What is ACT?

 Acceptance and Commitment Therapy (ACT said as one word and not as the initials A-C-T) is a third wave behavioral therapy that emphasizes acceptance, mindfulness, and compassion coupled with traditional behavioral interventions.
 
The first wave was categorized by behaviorism (e.g., operant conditioning, classical conditioning). The second wave integrated thoughts, feeling, and beliefs into behavioral therapy – Cognitive Behavioral therapy (CBT). The third wave cognitive behavioral therapies go beyond these approaches and promote health and well-being over symptom reduction or elimination. While traditional CBT deals with thoughts by disputing and changing their content, these new therapies look at the relationship between the person and their thought and feelings. The three most mentioned “third wave” behavioral approaches are Acceptance and Commitment Therapy (ACT), Dialectic and Behavior Therapy (DBT), and Mindfulness-based Cognitive Therapy (MBCT).
 
Let’s now talk specifically about ACT. ACT doesn’t try to change either your thinking or your emotional experience. It instead promotes acceptance of what exists and making behavior changes based on what is meaningful to you living a rich life. The major barrier to a full life and one that people frequently struggle with is psychological inflexibility. We all struggle when we lose our flexibility in dealing with things. We may try to control our feelings and thoughts, or we relate to people or situations in a rigid manner.
 
What maintains our inflexibility? First of all, we get stuck in our thought as if they were real things. The parent who yells at their child may think “I am a lousy parent” or “I am a terrible person.” We become fused with our thoughts. ACT teaches us to step back and recognize this is just a thought through a process known as defusion. It’s hard to be flexible when you are stuck in your thoughts.
 
Another way we become inflexible is by avoidance of the problem. Many people try hard to avoid situations, people, thoughts, or feelings that are painful or unpleasant. But it takes a lot of time and energy when we are in the avoidance mode of living. It also interferes with the ability to live a rich, healthy life. ACT teaches us to accept these challenges and still learn to live a valued life.
 
There are six core processes in ACT that are aimed at increasing psychological flexibility: acceptance, defusion, present moment awareness, self as context, values, and committed action.
•          Acceptance refers to the process of willingly experiencing thoughts, feelings, and sensation without attempting to control of modify them.
•          Defusion refers to the process of noticing thoughts and images and stepping back and watching our thinking instead of getting tangled up in them.
•          Contact with the Present Moment refers to the process of intentionally paying attention to our experiences in the moment.
•          Self-as Context refers to the process of experiencing yourself as an observer – the noticing self.
•          Values refers to connection with our freely chosen life directions,
•          Committed Action refers to our willingness to take action in the service of living a life consistent with our personal values.
 
The goal of ACT is to use all these processes to produce greater psychological flexibility. In a nutshell, if you’re flexible, you’re going to be able to take action to do the things that matter to you. You then will have more energy to take steps toward the things that you value in life.
 
There are many excellent introductory books on ACT. Just go to Amazon and type Acceptance and Commitment Therapy for beginners. One of my favorites is “Act Made Simple” by Russ Harris
 
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ACT and Individuals with Developmental Disabilities (DD)
 
Interventions based on ACT have been evaluated for both children and adults with developmental disabilities. Although the number of studies is small, it is growing.  Some of the benefits of using ACT with this population include:
•          It incorporates acceptance and mindfulness.
•          It focuses on value based action.
•          It is very interactive, concrete, and focused on behavior change.
•          It has been used successfully for people with DD in treating anxiety, depression, stress, sleep difficulties and behavior difficulties.
 
 

While ACT is a therapeutic approach that is used in counseling sessions, a variation on ACT called ACTraining can be implemented in non therapeutic settings (e.g, by parents and other support staff. The focus of ACTraining is to increase flexibility through the use of one or more of the core processes. Frequently used processes are present moment awareness (i.e. mindfulness), values clarification, and committed action (ie.g.. skill building exercises like assertiveness training and problem solving).
“Moving Beyond Meltdowns” incorporates PBS and ACTraining along with relationship based approaches.