What is the ACT

ACT - a further development of cognitive behavior therapy

Acceptance and commitment therapy (“ACT” - spoken as a whole word) is a new type of treatment approach that is included in the so-called “third wave” of behavioral therapy. The “third wave” means that behavior therapy, with its inherent scientific claim, is now also approaching very complex phenomena of human behavior that were previously difficult to access with the principles of conditioning learning and the concept of cognitive information processing. These include mindfulness, acceptance, spirituality and personal values.

More mental flexibility

In the ACT, strategies of acceptance and mindfulness as well as strategies of behavior change and committed action are used. The overriding goal is to increase the psychological flexibility that is required for a value-oriented life under constantly changing internal and external living conditions. Mental flexibility means that a person is in full contact with the present moment and can change their behavior or persistently maintain it - depending on what the current situation and the self-set value-related goals require.
In the ACT, psychological flexibility is therefore not an end in itself, but serves what is existentially important to the person. That is why life goals are developed that provide the motivation to give up emotional avoidance behavior. At the same time, these life goals promote committed and decisive action by showing the way to a rich and meaningful life.

The Relational Frame Theory as a scientific basis

ACT assumes, among other things, from clinical experience that logical analyzes, rational explanations and insights are often insufficient to advance a therapeutic process and everyday behavioral changes. Why this is so can be understood through the investigations carried out in the context of the Relational Frame Theory (RFT). The RFT is a behavioral research program that began in the early 1980s and examines human language and cognition. The analyzes carried out so far in this research program show that and how language and cognition interact with the experiences made directly, cover them up and lead to considerable limitations in psychological flexibility and even to an extensive paralysis of personal development. In order to undermine these effects of language and thinking, the ACT predominantly works with metaphors, natural paradoxes, experience-oriented techniques and an intensive therapeutic relationship design.

Contextualism as a philosophical basis

Both ACT as a treatment approach and RFT as basic research are based on the philosophical location of functional contextualism, i.e. they start from the view that every decision, action or utterance takes place in a specific context and can only be understood in this context. Accordingly, ACT is less interested in the content of actions and cognitions than in the function that they perform in this very context. As a consequence, this means an epistemological as well as ethical pragmatism, because ACT and RFT are never about an abstract, absolute concept of truth, but always about the usefulness that has to prove itself in the horizon of freely and autonomously chosen values ​​and life goals.

Six core processes

The therapeutic work in the ACT comprises six dimensions, which on the one hand relate to the attitude of the therapist, but on the other hand also very specifically describe the treatment methods. At the same time, they define specific skills that the patient should learn and practice in the course of treatment. Specifically, these are willingness or acceptance, cognitive defusion, mindfulness, self-as-context, values ​​and finally the commitment derived from them. The individual components are not to be understood as categorically separable, independent processes, but as facets of a holistic event. Their differentiation is only useful for practical purposes and has to be proven even further in future component analyzes.

acceptance

Willingness or acceptance mean to accept unpleasant and painful inner experiences and to let go of the fight against them. Because it is often this fight against one's own feelings, thoughts and physical sensations that leads to people losing sight of their own life and the things that are actually important to them. And it is also this struggle that turns natural pain, fear, or sadness into psychological suffering.

Cognitive defusion

This means that you no longer take your own thoughts so literally or seriously. According to the results of the RFT, our cognitions tend to organize themselves in complex networks. We can become so entangled in these thought networks that they influence our experience and behavior much more than our direct experiences. We then speak of cognitive fusion (cognitive entanglement or fusion). An example of this is prejudice that can prevent us from seeing a person as they face us directly. An extreme form of cognitive fusion is shown in psychotic delusion. The skill of cognitive defusion is supposed to open up patients (and therapists) again to what they encounter immediately.

Mindfulness

Mindfulness is a skill that serves to be able to experience the world again in a more direct way and thereby to gain flexibility in action in order to be able to act in greater harmony with one's own values. As a non-evaluating (or constantly registering one's own evaluations) self-observation of one's own experience and actions (= self-as-process), it also provides the basis for us to experience ourselves as a place and space of our behavior and thus as WHOLE people .

Self-as-context

A special class of thoughts and beliefs are those that relate to ourselves. Assumptions about ourselves like “I can't do that” or “I need harmony” can especially contribute to the freezing of our behavior and personal development. ACT counteracts this with special techniques and exercises through which patients (and therapists) can learn to resolve the identification with such restrictive self-concepts. Careful contact with one's own location, from which we experience everything on the one hand and from which we observe our experiences at the same time, is of great importance. ACT calls this "self-as-context". The conscious change of perspective between experiencing and observing one's own experience is another form of being in which self-concepts lose their meaning. In this form of being we no longer need to refute negative self-image assumptions or to defend positive ones. This opens up new space for your own behavioral development.

values

Values ​​can give direction to this development. In ACT, we understand values ​​or directional goals as linguistic formulations that say something about how we live and how we want to fulfill the roles that are important to us. Values ​​or directional goals can never be achieved; Rather, they are qualities of goal-oriented action oriented towards a chosen attitude and are continuously realized from one moment to the next. There is of course always the risk that these values ​​are not genuinely our own, but are influenced by aspects of social desirability or rigid self-image assumptions, or that they serve as mere rationalizations to avoid unpleasant feelings. The ACT has developed a variety of exercises to avoid this.

Commitment

The point here is to actively live the formulated values ​​in day-to-day activities. To this end, ever more comprehensive patterns of effective action are being built on the basis of the continuously formulated values. These patterns of action are based on specific, achievable and value-related goals. They relate both to the temporal perspective (short, medium and long-term goals) and to the breadth of behavior (generalization to different situational contexts).

Area of ​​application and empirical validation

Acceptance and commitment therapy is not based on syndromic diagnoses such as the ICD-10 or DSM-IV. Rather, it is a transdiagnostic treatment concept that is based on functional and not formal aspects of behavior. As is in line with a current trend in psychotherapy research (e.g. Rosen & Davison, 2003), ACT accordingly bases diagnosis and treatment on empirically validated behavioral principles and psychological processes. This also makes ACT interesting for use in various fields outside of the clinical area of ​​application.
Although empirical therapy research on ACT is still in its infancy, a large number of process and result-oriented therapy studies with good results have already been published. So far, ACT has dealt with such diverse clinical pictures and problems as

  • depressions

  • Anxiety disorders

  • Obsessive-compulsive disease

  • chronic pain

  • psychotic illness

  • Addictions

  • Smoking cessation

  • Trichotillomania

  • epilepsy

  • diabetes

  • Stigma and burn out as well

  • Problems in the workplace

Proven to be effective. A (no longer entirely up-to-date) overview can be found in Hayes et al. (2006).