The Acceptance and Commitment Therapy or ACT is a technique belonging to the Third Generation or Contextual Therapies, and it is the most complete therapeutic approach.
If we look back and observe the development of psychotherapy until the present time, we appreciate the enormous variety of approaches that have been occupying a place in the history of psychology.
Currently, the psychological therapies that currently enjoy a better reputation are those based on scientific evidence and differ in their commitment to settle their methods and foundations in experimental evidence. That is, by the commitment to show the experimental basis of their methods.
Acceptance and Commitment Therapy (ACT)
It all started with the sharp separation between academic psychology and clinical psychology. In the 50s psychoanalysis and behavioral therapy predominated , later, in the 60s humanistic and systemic therapy emerged. Between the 60s and 70s the approach became more cognitive, with cognitive therapy emerging. And now the orientation is more eclectic, there is a multiplicity of therapeutic approaches and emerging third generation therapies.
There are occasions when the cognitive-behavioral approach is not able to give answers to cases of more chronic patients, refractory to treatment. Thus, there is a need for a therapeutic approach that allows those affected to have a sense of change, subjective wellbeing and functionality that such an approach is not able to achieve.
This is where third-generation therapies come into play that offer a totally different view to the one prevailing until now.
Theoretical foundations of third-generation therapies
Third-generation therapies are particularly sensitive to the context and functions of the psychological event and emphasize the role of contextual and experiential change strategies.
It is necessary to explain the events in your environment and give reasons for the behavior of others and your own. In the process of becoming a verbal being, the child learns to respond to their own behavior and that of others and does so by following the reasons that the verbal community encourages.
The conceptualization of private events as responsible for actions does not correspond to the true causes of behavior.
Principles of third-generation therapies
The two main principles underlying these therapies are acceptance and activation . The first refers to the acceptance of symptoms and discomfort as a normal life experience. And, the second refers to the search for the promotion of a behavioral change towards the pursuit of valuable goals in life.
The variables that are addressed are related to processes such as acceptance, values that guide behavioral activation, therapy conceived within a dialectical relationship, attention to the self, contact with the present moment, spirituality or the importance granted. to the therapist-client relationship.
Therefore, the main objective of these therapies is the focusing of interest in the psychological function of specific events and the intervention in the alteration of verbal contexts in which cognitive events are problematic.
Acceptance therapy and commitment
The ACT emerged through a series of conditions that were revealed in relation to the approach of psychological disorders, both in their formation and in their alteration.
Consequently, a therapeutic system emerges that brings together the following characteristics:
1- Global framework regarding the advantages and disadvantages of the human condition.
2- Maintenance of a contextual-functional philosophy and assumption of budgets on the impact of contingencies.
3- Consistency with a functional model on cognition and language.
4- Psychopathology where the central concept is the function of destructive experiential avoidance.
Premises of acceptance and commitment therapy
The ACT is structured around two central concepts; 1) the concept of experiential avoidance , which accounts for the maintenance of disorders and 2) of human suffering and personal values , as a guide for action.
The experiential avoidance is an inflexible behavioral pattern, generated from a pattern of ineffective verbal regulation, namely the avoidance of suffering, trying to control private events, sensations and feelings and circumstances that generate them . This avoidance produces an immediate or short-term benefit, but soon after, personal discomfort reappears, forcing us to try again to make it disappear.
Personal values are established verbal reinforcers that have to do with what people give more importance in their lives. The process of training them, allows us to explain why we direct our actions towards something.
Before these concepts arise the following premises, which in turn influence the mode of intervention of the therapist.
1- The problem of the patient is his reaction to thoughts or feelings valued negatively. These are considered normal because they are reactions that have been shaped throughout the history of the person and that constitute their repertoire.
2- Consideration of psychological distress as part of life . With an attitude of experiential avoidance there is a restriction that can be harmful.
3- Understanding psychological health as the development and maintenance of useful behavior patterns in the areas of the person’s life.
4- Teach patients that their way of solving problems they have now is useless and unproductive and it is necessary to change plans.
5- The psychological problems are not given by the presence of disturbing psychological content, but by the role that these contents acquire in relation to the control of behavior.
6- Emphasis in the therapeutic context where the role of the therapist is defined not as the specialist with knowledge but as the companion, assistant and caregiver of the patient in his personal path.
In the literature we find a metaphor that explains the foundation of Acceptance and Commitment Therapy. It is about the metaphor of the building.
The ACT can be like a three-story building; on the top floor we find the specific development of ACT as therapy; on the second floor we find the theory of relational frames ; On the first floor, we find the applied behavioral analysis and its functional analysis. And, finally, in the foundations of the building we observe that they are constituted by the paradigm of functional contextualism .
The paradigm of functional contextualism alludes to the behavior framed in a specific environment, since the actions are historical and contextual and must be contemplated within the environment.
It uses the act in the context as a root metaphor, that is, to understand the nature and function of an event, the context is fundamental. In addition, it refers to pragmatism and, finally, specifies the scientific goals or objectives, which are applied under this criterion.
Theory of relational frames
Regarding the theory of relational frameworks is an approach that tries to account for complex human behaviors, as is the case of verbal and cognitive behavior. The verbal is determined by the ability of the subject to relate events arbitrarily and transform the functions of a stimulus based on their relationship with others.
Verbal behavior is based on relational learning. A stimulus is defined verbally when part of its functions have been established by its participation in a relational framework.
The derivation of relations between stimuli is an operant learned behavior (response that provokes results) generalized functional and that is characterized by allowing to respond to a stimulus based on the arbitrary relationships formed through the personal history between the stimulus and others. (Example: relationship between the sound of the word ball in Spanish and the object is arbitrary).
Relational learning involves relationships of mutual bonding (A = B and B = C), combinatorial link relations (A = C and C = A) and transfer of functions. For example, if a person due to his history of contingencies thinks that having a cat is a characteristic of solitary and independent people, and this characteristic produces a certain rejection, if he knows someone who has a cat, he will transfer that rejection towards the person , although I do not know it.
Let’s give an example of what I just mentioned to make it a little clearer. “Let’s think of a child, if he hears the sound of the word chocolate associated with real chocolate, and later hears the sound of the word chocolate associated with the written word, then a child will establish an equivalence or link between chocolate and his writing, although this has not involved previous training.
In addition, then the generalized operant derived relational response emerges. “Imagine that the child is told: take, here is your ball, then all the contextual clues present will begin to associate and the child will learn that if the sound of the word ball is the ball object, when asked where it is the ball, the child will identify the sound with the real object. Thus, relational learning will be placed under the control of contextual clues.
A contextually controlled and arbitrarily applicable response pattern defines the concept of a relational framework. This framework where words are related to events, acquires the functions of them and can replace them in a way that controls other behavior without having been previously reinforced.
For example, a person who thinks “I have to lose weight” handles a complex framework of relationships between events such as the evaluation of thinness, social judgments of being thin in their social context, anxiety related to thinness … and will have built a endless reasons for their feeding behaviors.
They are thoughts that work as stimuli for the situations they represent and generate a similar reaction to what they think is real.
In summary, the functions that words or thoughts acquire through the different frameworks of relationship between stimuli and in relation to relational learning can lead to patterns of verbal regulation or rules that justify the behavior that is carried out and that can be maintained. even if they are not effective and are outside the contingencies.
Procedure of acceptance and commitment therapy
Once theoretically contextualized the provenance of the ACT and defined its fundamental principles, we went on to define the structure of this therapy.
The objective of the therapy will be to produce greater psychological flexibility in situations where experiential avoidance is predominant, and does not allow the person to live fully. Flexibility is the ability to fully contact the present moment, as a conscious human being to change or persist in what he does, always aimed at the desired goals or values.
The structure of the therapy is flexible and has different strategies depending on the objectives and steps to be taken. We will work with creative despair, orientation towards values, the approach to control as the problem, acceptance, cognitive defusion, the self as a context and committed action.
The creative hopelessness tries that the subject is conscious of the uselessness of the attempts to solve the problems that it carries out. It tries to make him see that these attempts, instead of solving, worsen and chronify the problem.
With the orientation towards values, it is a matter of providing the patient with the conditions to clarify his goals in life in terms of his values. He is asked to indicate what lands are valuable to him and to think what direction and path are suitable to reach them.
On the other hand, we try to show the patient that his attempts to control are the problem itself. For example, someone who has anxiety if he goes to such a place and stops going, is actually making the problem worse, because there are more and more places that he is avoiding.
In terms of acceptance, the person is instructed to open up to the experience of thoughts, feelings, emotions and sensations without doing anything to make them disappear. Acceptance implies opening up to suffering in the pursuit of values and objectives. For example, feeling anxiety and discomfort and accepting it as something that happens, as an emotion, as a thought, nothing more.
Cognitive defusion refers to the process of making a change in the use of language and cognitions in such a way that the thought process becomes more evident. Patients are encouraged to change the relationship with thoughts and see them as mental events that come and go. Many patients act as people fused to their thoughts, and if they understand that these are mere thoughts they can act normally.
With regard to the self as a context, the construction of the self as a person is verbally situated as a center from which to act, differentiating it from its emotions, thoughts or memories. Thus it is intended that customers lose their ties to verbal content. For example, if a person suffering from a social phobia says, “I am a social phobic,” in this way he proceeds in his life confirming his sense of identity and preventing him from progressing through the appropriate choices.
Finally, the action committed, involves defining goals in the defined areas of the road, with acceptance, and despite the obstacles that may appear along the way.
Due to the high degree of flexibility of the ACT, the therapist will be able to adjust the different components of the therapy to the types of ineffective regulation observed in the functional analysis, adjusting the interventions and clinical methods.
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This therapy has been effective in numerous studies and has been applied in a broad, brief, individual, group and with different disorders such as depression, work stress, obsessive-compulsive patterns, anxiety …
It is very effective in monitoring and is useful to avoid chronicity.