Acceptance and Commitment Therapy is built on empirically based principles aimed
to increase psychological flexibility using a mindfulness-based approach with
behavior change strategies.
We’ve said that several times in this training and it bears
repeating.
Acceptance and Commitment Therapy is built on functional contextualism and
relational frame theory and aims to increase psychological
flexibility while using
mindfulness interventions during empirically supported treatment plans.
There are
many different ways to discuss ACT.
And one traditional introductory approach to the therapy is to use the ACT hexagon
model.
Steve Hayes and fellow behavioral scientists developed
this six-point approach
to discuss the components that lead clients to greater
psychological flexibility.
The ACT community embraces the idea that Acceptance and Commitment Therapy
establishes greater psychological flexibility primarily
through acceptance, defusion,
establishment of a transcendent sense of self otherwise
known as the self as context,
contact with the present moment, values and building larger and larger patterns of
committed action linked to those values.
These six components form the ACT
hexagon model which is sometimes humorously referred
to as the hexaflex model
because it is the hexagon that leads to flexibility.
Please take a look at this conventional ACT hexagon model.
And keep in mind that ACT comes from the foundation of behavior analysis and
resides in the realm of cognitive behavioral therapy.
Both behavior analysis and
cognitive behavioral therapy are traditionally linear
in their basic models.
For
instance, behavior analysis provided the historical context for ACT and the typical
behavior analyst takes a look at the study of behavior through an ABC model.
Traditional behavior analysts talk about the antecedent-behavior-consequence
functions.
A is followed by B which is followed by C.
Antecedents set the occasion for
behavior to occur.
And after the behavior, a consequence will make it more or less
likely for that behavior to happen again.
This is a linear process.
And if you look at
traditional CBT models, they are often linear models as well.
For instance, Albert Ellis,
one of the chief pioneers of CBT, the developer of Rational
Emotive Behavior Therapy,
forwarded an ABC model as well.
REBT assumes that there are activating events that
elicit beliefs that are followed by emotional consequences.
If something happens in
the environment that is aversive, it can be an activating event that leads to an
irrational belief which can lead to clinically relevant
emotional consequences.
In REBT
treatment, this is to be followed by disputation in order
to lead to effective emotion
and action.
So this is actually an ABCDE model.
Again, very linear.
And Acceptance and Commitment Therapy comes from both traditional behavior
analysis and is part of the CBT community.
But look at the ACT model.
It isn’t a linear model.
It is a circular model.
You can joke
around with me and say, it isn’t a circular model.
It’s a hexagonal model.
And I’d laugh
and have to agree.
But in Philosophy, when we talk about circular models, we’re
highlighting that a method doesn’t have a specific beginning point or ending point.
And let’s highlight that all the points on this model are
equidistant from the center.
So
none of the components are more important than the other ones.
The reason I’m
highlighting this idea is not just to make an academic point about the history of ACT
or to make a philosophical point about the model but to emphasize two important
application ideas.
One is that as you start to do the therapy, you will not
likely access treatment plans or
develop treatment plans that say, in session one, we’ll
talk about defusion and in
session two, we’ll cover values and in session three, we’ll
talk about self as context
and so on.
Could you imagine trying to help a client build psychological flexibility with
such a rigid and inflexible treatment plan?
In ACT, the therapist is going to model the
model.
In other words, you as the clinician will perform ACT more effectively if you
observe your client’s clinically relevant concerns as they
show up in the therapy room
and then flexibly move through the model to address whatever is showing up in the
present moment.
You flexibly model the model of flexibility.
I mentioned that there are two important application ideas.
The second idea is that
being able to effectively model flexibility will require
your own mindfulness skills.
If
you are going to effectively respond to your client, it will
help a great deal if you work
on contacting the present moment as regularly and fluidly as possible.
You will once
again be called on to model the model.
Clients may regularly bring up new topics and
issues that contribute to their own psychological inflexibility.
It is incumbent on the
therapist to be in the here and now.
Focus on the client’s verbal behavior and overt
behavior and then address any clinical issues that come
up with one of the points on
the hexagon model.
You mindfully model the model of mindfulness.
It will be helpful
for the client to see your commitment to flexibility and mindfulness.
Each one of these ACT components, acceptance, defusion,
self as context, contact
with the present moment, values and committed action,
each one of them have their
own way of being measured and each of them have different interventions and skills
building exercises.
And this is a situation where the whole is greater than the sum of
the parts.
ACT utilizes these six components to blend together and increase
psychological flexibility for the client.
And if you recall from a previous video, the
more psychologically flexible you are, the lower your scores are on measures of
psychopathology and the higher your scores are on quality of life inventories.
We’ll
walk through each one of these six components in the next two modules.
But before
we do a deeper dive into the details of the ACT hexagon model, it is important to
highlight several ideas that have yet to be mentioned.
First, the ACT hexagon model is not the only way of talking about Acceptance and
Commitment Therapy.
There are other approaches such as the mindful action plan,
the choice point, the DNA-v model and the ACT matrix just to name a few.
So as you
continue to explore Acceptance and Commitment Therapy,
you will see it is a robust
therapeutic endeavor with diverse ways of leading to psychological flexibility.
ACT embraces solid clinical skills
Empathy Self-compassion Collaborative
stance
Self-disclosure
Second, ACT embraces solid clinical skills in order to assist clients in developing
psychological flexibility.
We will not spend too much time on these concepts in this
training but understand that there is an assumption that
clinicians will have empathy
for their clients, teach concepts like self-compassion
and show unconditional positive
regard with an equal collaborative stance rather than an authoritative stance.
The
therapist will meet the client where they are at and not force the hexagon exercises
on the client in some kind of problematic manner.
Self-disclosure might also be a part
of the therapy if the clinician is ready for such a therapy move.
We would want to
demonstrate in session the oft used phrase in the ACT community that we all swim in
the same soup.
or in other words, every person needs help dealing with the human condition which
leads to the third point.
It will be very helpful if you, the consumer of this
training, could start to embrace
these concepts and apply them to your own issues.
A psychologically flexible
therapist is likely to be more effective not just through
modeling the approach but in
actually executing the applications with the client as well.
In modules 2 and 3, we will introduce the six essential components from the ACT
hexagon and bring them all together to show how they
facilitate each other in order
to accelerate psychological flexibility.
I thank you very much for completing module 1 of the Demystifying ACT.
Before moving to module 2 or prior to taking a break
between trainings, I’m going to
invite you to center yourself with a closing mindfulness exercise.
Take a nice clean full
breath.
And if it is safe to do so during your next exhale, close your eyes.
And for the
next few moments, I’ll ask you to stay committed to attending to your breath.
Notice
what it feels like to inhale and exhale.
Notice the rise and fall of your chest, the
coolness of the air as you inhale and how it is warmer when you exhale.
And if any
thoughts come up that distract you from such a simple present focused commitment,
I’ll simply ask you to gently bring your attention back to
the invitation to attend to
what you are doing in this present moment.
Breathing.
And I will invite you to take
this same approach to any other behaviors you do after this training is over.
Invite
yourself to be fully in the present moment committed to your important actions and
simply aware of but not distracted by any thoughts or emotions you’re experiencing.
And now, I will invite you to take another full clean deep breath.
And when you
exhale, open your eyes and prepare to be psychologically flexible as you go about
your day.
There are 3 key points in this video.
1.
There are many different ways to discuss Acceptance and Commitment Therapy
but this training will focus on the traditional introductory
approach using the ACT
hexagon model.
2.
Acceptance and Commitment Therapy’s hexagon model is non-linear, meaning
that it is used flexibly depending upon what is showing up in the room with the
client’s clinically relevant concern and such fluid usage will benefit from the
clinician being more mindful of the present moment themselves.
3.
ACT is applied within the framework of good solid therapeutic relationships.
And
therefore, what you do as a therapist as long as it is
effective is likely to blend very
well with the Acceptance and Commitment Therapy model.