Research-based Recovery Information*
for Adult Survivors of Childhood Abuse and Adversity

ACCEPTANCE AND COMMITMENT THERAPY


"Not everything that is faced can be changed.

               But nothing can be changed until it is faced."

                James Baldwin

Recent Review of Evidence-based Status --    [LINK]

The general goal of Acceptance and Commitment Therapy (commonly known by the single word ACT) is to increase psychological flexibility -- broadening and enabling the range of possibilities available to tbe person. Psychological flexibility is established through six core ACT processes. Each of these areas are conceptualised as a positive psychological skill, not merely a method of avoiding psychopathology. ACT is a modern form of evidence-based therapy originally developed and popularised by academic clinicians at the University of Nevada, Reno, in the tradition of "Radical Behavior Therapy" developed by B. F. Skinner. It is known practisd and researched worldwide, with national and international conferences. Concurrent with it development as a therapy has been the development of a comprehensive theory of human behavior known as Relational Frame Theory.

ACT (and RFT) sees human language as one of the causative bases for human problems, problems which are formulated and maintained by the "verbal rules" we try to use to enable us to try to both cope better and get our needs met. It sees humans as trying to avoid confronting and accepting unpleasant "internal events" (such as unpleasant emotions, feelings, memories, and "behavioral predispositions", such as to use alcohol or druge). A relatively complete outline of the influencess on human behaviour is depicted in the Hexaflex is available here -- [LINK].

A number of terms have particular meanings within the ACT model:

Experiential avoidance has been found to be correlated with, and is believed to be causally related to, a number of different forms of psychological disorders, including depression, anxiety, and posttraumatic stress disorder. This relationship has been found to be true in those with histories of childhood trauma, as well as in other people (Kingston, Clarke, & Remington, 2010) -- [LINK]. Thus, it is important to target experiential avoidance in the course of treatment. Particularly, forms of particular avoidance might be practicable and efficient, in the short term, but cause significant problems if relied on to too great an extent, or in inappropriate contexts. Substance abuse, perfectionistic behaviour, and "comfort eating" would constitute problematic forms of experiential avoidance. An ACT orientation would encourage acceptance of unpleasant experiences which might otherwise be avoided, if such acceptance is in the service of more highly valued behaviour. Thus, ACT therapy helps the client learn means of overcoming dysfunctional avoidance and identifying and committing to valued action. Overcoming experiential avoidance can colloquially be called "showing up" to the reality of experience, and then taking action.

Cognitive defusion can be thought of as the "de-realization" of one's thoughts, like viewing them from afar, as if they belong to someone else except for saying to oneself: "I am having the thought, .... I am having the feeling .... that ..." one does not seek to deny such thoughts or feelings, but accepts them as they are, a product of one's early experiences in a particular context and remaining "mindful" of this experience, whilst remaining awaare that one is now in a different context, is a vitally important part of the ACT therapeutic process -- retaining the ability to act differently in a new context to that which created the way of coping in the previous context, a way of coping less suited to the present context. A discussion of some defusion techniques is available here -- [LINK]. A journal article discussing defusion techniques for the relief of psychological distress is available here -- [LINK].

By practising Mindfulness -- non-judgemental awareness and observation -- you can be aware of when you are in the present moment rather than being ‘lost in your head’ - perhaps thinking about the past or worrying about the future. Notice what you don’t usually notice – sights, sounds, sensations, thoughts, textures etc.

The combination of lack of acceptance and low mindfulness has been linked to both posttaumatic stress symptoms substance abuse problems -- Garland & Roberts-Leweis (2012) -- [LINK]. Results indicated that thought suppression, rather than extent of trauma history, significantly predicted post-traumatic stress symptom severity while dispositional mindfulness significantly predicted both post-traumatic stress symptoms and craving. In multiple regression models, mindfulness and thought suppression combined explained nearly half of the variance in post-traumatic stress symptoms and one-quarter of the variance in substance craving. Moreover, multivariate path analysis indicated that prior traumatic experience was associated with greater thought suppression, which in turn was correlated with increased post-traumatic stress symptoms and drug craving, whereas dispositional mindfulness was associated with decreased suppression, post-traumatic stress, and craving. The maladaptive strategy of thought suppression appears to be linked with adverse psychological consequences of traumatic life events. In contrast, dispositional mindfulness appears to be a protective factor that buffers individuals from experiencing more severe post-traumatic stress symptoms and craving.

Both experiential avoidance and "fusion" may be (but don't have to be) forms of cognitive and behavioral inflexibility. Within an ACT framework, no behaviour is ever "good" or "bad" -- it depends on the context, and the "cost" of the behaviour -- cost in terms of difficulty moving towards valued ends. The consequences of behaviour are seen to be both actual and perceived, and it is seen to be critical to get an accurate gauge of what are the actual consequences of alternative behaviours -- the differences between actual and perceived consequences are depicted in a range of cartoon images -- [LINK] -- available on Dr Joseph Ciarrochi website at the University of Wollongong, Australia.

You can learn more about ACT and RFT on the >website -- [LINK] -- of the Association for Contextual Behavioral Science.

An even simpler form of the ACT Model known as the Matrix is a simple method for teaching clients to understand the function of their behaviors (e.g., avoidance/escape versus moving toward values) as well as discriminate between events within and outside the skin (e.g., mental experiencing and direct experience). It was created by Kevin Polk, Mark Webster, and Jerold Hambright.

It is discussed in three videos available on YouTube:

The Australian medical doctor, and psychotherapist, Russ Harris has a number of free resources -- links to articles, MP3 recordings, and other materials -- available on his website -- [LINK]

Personally, I find the free resources provided with his first book "The Happiness Trap" amongst the most useful, in particular his suggestions for:

ACT is considered to be part of the "third wave" in cognitive behavioral therapies (sometimes called "contextual behavioral therapies" -- see here for a review -- [LINK] -- of such therapies for PTSD), and as such, shares features in common with other third wae therapies such as
Dialectical Behavior Therapy (DBT) -- [LINK].

Unsurprisingly, Harris' website is called ACT Mindfully -- [LINK]. Mindfulness is related in some ways to meditation, but has some important differences -- as discussed in this journal article -- [LINK].

Harris' website also has several useful mindfulness meditations -- a common component of ACT therapy. A very sizable research literature, outside of ACT, shows the value of mindfulness training for improving such skills as emotional regulation -- a common problem amongst those with histories of childhood trauma. See also -- An Introduction to Mindfulness, with links to online resources. [LINK]