We know that cognitive-behavioral therapies are based on understanding how people think (cognitive approach) and how we behave (behavioral approach). The goal of this approach is to teach us that change is possible, but to achieve it, we must first learn to improve our thoughts, attitudes, and behaviors.
Now, imagine someone saying, “I need the motivation to keep working,” “without love, I cannot go forward” or “I have to guarantee that I will get what I want to go forward “. These are familiar phrases that we all told ourselves at one point and that indicate a significant degree of discomfort. Acceptance and commitment therapy can help us.
The above expressions are prejudicial and do not help to solve our problems: they imply that there is a requirement and that if we do not do it, we will not be able to move forward. We give an explicit causal value to the content of thought and feeling while emphasizing that certain private content or events are negative.
Acceptance and commitment therapy (ACT) is a form of psychotherapy that originates in cognitive-behavioral therapies.
This psychotherapy was developed by Steven C. Hayes and was tested by Robert Zettle in 1985, but was actually developed and finalized in the late 1980s. There is a wide variety of protocols that depend on the therapeutic target.
The goal of this therapy is not to remove feelings of difficulty, but rather to learn how to cope with what life brings to us and evolve toward desired behaviors. This therapy requires patients to open
up to unpleasant emotions and to learn not to over-react to them, and not to try to avoid the situations that make them arise.
In short, what is acceptance therapy and commitment? What is acceptance and commitment therapy? What about these principles and its applications? Find in this article all the answers to learn more.
I – Definition of Acceptance and
Acceptance and commitment therapy is a form of behavioral and cognitive psychotherapy based on the relational framework of language and human cognition. It represents a perspective of psychopathology emphasizing the role of experiential avoidance, cognitive fusion, the absence or weakening of values, and the resulting rigidity or behavioral inefficiency in the onset and realization of it.
It is one of the so-called contextual therapies, also called third wave therapies.
Acceptance and Commitment Therapy (ACT) is not a new or recent technology, although it is a third-generation therapy. It has been developed over nearly twenty-five years, although its popularity is recent.
According to the acceptance and commitment therapy, one of the patient’s problems is that he confuses the solution with the problem. The affected person follows a way of life in which they deliberately avoid private events (thoughts and feelings) with repulsive verbal functions (cataloged as suffering, distress, anxiety, depression, etc.), obtaining nothing other than an amplification of symptoms.
II – What is the Acceptance and Commitment Therapy?
It aims to improve psychological flexibility, that is, the ability to be in touch with the emotions and thoughts of the present moment while maintaining or changing as necessary its action in the pursuit of its goals or values.
For example, psychological flexibility makes it possible to accept anxiety that goes hand in hand with certain actions that one wishes to perform while seeking to avoid this emotion may lead to not being able to achieve one’s long-term goals.
Flexibility is thus described as a capacity for acceptance and commitment. Acceptance is the will to live undesirable private events in order to pursue one’s values and goals.
In order to develop flexibility, ACT aims to promote:
– Development of skills to cope with negative thoughts and feelings. These skills are called mindfulness. The latter is defined as a state of consciousness (being present), of attention and openness to the experience of the present moment. While in many models of coaching and therapy, mindfulness skills are taught mostly through meditation, in ACT, meditation is only one means among others. (Mindfulness was part of the vocabulary of many cognitive models of psychological functioning long before meditation became popular in the West.)
– The clarification of values, that is, what is truly important and meaningful to the person and the use of that knowledge to guide and motivate changes for the betterment of one’s life.
*** Central cognitive processes
Six central cognitive processes in this process are:
– Contact with the present moment: to be psychologically present (to be aware of the here and now) with openness, interest, and receptivity.
– Cognitive fusion: learning to step back and get away from thoughts, worries, and memories that do not help.
– Acceptance: allow negative thoughts and emotions to come and go without fighting against them but without being overwhelmed.
– Self-observation: practicing the recourse to the “observer self” which is to be distinguished from the “thinking self”. Mindfulness skills are based on this distinction and access to the observant self can be developed through practice.
– Values: discover what is most important to you.
– The action is taken: set objectives according to its values and implement them responsibly.
Depending on the context, a person must be flexible as to the extent to which it bases its action on the current contingencies of the situation or on the internal events (thoughts, emotions) that they are undesirable, desirable or neutral.
Because of the importance of the context in determining the desirable response to emotions and thoughts (such as distancing for example) and in determining the appropriateness of maintaining or modifying behaviors for the pursuit of goals or In terms of values, authors believe that the term “contextual cognitive therapies” would be preferable to the term “third wave cognitive therapies” for therapies such as ACT.
III – Principles of Acceptance and Engagement Therapy
1 – Experiential Avoidance
Pain is an inseparable part of human existence, but suffering is “another refrain”. Feeling bad is a state that every one of us wants to avoid or, to the extent that he is already installed in us, to escape. Therefore, we struggle to cancel negative emotions and feelings as soon as possible.
To a greater or lesser extent, we all tend to avoid suffering (unless there are some very important secondary rewards: someone may want to be “a little sick” to get attention), and this is something logical and desirable. However, there are times when the price to pay for that, to make mistakes in the way we do it, becomes very high.
The important thing is to “become aware” when the avoidance of suffering is not a valid solution. Once we have done this, we will be able to learn to achieve a “psychological gap” from seemingly negative private responses if it promotes what we value in life. In other words, once we understand that it is of little use to live by devoting all our resources to avoiding suffering (which does not mean we have to look for it), we can accept it when we feel it.
*** The troubles that appear to try to avoid suffering
We have previously defined what experiential avoidance is. There are many people who try to avoid in a chronic way and generalized what causes malaise and, consequently, who live a very limited existence. This model ends up spreading suffering to many facets of their lives.
These people live surrounded by this avoidance scheme, the personal cost of which is very high, preventing them, for example, from achieving many of their goals. It is in these circumstances that we speak of experiential avoidance disorder.
Western culture and its main vectors, families, encourage the realization of private events (thoughts, feelings or sensations) “just” or “appropriate” to live. For example, we encourage the fact that to function well and succeed, a state of motivation or specific emotion or a way of thinking about oneself is necessary.
The problem arises when the person’s experience is successful and despite everything, she tries to find those private states that have been taught to her as determinants in order to accomplish what she has already accomplished. To take a very extreme example, let’s imagine this man who won the lottery. Since childhood, he has been taught that money comes from work and that if he wants to be rich, he will have to work hard. Well, despite being rich he continues to work hard every day to try to fill the first part of the association.
Therefore, it seems that many people consider that the success sought is only valid if it has previously been suffering. So when they get it, they look for it or keep looking for it. The avoidance, on the other hand, would overwhelm the person in another type of circle. In this hypothesis, the person would like to win the lottery, but the work represents for her suffering that she wants to flee, so that she renounces the success because she understands that to work (to suffer) is the only way to get there. She would then settle in another suffering: that of not getting what she wants.
*** In fact, the solution is the problem
Unfortunately, however, the evidence shows that the result is contrary to the person’s purpose: despite the many efforts to avoid suffering, the fact is that she continues to suffer. Thus, this avoidance scheme becomes paradoxical.
That said, we would be faced with a solution that is really the problem. This is the real question: a pattern of life that includes the deliberate escape from malaise, suffering, and anxiety, and that only succeeds in generating malaise, suffering, and anxiety.
Experiential avoidance disorder occurs when a person is unwilling to come into contact with their private experiences of negative valence (be it states or sensations of their body, thoughts, or memories). A concrete example of negative private experience could be “unwanted” emotions, such as anger or sadness.
Thus, in the experiential avoidance disorder, the person attempts to change the origin, form or frequency of said experiences so that they do not occur. For example, imagine someone in an emotional state where sadness predominates. A common attitude in this kind of situation is to treat sadness like a fly: to make it disappear by repelling it. Faced with this impulsive and ill-advised strategy, the fly will continue to warn; it’s the same with sadness.
That’s how we give ourselves permission to feel that. We often forget that people “must” feel sad from time to time just because they are human beings. When we avoid this experience, it becomes more intense because everything we avoid or resist persists.
*** Beneficial in the short term, harmful in the long run
This pattern of behavior often seems effective in the short term because it relieves the negative experience. However, when it occurs in a chronic and generalized way, it prolongs the negative experiences and ends up producing a limitation in the life of the person.
In other words, the person ends up going against what is good for her, suicide being the extreme case of experiential avoidance. The paradoxical nature of the experiential avoidance disorder lies in the fact that the one who suffers it is involved in realizing what he understands he must do to eliminate suffering (using time and effort in such an objective).
Nevertheless, what she gets, in the long run, is that what makes her suffer is more and more present and her life more and more closed. She becomes unable to move forward to achieve the goals and values that are important to her.
2 – Cognitive Fusion
Cognitive fusion is the most abstract concept we will deal with in this article about acceptance therapy and engagement. To understand it, we can think of our mind (thread of thought) as a radio. A radio capable of telling us what we feel or what we are doing is sufficient or not to achieve a given goal. It can further damage our self-esteem by stating that we are not good enough to please someone. Many of our radios send this type of messages.
The problem arises when we “merge” these types of messages with reality when we give them this status when we think that what our radio says is necessarily true. Hence the importance of meta-thinking, to think about how we think and adjust, to understand that what our inner voice tells us does not stop being a voice, like the many existing ones in a radio debate.
On the other hand, this radio can be useful to us in the sense that it can provide us with information (on the radio there are not only opinion debates, but also informative messages: the same thing happens in our mind ). She can tell us if it’s going to be hot, or even give us her opinion on whether it’s worth going out or not with that heat, but it’s just a recommendation we can follow or not. This radio, to return to psychology, can tell us that during a party there will be tension, or even advise us not to go, but we will be the one who will make the decision in the end. This is why it is very important, in therapy, to separate the fusion that has occurred between what the radio says and our probabilities of action.
3 – Values
Acceptance and commitment therapy places a special emphasis on people’s values. The fact that a person evaluates, for example, a certain object as ugly or beautiful is, to a large extent, related to that person’s historical antecedents in the corresponding culture.
We perceive changes in these assessments: both across different cultures and over time. We should begin to realize that many of our qualifying responses (ugly/pretty, good/bad, funny/boring, for example) could have been completely different if we were born at another time or place. The same goes for values and especially when we focus on their limits or when we face moral dilemmas.
4 – Behavioral Rigidity
This term is easier to define. Behavioral rigidity consists of always performing the same acts so as not to have a wider repertoire. In other words, we often turn around the same problem and never arrive at an effective solution. According to the therapy of acceptance and commitment, this is due to the fact that we do not have more “solutions” to face the problems since we do not look for them either.
V – Applications of Acceptance and Commitment Therapy
An analysis of the published studies on acceptance and engagement therapy suggests that clusters of disorders where a larger body of science has been assembled are, in this order:
– The dependencies
– Mood disorders
– Psychotic patterns
It is quite possible that this differential efficiency is due, on the one hand, to the emphasis of ACT on acceptance – an element that is certainly necessary in the face of experiences associated with emotional pain (anxiety, depression, bereavement, post-traumatic stress disorder, etc.) – and, on the other hand, the improvement of personal commitment – which, in turn, seems crucial for treating disorders that involve behaviors that endanger health (sexual intercourse unprotected, alcohol and drug use, etc.).
In addition, taking the patient to distance himself and being able to question his thoughts and ideas can be a basic aid for the treatment of any psychotic episode. It is important to note that, in all cases, the population that can benefit from this therapy is limited to adults with oral skills.
– The therapy of acceptance and commitment is effective in the approach of depression.
– His goal is to train ourselves in psychological flexibility to improve the orientation of our thoughts and to promote change.
– She uses a series of practical exercises to recognize the emotional problem, to see the effect they have on our thoughts and behaviors and thus to assume a sincere and total commitment to ourselves.