Evaluating acceptance and commitment therapy: An analysis of a recent critique.

Abstract

Acceptance and commitment therapy (ACT) is a novel acceptance/mindfulness-based behavioral treatment that has been increasing in popularity in recent years. A detailed description of ACT theory and technique is beyond scope of current article, and thus it will only be summarized briefly here. Readers are referred to other books and articles that provide more detailed descriptions (Hayes, 2004a, 2004b; Hayes, Barnes- Holmes, & Roche, 2001; Hayes, Luoma, Bond, Masuda, & Lillis, 2006; Hayes & Strosahl, 2004; Hayes, Strosahl, & Wilson, 1999). ACT stems from a philosophy of radical behaviorism. The approach itself is rooted in a specific theoretical model, called Relational Frame Theory (RFT) (Hayes et al., 2001), which was developed to provide an updated behavior analytic account of that expands upon previous work of B. F. Skinner. In general, ACT can be described as combining acceptance and mindfulness strategies with overt behavior change efforts to improve what its creators call psychological flexibility (Hayes et al., 1999). Psychological flexibility is defined as the ability to contact present moment more fully as a conscious human being, and to either change or persist when doing so serves valued ends (Hayes, Strosahl, Bunting, Twohig, & Wilson, 2004, p. 5). In other words, healthy psychological functioning is proposed to be related to a person's ability to adaptively respond to changing environmental contingencies. In contrast, psychological inflexibility or rigidity is theorized to be result of what ACT calls cognitive fusion and experiential avoidance. Cognitive fusion is defined as the tendency of human beings to live in a world excessively structured by literal language (Strosahl, Hayes, Wilson, & Gifford, 2004, p. 39). For example, when a person is fused with a thought am depressed), he/she is experiencing that thought literally (I = depression). This cognitive fusion permits literal content of thinking to dominate over a person's behavior can't go to work today because I am depressed). Cognitive fusion also fosters experiential avoidance, which is defined as the attempt to escape or avoid form, frequency, or situational sensitivity of private events, even when attempt to do so causes psychological harm (Hayes et al., 2004, p. 27). When engaged in experiential avoidance, person attempts to avoid or suppress undesirable private material such as thoughts, memories, emotions, and bodily sensations as if they were inherently harmful, even though doing so can paradoxically worsen these problems in long-run (Wenzlaff & Wegner, 2000). The co-processes of fusion and experiential avoidance result in narrowing of a person's behavioral repertoire (i.e., psychological inflexibility), which is believed to lead to and maintain a wide spectrum of psychopathological behaviors. ACT targets six core processes for psychological flexibility: promoting acceptance of distressing internal experiences, fostering cognitive de- fusion so literal content of thought does not dominate over a person's behavior, practicing awareness of ongoing experience in present moment, establishing a stable sense of self that is broader than merely its evaluative content, developin g personal valued life directions to guide behavior, and committing to actions that are consistent with these personally chosen values. Various psychotherapeutic techniques, many of which are inspired by or borrowed from other approaches to psychotherapy (e.g., humanistic, gestalt), are used to address psychological inflexibility. In particular, ACT makes heavy use of metaphors, logical paradoxes, and experiential exercises, as well as more traditional behavioral techniques (e.g., behavioral activation, exposure). The goal of these strategies is to improve psychological flexibility by fostering acceptance of internal states of distress and cognitive defusion from problematic language-based processes. …