How does acceptance and commitment therapy work?
It uses six core processes that are acceptance, cognitive defusion, being present, the self as context, values, and committed action. This framework is known as the Hexaflex and is the basis of ACT. Let’s take a closer look at the elements of the Hexaflex.
Acceptance is the process of finding a way of acknowledging that the negative exists and suffering is necessary. It is, essentially, a way of recognizing that we have bad experiences that cause us suffering that we might not be able to change and ignore. Instead, we accept them and focus our efforts on changing other aspects of our life. Acceptance is a technique, not a goal.
Cognitive defusion is a set of techniques that tries to change how a person reacts to their thoughts and feelings. In ACT, the goal is not necessarily to avoid negative things but rather to react to them in a way that does not leave the person stuck or fixated.
Being present is the element this approach shares with mindfulness. It involves cultivating awareness of the present moment without judgment. The person learns how to engage with the experience they are having.
Self as context is the idea that an individual exists beyond their experiences, thoughts, and emotions. The individual is not just what is happening to them but there is a self that is experiencing that.
Values refer to the qualities a person chooses to work towards in any given situation. ACT tries to help the person to live a life that is consistent with their values.
Committed Action refers to the actions we take towards living the life we want to live.
The Hexaflex covers both the goals and the general techniques used in ACT. It is a therapy that tries to help the person accept and live with the things they cannot change and help them become more flexible, which can allow them to live better lives.
How does ACT work in practice?
Generally, ACT usually starts with a broad overview of the intervention and an introduction to acceptance. Acceptance is something that the person cannot control, whether it is a trait, an emotion, or a situation like pain. If the person focuses on changing something they cannot change, they are wasting their time and energy. They are bound to end up frustrated and without achieving what they wanted. Instead, it’s better to work with what is rather than what could be.
Acceptance involves allowing thoughts and emotions to happen without necessarily acting on them or allowing some things to continue as they are or taking responsibility for one’s own reaction even if the situation is beyond the person’s control.
ACT works to change the way in which a person views their own feelings and thoughts. People might feel anxious about having intrusive or obsessive thoughts or suddenly experience the impulse to do something. The therapy tries to help them understand what is happening and works with cognitive, behavioral, and mindfulness techniques to let these things happen and pass.
ACT is a unique and empirically sound approach with broad applicability. It can be especially useful for problems that are difficult to change or that involve recurring situations.
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Ghouchani, S., Molavi, N., Massah, O., Sadeghi, M., Mousavi, S., & Noroozi, M. et al. (2018). Effectiveness of Acceptance and Commitment Therapy (ACT) on aggression of patients with psychosis due to methamphetamine use: A pilot study. Journal Of Substance Use, 23(4), 402-407. doi: 10.1080/14659891.2018.1436602
Heydari, M., Masafi, S., Jafari, M., Saadat, S., & Shahyad, S. (2018). Effectiveness of Acceptance and Commitment Therapy on Anxiety and Depression of Razi Psychiatric Center Staff. Open Access Macedonian Journal Of Medical Sciences, 6(2), 410-415. doi: 10.3889/oamjms.2018.064
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