A Primer in Acceptance and Commitment Therapy

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A Primer in Acceptance and Commitment Therapy

• Kirk Strosahl Ph.D.
• mconsultinggrp_at_embarqmail.com

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Acceptance and Commitment Therapy Overview

• Human pain (physical and psychological) is
  ubiquitous, normal and self restorative
• Unwillingness to have pain leads to reliance on
  avoidance and control based strategies
• This lack of willingness leads to a loss of
  contact with committed actions vital purposeful
  living
• It is not physical/mental pain per se that is the
  enemy but our attempts to avoid or control it
  (i.e., suffering)

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ACT Model of Suffering FEAR

• Fusion Attaching to unwanted private experiences
  through literality
• Evaluation Imbuing experiences with primary
  evaluative properties that become fused with the
  experience
• Avoidance Using behavioral or psychological
  strategies designed to eliminate or contact
  exposure
• Reason Giving Providing a socially supportable
  justification for dysfunctional and unworkable
  behaviors

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The ACT Alternative

• Accept Get present, without struggle or
  evaluation, with what is there for what it is,
  not what it advertises itself to be
• Choose Based upon personal values, identify a
  compass heading that will make purposeful and
  legitimate what is to be gone through
• Take Action Act in ways that are consistent with
  values, regardless of the magnitude of these
  actions, understanding that one does not obtain
  values

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Core ACT Processes

• Defusion Deliteralizing provocative events
• Acceptance Non-judgmental awareness
• Getting in the present moment Showing up
• Self as context Contacting the transcendental
  sense of self in which all experience is safe
• Valuing Standing for something in core areas of
  existence
• Committed action Engaging in behaviors that are
  consistent with personal values

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When Is Acceptance An Alternative To Change?

• Remember the serenity prayer?
• With natural, conditioned uncontrollable private
  experiences such as emotions, memories, thoughts,
  sensations
• When a situation cannot be changed
• Presence of chronic disease, pain, terminal state
• The attitudes, beliefs and behaviors of others
• When change or control strategies produce
  paradoxical results (i.e., try not to think about
  X)

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What Can Be Controlled and Changed?

• Most are within the patient
• Behavioral responses
• Willingness to get present
• Clarification of values and associated strategies

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Forms of Acceptance

• Resignation or defeat
• Toleration
• Willingness to be present with struggle
• Non-judgmental awareness
• Sublime acceptance

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Clinical Impacts of Acceptance

• It tacitly normalizes events that might be
  viewed as abnormal
• It highlights the distinction between the human
  and the event
• It highlights learning to live with undesirable
  but unchangeable circumstances
• It provides a place from which valued actions can
  be undertaken in the face of adversity
• It orients the provider to the limitations of the
  eliminate and cure agenda

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How to Introduce Acceptance as the Alternative

• Highlight the unpredictable, uncontrollable
  nature of the problem
• Empathize with the patients normal, socially
  supported desire to control/eliminate the problem
  (what have you tried?)
• Help the patient connect with direct experience
  of failing to succeed at this agenda (how has it
  worked?)
• Connect the patient with the paradoxical effects
  of the eliminate/control agenda (what has it cost
  you?)

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How to Introduce Acceptance as the Alternative

• Get the patient in contact with the most
  important cost Cessation of value driven,
  committed actions that promote quality of life
• Suggest willingness as an alternative to
  control/elimination
• Be comfortable promoting tidbits of willingness
• Emphasize that willingness is not a trick to
  change the situation
• Emphasize acceptance is not a static mental state
  but a continuing process of committed action
  (choice)
• Dont guarantee any outcome!! What will happen
  will happen

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Values and Committed Action

• Values are the diamond in the rough that we
  want to activate
• Work/career/community usefulness
• Love/intimate relationships
• Family/parenting
• Friends/social connectedness
• Personal growth
• Health and hygiene
• Spirituality

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What Freud Said!

• The foundation of freedom from neurosis is the
  successful pursuit of three main objectives in
  living
• Work
• Love
• Play

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Unusual characteristics of values

• Not based upon reasons, but rather represent
  starting assumptions (I stand for X) and cannot
  be argued
• Cannot be obtained in any single event (there is
  always more west to go)
• A source of tremendous intrinsic motivation
• Often suppressed in our acculturation and in the
  process of victimization
• A very clean hands place to go clinically
• Pulls the best of us

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Committed Actions

• Actions which are consistent with ones self
  identified values
• These actions are choices that will be made in
  the presence of reasons, but not for reasons
• Not choosing is a form of choice, often
  succumbing to reasons
• Committed action is not based on the magnitude of
  the act
• The sense of vitality, purpose of meaning in the
  present moment is always greatest when actions
  are consistent with values
• Committed actions can also produce clean pain

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Basic ACT Question

• Would you be willing to experience, fully and
  without defense, what is there to be experienced,
  and, at the same time, do what needs to be done
  to promote a sense of vital purposeful living?

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Suggested Readings

• Hayes, S. Strosahl, K. (2005). A practical
  guide to acceptance and commitment therapy. New
  York Springer Publishing.
• Hayes, S., Strosahl, K. Wilson, K. (1999).
  Acceptance and Commitment Therapy An
  experiential approach to behavior change. New
  York Guilford Press.