. Our task as human beings is to learn how to carry pain without needlessly amplifying it into suffering, while creating a values-based life. Steven C. Hayes University of Nevada, Reno

Steven Hayes March 6, 2006 - 6:05pm

Time Magazine: Happiness is Not Normal (2006)

John Cloud wrote this article for Time magazine in February 2006, in which he described the contrast between 'third wave' approaches (specifically Acceptance and Commitment Therapy) and more traditional cognitive behavioral therapies.

For more information, see attached. Please note: You must be logged in as an ACBS member in order to view the content below.

For more discussions about the Time Magazine article, click here.

Joel Guarna September 23, 2009 - 10:48am

The Time Magazine story (2006)

There are a number of popular stories on ACT / RFT that have appeared. You can find the ACT ones in "About ACT / Communicating about ACT / Popular Media" but given the prominence of Time Magazine this one is listed here. The article in Time (Cloud, 2006) came out in the February 13, 2006 issue. It was pretty long -- 6 pages -- and dealt with ACT in some depth. It sent Get Out of Your Mind and Into Your Life into the top 25 books (and number 1 self-help book) on Amazon for nearly a month and is still reverberating in the form of stories in the popular media in various other outlets.

Some of the issues raised by the Time story are discussed in the child pages attached to this page.

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Happiness Isn't Normal
by John Cloud
February 13, 2006

Before he was an accomplished psychologist, Steven Hayes was a mental patient. His first panic attack came on suddenly, in 1978, as he sat in a psychology-department meeting at the University of North Carolina at Greensboro, where he was an assistant professor. The meeting had turned into one of those icy personal and philosophical debates common on campuses, but when Hayes tried to make a point, he couldn't speak. As everyone turned to him, his mouth could only open and close wordlessly, as though it were a broken toy. His heart raced, and he thought he might be having a heart attack. He was 29....

Steven Hayes February 8, 2008 - 2:13pm

Is ACT a Cult? Is ACT Just a Fad?

These thoughts are in bullet point form from a power point presentation by James Herbert at Drexel University.

He gave this talk at the ACT Summer Institute at La Salle University in summer of 2005.
I've (SCH) tweaked it to make it more readable and understandable in this form.

Is ACT Just a Fad or a Cult? Addressing the Critics
James D. Herbert, Ph.D.
Drexel University

As ACT has moved into the mainstream, a variety of criticisms have emerged from within the academic community.

As ACT becomes more popular, we can anticipate even more criticism from even more voices. The common theme is that
ACT is merely the latest therapeutic fad to litter the mental health landscape.

The purpose of these points is to outline the criticisms so far, examine them critically and honestly, and explore how we as a community may respond.

There are a number of complaints about ACT. These include the following:

Overly-hyped claims
“Getting ahead of the data”
Excessive enthusiasm among those interested
ACT is a cult
ACT has excessive and grandiose visions
Proselytizing
ACT as a “way of life"
Promotes “undue influence” by seeking to identify principles and technologies that could be used to impact behavior without their explicit consent
Experiential exercises in ACT training are coercive and manipulative
There’s “nothing really new” here
Premature dissemination to the public via self-help books
Both ACT and especially RFT are plagued by obscurantist jargon

Let’s look at each of these in turn.

Getting Ahead of the Data

In order to evaluate this we must examine the evidential warrant of specific claims

Some critics have tried to say that the ACT community is making excessive claims based on the ratio of theoretical to empirical papers. But this means that mere interest would indicate excess. That is not fair. The ratio isn’t a proxy. Nor are dreams/visions

Some critics are clearly unaware of the data that exist (e.g., see Hayes, Luoma, Bond, Masuda, & Lillis, 2006); those who are correctly note that it’s limited, but don’t generally compare specific claims with evidence, or consider the research strategy being pursued.

In fact it seems that ACT proponents have in fact been appropriately cautious in claims

Our response: Continue to be clear about specific claims and back claims with evidence

Excessive Enthusiasm

This seems to be largely based on reactions to the listserv, and to reactions of some professors to their students returning inspired from workshops. But enthusiasm per se is only a problem if it interferes with critical thinking. Is there any evidence of this? If so, let's look at it, but so far the concerns do not seem to be linked to such interference.

Our response: Make sure not to be blinded by enthusiasm.

The “C” word: Is ACT a Cult?

“Cult” label usually evoked by:

A closed system
A charismatic leader, or if there is more than one, a very small group of such leaders hand picked by the main leader
A strong profit motive
Financial and/or sexual exploitation of vulnerable populations
A hierarchy of secretive levels to pass through in order to gain special knowledge or status
Intolerance of dissent

Such groups also:

Challenge the status quo
Offer a grand vision
Engender high levels of enthusiasm

So is ACT a Cult?

The first set of features don’t apply. This website is an example; the list serve is an example. Anyone can participate and argue and have their say. But the second set of features clearly do apply. However, these latter features are poor discriminators of science vs. pseudoscience or cults.

Our response: This is silly; ignore it -- but also make sure that we maintain an open, horizontal, self-critical, empirical culture.

Grandiose Visions

Rightly or wrongly, ACT does indeed aspire to great things. Helps to understand history of behavioral analysis to appreciate the historical context. Behavior analysis always had a utopian vision (e.g., Walden II). It is critical to distinguish specific claims from distal goals and dreams; the former are subject to direct examination via evidential warrant; the latter are not.

Problem is that mainstream psychotherapies are cautious about big claims, whereas many dubious ones are not. So unless people look carefully, ACT can look too expansive.

Our response: Clarify explicitly the distinction between specific claims and distal visions.

Proselytizing ACT as a “Way of Life”

There are two variations of this: Clinicians must adopt an ACT perspective to their own life, and the focus of the client’s presenting problem is inappropriately shifted to ACT-consistent goals. Although ACT does suggest that clinicians try out some principles on themselves, it doesn’t require them to adopt any particular belief system.

Regarding clients, this is not unique to ACT, as all psychotherapies attempt to socialize the client to their model. The key in all cases is informed consent.

Our response: We could probably be clearer on these points, and we need to be cautious about things an individual clinical may do in applying ACT to her or her life and things that are said to be "necessary" in the absence of data. Individuals are free to explore -- claims can only be made based of scientific criteria.

ACT Seeks “Undue Influence” Over Others

This is a very familiar criticism to radical behaviorists. There are ethical issues surrounding parameters of informed consent that are an important cultural values. Like all values, must be decided independent of science per se. An extreme Libertarian stance rules out all public health interventions (e.g., programs promoting smoking cessation, safe sex to prevent STDs, routine diagnostic procedures like mammograms and prostate exams, childhood vaccinations). The fact that a technology could possibly be misused is no reason to stifle science.

Our response: Participate in the broader public ethical dialogue.

ACT Offers “Nothing New”

This is generally argued by those with minimal familiarity with ACT. Ironically, traditional CBT folks sometimes who make this argument have themselves been on the receiving end of this allegation from psychoanalysts and others. Many (though not all) techniques and strategies are indeed openly borrowed, and so aren’t new. What is new is the organizing model, and especially the close link with theory, a basic research program, and philosophy.

Our response: Point this out when challenged. Help others learn RFT, behavior analysis, and functional contextualism, and to see how this informs treatment development.

Experiential Exercises in Training Are Coercive and Manipulative

Experiential exercises are used in ACT to highlight consciously self-reflective nature of ACT. But we must remember the audience, and be very careful to avoid coercion, even implicitly. Degree of focus on experiential exercises remains an unresolved issue empirically.

Our response: Examine this issue openly within the community, ethically and empirically. Until this is worked out, be mindful of the issues, open to the concerns, and cautious.

Self-Help Books

There is a legitimate debate over appropriate threshold for direct dissemination via popular literature. On the one extreme some say you must have strongly supportive data, not only of general approach, but its effectiveness in the self-help format and for the specific problem in question. A growing number of ACT self-help books are being studied in randomized and open trials for effectiveness (as of 2011, we know of trials assessing Get Out of Your Mind, The Mindfulness and Acceptance Workbook for Anxiety, and Living Beyond Your Pain). Even outside of ACT, only a tiny number of books have that. At the other extreme: Anything goes. Reasonable people can disagree about this, but it is in no way unique to ACT.

Our response: Encourage authors to be appropriately cautious, while participating in the broader dialogue - and continuing assessing self-help book efficacy.

Obscurantist Jargon

Some critics see too many new terms in ACT and RFT, and reject them before learning these terms. The problem is that one person’s obscurantist jargon is another’s technical vocabulary. All other areas of natural science have technical languages. To evaluate jargon, must look at things like theoretical coherence, precision, scope, and connectivity. The ACT / RFT community has largely done this so far.

Our response: Develop the language as necessary, but be mindful of Occam’s razor. Distinguish scientific talk from clinical talk. Be prepared to defend the use of a technical term by showing that no existing term would do.

The Bottom Line

These criticisms fall into four camps. Those base on: Ignorance; style; a challenge to the status quo; and substantive issues. It is critical to distinguish these, as each calls for different responses.

Criticisms Based on Ignorance

Educate (e.g., journals, workshops, books, presentations), with a sensitivity to the audience

Criticisms Based on Style

Attempt to understand the reaction, and decide how to respond. We are not obligated to address every stylistic criticism. But we should be mindful of our audience and our purpose. Remind others that this tradition is not about individuals but a scientific model. If person X has the wrong style, focus on the message, not the messenger and evaluate the evidence.

Criticisms Based on Challenges to the Status Quo

Continue to do good science, including modifying theories and technologies based on data. Science is inherently self-correcting, so if ACT lives up to its promise it will eventually win hearts and minds. But be wary of striking the pose of Galileo; it isn’t enough to be novel – we must also be “right” in the sense of useful as considered against the goals of "prediction and influence with precision, scope, and depth"

Substantive Criticisms

Carefully consider substantive criticisms, especially those challenging the evidential warrant of specific claims and specific theoretical issues. Then, offer a thoughtful response, and remain open to change when appropriate based on arguments and data.

Steven Hayes February 8, 2006 - 3:52pm

Steve's reactions to the Time article

The author did a terrific job, in my view. He starts out with a sentence that has me as a mental patient and finishes with a paragraph that says for ACT to go mainstream it will have to shed "its icky zealotry and grandiose predictions" but in between is a pretty serious effort to understand and explain.

I want to acknowledge John Cloud publicly. If every reporter treats this work as carefully and fairly we will be blessed. He is an honorable guy who worked really hard over several months to get it right.

The first thing John said was "I'm doing the RFT tutorial. I'm half way through it." I paused and replied "OK. If you are doing that, I'm there. If you are that serious I will answer every question and spend every ounce of energy needed to help you do your work." And I did. I was an open book (as you can see!). Some of what is in that story my mother did not know. But he earned that.

Of course, he is a writer, and writers need angles. The angle he chose was almost mythological: wild eyed rebel vs. the establishment. Even the photos fit that theme (me in a motorcycle jacket; in a tree fort; etc). So some of the basic science, the grants etc were deemphasized and things like bad clothes or weird rings were emphasized.

But, hey, in the grand scheme of things ACT is more outside than inside, so it was not a functional distortion to omit some things like that.

I apologize for the focus on me. That was not of my doing: John came to ABCT, interviewed Tim Beck, David Barlow, Judith Beck and many others. He went and saw talks by Kelly, Kirk, and many others. He then wrote the story as he chose. I suppose he felt that he needed to get people to care about the issue enough to read a very long story ... and he did that by putting my own struggles at center stage.

Mostly all other names in the ACT / RFT universe are not in the story. I did try repeatedly to push the names of researchers or co-authors (as John will attest!) but reporters just make their own calls on such things. And I wish he'd mentioned behavior analysis at least once (I begged!). But RFT is there by name; and some of the science is there. He does mention in a general way the students and the researchers and clinicians around the world. And the World Conference is mentioned! Woo Hoo. And the website is there ... which may be why you are reading this.

I am so thankful that there were no "anti" quotes from the ACT side about anyone. The story shows us (well, at least me) as a bit goofy, but not negative toward others. We took a few shots ... but that is to be expected I suppose.

Is this story premature? Maybe, but the culture decides on such things, and through accident and interest, here we are.

On the issue of grandiosity

No predictions are in there that are grandiose. What is in there is the willingness to see that the culture needs so much more from behavioral science than it is providing. I did say "Our survival really is at stake." That is so. Can anyone looking at the "war on terrorism" not realize that soldiers alone cannot do it? But that does not mean I think we can solve the problem. I did not say that and that is not in the quote. I just think we have to try. We have to try to solve the problem of hatred. We have to find a way to help people learn to love themselves and others, and to act in accord with their deepest values. And I do think we may have a possible path forward inside this work -- let's see. Together, let's see. That is a grand vision maybe ... but I'm not the only one dreaming. Who knows about outcome ... can we begin the process?

On the cult deal ... look for the other page and James Herbert's great talk on that given at the ACT Summer Institute.

My bottom line

In the long run what will matter is the substance: the science and the human value of the work we do. We will need every ounce of community and shared values and purpose we've gathered to do our work together as it becomes more visible and as the resulting centrifugal forces gather. The reason this work is being noticed is because of a community that cares. It is not a cult. There is no forced agreement. Look at this site! Anyone can post anything; and to be a member you just join. How much more open can a group be? I know of no other scientific group that is developing as an open community like this. How can a shared, open, self-critical community be a cult! It is just a fear word.

To the critics who say it, I say, join the group and post your views. You will find reason, support, and compassion here, not hierarchy.

So let's keep our eye on the horizon and remember why we got into this work in the first place. It was not about attention in magazines, nice though that might be. Unlike the fear expressed from by others outside of this community, it does not run on artificial agreement or hierarchy -- we need each of us to bring ourselves forward and to create something of value together. As individuals. Together.

Despite the worries, it seems clear we are entering into the conversation in a new way. That is an opportunity. It is also a burden. It will cut in multiple ways.

Could I also say on a personal level that I appreciate the support I've received in this process from many of you who have known it was going on. The letters and emails I am now getting from people who are suffering are enough to make me weep ... as my students have seen. Let's remember them. This work is about them.

Steven Hayes February 8, 2006 - 2:17pm

Reacciones de Steve sobre la entrevista en la revista Time (traducción al español)

El autor hizo un trabajo excelente, en mi opinión. Comienza con una oración acerca de mí como paciente y termina con un párrafo que dice que para que ACT se haga popular tendrá que sacudirse su “fanatismo y predicciones grandiosas”, pero entre esas dos afirmaciones hay un serio esfuerzo por entender y explicar.

Quiero reconocer a John Cloud públicamente. Si cada reportero tratase su trabajo tan cuidadosamente y equitativamente podríamos sentirnos afortunados. Es una persona honorable y ha trabajado realmente duro durante varios meses para entenderlo bien.
La primera cosa que John dijo fue “estoy haciendo el tutorial de RFT. Voy por la mitad”. Yo me detuve y contesté “Ok, si estás haciendo eso, estoy aquí. Si estás tan comprometido voy a contestar cada pregunta y dedicar cada gramo de energía que sea necesario para ayudarte a hacer tu trabajo”. Y lo hice. Fui un libro abierto (como se puede ver!). Algo de lo que apareció en esa historia no lo sabía ni mi madre. Pero él se lo ganó.

Por supuesto, es un escritor, y los escritores necesitan ángulos. El ángulo que él eligio fue casi mitológico: rebeldes vs el orden establecido. Incluso las fotos encajan en ese tema (yo con una campera de motociclista, en un casa en un árbol). De manera que las partes de ciencia básica, las becas de investigación fueron minimizadas y cosas tales como la vestimenta o los anillos raros fueron enfatizadas.

Pero, ey, en el panorama general de las cosas ACT está más afuera que adentro, de manera que no fue una distorsión funcional el omitir esas cosas.

Me disculpo por el foco en mí. No fue obra mía: John fue a la ABCT, entrevistó a Tim Beck, David Barlow, Judith Beck y muchos otros. Y luego fue a ver charlas de Kelly [Wilson ], Kirk [Strosahl], y muchos otros. Y luego escribió la historia en la manera en que quiso. Supongo qu esintió que necesitaba que la gente se interesara en el tema lo suficiente como para leer una historia muy larga… e hizo eso poniendo mis propias luchas en primer plano.

La mayoría de los otros nombres en el universo ACT/RFT no están en la historia. Repetidamente intenté introducir los nombres de investigadores y coautores (y John puede dar fe de eso!), pero los periodistas toman sus propias decisiones al respecto. Y desearía que hubiese mencionado el análisis conductual al menos una vez (se lo rogué!). Pero RFT está mencionado; y parte de la ciencia está ahí. Menciona de manera general a los estudiantes, investigadores y clínicos que están por todo el mundo. Y se mencionan las Conferencias Mundiales! Woo hoo! Y el sitio web está ahí… lo que quizá sea el motivo de que estés leyendo esto ahora.

Estoy muy agradecido de que no hubiera citas “anti-“ del lado de ACT acerca de nadie. La historia nos muestra (bueno, me muestra a mí), como un poco torpes, pero no negativos hacia los otros. Recibimos algunos golpes…pero eso es esperable, supongo.

La historia fue prematura? Quizá, pero la cultura decide sobre esas cosas, y a través de accidentes e intereses, aquí estamos.

Acerca del tema de la grandiosidad.

No hay ninguna predicción nuestra que sea grandiosa. Lo que hay allí es la disposición a ver que la cultura necesita mucho más de la ciencia conductual que lo que se está proporcionando. Dije “nuestra supervivencia está en juego”. Esto es así. Puede alguien que esté viendo la “guerra contra el terrorismo” no darse cuenta que los soldados en sí no bastan? Pero esto no significa que crea que podemos resolver el problema. No dije eso y no está en la cita. Sólo creo que debemos intentarlo. Tenemos que intentar resolver el problema del odio. Tenemos que encontrar una manera de ayudar a que las personas aprendan a amarse a sí mismas y a los otros, y actuar de acuerdo con sus valores más profundos. Y creo que quizá tengamos un camino posible dentro de este trabajo –veamos si es así. Juntos, veamos si es así. Es quizá una gran visión… pero no soy el único que sueña. Quién sabe cuál será el resultado?... pero podemos empezar el proceso?
Respecto a lo del culto… busquen la otra página del sitio web y la charla de James Herbert en el ACT Summer Institute.

Mi línea final.

A largo plazo lo que importará es la sustancia: la ciencia y el valor humano del trabajo que hacemos. Necesitamos cada gramo de la comunidad, los valores compartidos y el propósito que hemos reunido para hacer nuestro trabajo juntos a medida que se vuelve más visible y como resultado de las fuerzas centrífugas que se van generando. La razón por la cual este trabajo está siendo notado es porque hay una comunidad que se interesa. No es un culto. No hay un acuerdo forzado. Vean el sitio web! Cualquiera puede postear cualquier cosa, y para ser un miembro sólo debes unirte. Cuánto más abierto puede ser un grupo? No conozco ningún otro grupo científico que se haya desarrollado como una comunidad abierta, tal como este. Como puede ser un culto una comunidad compartida, abierta y autocrítica? Sólo es una palabra temida.

A los críticos que dicen eso, les digo: unanse al grupo y publiquen sus opiniones. Encontrarán razón, apoyo y compasión allí, no jerarquías.

De manera que mantengamos nuestros ojos en el horizonte y recordemos por qué empezamos con esto. No fue para obtener la atención de las revistas, halagador como pueda ser eso. A diferencia del temor que albergan algunos fuera de la comunidad, ésta no se rige por acuerdos artificiales o jerarquías –necesitamos a cada uno de nosotros para avanzar y crear algo que valoremos entre todos. Como individuos. Juntos.

A pesar de las preocupaciones, parece claro que estamos entrando en la conversación de una nueva manera. Esto es una oportunidad. También es una carga. Repercutirá de múltiples maneras.

Podría agregar a título personal que aprecio el apoyo que he recibido en este proceso de parte de muchos de ustedes que sabían lo que estaba pasando. Las cartas y los emails que estoy recibiendo de personas que sufren son suficientes para hacerme sollozar… como han visto mis estudiantes.

Recordémoslos. Este trabajo es para ellos.

Fabian Maero December 9, 2012 - 11:52pm

The Epilepsy study

The epilepsy study mentioned in the article is this one: Evaluation of Acceptance and Commitment Therapy (ACT) for refractory epilepsy: A randomized control trial in South Africa The positive effects of psychological methods have long been known, but the research has hardly made an impact on the treatment of epilepsy. The purpose of this study was to develop and evaluate a psychological treatment program consisting of Acceptance and Commitment Therapy (ACT-said as one word) together with some behavioural seizure control technology shown to be successful in earlier research. The method consisted of a RCT group design with repeated measures (N= 27). All participants had an EEG verified epilepsy diagnosis with drug refractory seizures. Participants were randomized into one of two conditions; ACT or attention control (AC). Therapeutic effects were measured by examining changes in quality of life (SWLS and WHOQOL) and total seizure time per month. Both treatment conditions consisted of only 9 hours of professional therapy distributed in two individual and two group sessions during a five-week period. The results showed significant effects over all of the dependent variables for the ACT group as compared to the control group at the 12-month follow ups. Seizures were reduced more than 90% at the one year follow up. The results from this study suggest that a short term psychotherapy program combined with anticonvulsant drugs may help to prevent the long-term disability that occurs from drug refractory seizures. Key words: Epilepsy, Acceptance and Commitment Therapy, Seizure control techniques, South Africa Tobias Lundgren, tobiaslundgren455@hotmail.com Cellphone +46 70 612 4555, JoAnne Dahl, JoAnne.dahl@psyk.uu.se Cellphone +46 70 66 34 345 Lennart Melin, Department of Psychology, Uppsala University, Sweden Bryan Kies Department of Neurology, University of Cape Town, South Africa

Steven Hayes February 8, 2006 - 2:14pm

Psychology Today: Negativity: Don't Even Think of It (October 2005)

Negativity: Don't Even Think of It

By: Kathleen McGowan

Summary:

With practice, you can learn to recognize your repetitive and negative thoughts. And keep them from becoming all-consuming. Life would be much easier if we had perfect control over our thinking -- especially where emotions are concerned. We could quickly forget about the people who make us frustrated or angry and allow disappointments to fade into the past without recriminations. But in reality, this kind of emotional equanimity is rare. Most of us spend a lot of time thinking over unpleasant feelings and mulling over regrets and resentments.

Unfortunately, many of these mental interpretations of our feelings make us feel worse about the situation. What started out as a small hurt or frustration, amplified by a thought process that focuses on pain and anger, may balloon into a major preoccupation. Our minds often repeat painful thoughts or scenarios over and over, even when we'd much rather let them go.

If you start paying attention to your interior monologue, you may find that you are dwelling on the ways your parents let you down, angry at someone who has hurt you, afraid of the challenges you face in the future, or ashamed that you haven't yet done the things you'd planned to in life. You'd rather stop all of these thoughts in their tracks -- but that's much easier said than done. Instead, you're left feeling as if there's something wrong with you: Why can't I just get over it? Why can't I just relax and be happy?

Generally, when you try to squelch one of these distressing trains of thought -- or "just get over it" -- your strenuous efforts to suppress it only make things worse. Research has shown that if we actively try to prevent anxiety-provoking or frightening thoughts, they generally become more powerful and harder to ignore. As a result, mental "fix-it" strategies generally backfire, whether that's trying to deny your unhappiness, avoiding the situations or people that make you anxious, or drinking to numb the feelings. Accepting the negative feelings and learning to distance yourself from the thoughts that amplify them can be a much more effective coping strategy, says psychologist Stephen Hayes of the University of Nevada in Reno.

In his book Get out of Your Mind and Into Your Life, he outlines a number of techniques from cognitive psychology that can help you resist getting lost in painful thoughts. With practice, you can learn to recognize your repetitive thoughts, and hold them at arm's length.

A few of Hayes' suggestions:

Practice noticing your thoughts. Try to be conscious of where your mind leads you, and label the type of thought you're having to yourself. For example, if you've made a mistake at work and are feeling bad about it, think to yourself: "I've noticed that I'm focused on my error right now." If you're feeling stupid about the mistake, say to yourself: "Right now, I'm criticizing myself."
If you find that one particular thought or phrase is running through your head -- I'm a loser" or "She screwed me over," for example -- try saying your troubling thought out loud, and either very slowly or in a funny voice. It seems silly, but by doing this, you're actively separating yourself from your mental soundtrack. You remind yourself that these thoughts are being generated out of a mental habit.
Try thinking of your mind as just another organ of your body. If you find yourself preoccupied by fears, imagine that your brain is just like your hungry stomach when it rumbles, or your feet when they're tired after a long day. Think: "There goes my mind again, worrying about something trivial."
Think of your self-destructive or self-critical thoughts as Internet pop-up ads. Don't criticize them or yourself for having them. Just think of them as unnecessary, meaningless noise. All of these tactics are ways to become aware of your inner mental monologue without either getting caught up in it or trying to shut it down. Distancing yourself from your difficult thoughts can help you learn to stop turning small problems into dilemmas that seem all-consuming or hopeless.

Steven Hayes January 15, 2006 - 8:39pm

Martha Beck column in O magazine: Get a New Leash on Life (2001)

Martha beck Column "Beck on Call" in "O" - The Oprah Magazine

From: http://www.oprah.com/omagazine/get-happy

An innovative therapy argues that acceptance is the route to happiness. Martha Beck brings you a new leash on life!

I'm trying an exercise designed by psychologists to help me gain my sanity by gently losing my mind. This process is utterly different from typical attempts to pursue happiness, most of which depend on controlling events and feelings.

Think of a problem that has plagued you for a long time—your weight, a loved one's bad habits, fear of terrorism, whatever. No doubt you've tried valiantly to control this issue, but are your efforts working? The answer has to be no; otherwise you would have solved the problem long ago. What if your real trouble isn't the issue you brood about so compulsively, but the brooding itself?

Psychologists who subscribe to acceptance and commitment therapy (ACT) call "clean" pain what we feel when something hurtful happens to us. "Dirty" pain is the result of our thoughts about how wrong this is, how it proves we—and life—are bad. The two kinds of suffering occupy different sections of the brain: One part simply registers events, while another creates a continuous stream of thoughts about those events. The vast majority of our unhappiness comes from this secondary response—not from painful reality but from painful thoughts about reality. Western psychology is just accepting something saints and mystics have taught for centuries: that this suffering ends only when we learn to detach from the thinking mind.

Judge not...

Learning to detach starts with simply noticing our own judgmental thoughts. When we find ourselves using words like should or ought, we're courting dirty pain. Obsessing about what should be rather than accepting what is, we may try to control other people in useless, dysfunctional ways. We may impotently rage against nature itself, even—perhaps especially—when that nature is our own.

This amounts to mental suicide. Resisting what we can't control removes us from reality, rendering our emotions, circumstances and loved ones inaccessible. The result is a terrible emptiness, which we usually blame on our failure to get what we want. Actually, it comes from refusing to accept what we have.

Victory by Surrender

Surrendering allows the truth to set us free. And how do we surrender?

I recently watched television interviews with two actresses, both in their late fifties. Each was asked if she'd found anything good about aging. Both snapped, "No. Nothing. It's horrible." A few days later, I saw Maya Angelou on TV. She said that aging was "great fun" and gleefully described watching her breasts in their "incredible race to see which one will touch my waist first."

"Sure, the body is going," she said. "But so what?"

Ms. Angelou has said many wise things, but I thought "So what?" was one of her wisest. It expressed the sweet detachment of someone who has learned how to rest in her real being and knows that it is made not of flesh or thought, but of love.

The Fruits of Acceptance

There is enormous relief in detaching from our mental stories, but in my experience, the results go well beyond mere feeling. Surrendering leads directly to our right lives, our hearts' desires. Whenever I've managed to release my scary stories and accept the truth of my life, I've stumbled into more happiness than I ever dreamed possible.

When I stop trying to control my mind—that verbose, paranoiac old storyteller—my thoughts become clearer and more intelligent. It's a delicious paradox: By not trying to control the uncontrollable, we get what we thought we'd get if we were in control. This thought pleases me greatly.

Still not happy? Your mind might be your biggest obstacle.

Steven Hayes January 15, 2006 - 8:41pm

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