MODULE 3

ACCEPTANCE & COMMITMENT THERPAY

At its core, ACT is a behavioral therapy: it’s about taking action. First, it’s about values-
guided action. do you want to stand for in life? What really matters, deep in your heart?
What do you want to be remembered for at your funeral? Second, it’s about “mindful”
action: action that you take consciously, with full awareness—open to your experience and
fully engaged in whatever you’re doing.
Acceptance and commitment therapy (ACT) has been described as part of the third wave of
cognitive–behavioural therapy (CBT)
ACT gets its name from one of its core messages: accept what is out of your personal
control, and commit to taking action that enriches your life. The aim of ACT is to help us
create a rich, full, and meaningful life, while accepting the pain that life inevitably brings.
Relational Frame Theory

 ACT rests on an underlying theory of human language and cognition called relational
frame theory (RFT), a theory that now has over one hundred and fifty published
peer-reviewed articles supporting its principles.
 Relational frame theory (RFT) has been developed over the past 25 years as a post-
Skinnerian model providing an empirically based account of language and cognition
(Hayes 2001) that underpins ACT.
 This theory emerges from earlier work on rule governance and derived stimulus
relations in the behaviour analytic tradition. Relational frame theory extends these
ideas to regard thinking itself as a special form of learned behaviour in its own
particular class.
 From the RFT perspective, language is seen as the main difference between humans
and non-humans and relational framing as the core process in developing language.
relational frames continue to expand throughout the lifespan.
 Relational frame theory attempts to offer an explanation of how human beings can
solve problems even in absence of actual objects. The theory is interested in the
process of thinking. This language ability is called ‘transformation of functions’ and it
appears to have played a significant role in allowing the human race to become
successful problem solvers and attain a position of dominance on the planet.
 From a clinical perspective, RFT shows how humans are able to interact with events
purely on the basis of verbally ascribed functions. In ACT clinical work, undermining
the functions contained in language plays a central role, as opposed to changing the
content of thoughts themselves
ACT MODEL OF PSYCHOPATHOLOGY
cognitive and behavioural processes that underlie many forms of psychopathology: cognitive
fusion and experiential avoidance
1. Cognitive Fusion
- The tendency to act in the world on the basis of verbally ascribed functions is
referred to as cognitive fusion.
- The thought and the person thinking the thought become as one, or fused, hiding
the nature of the language process.
- Cognitive fusion basically means that our thoughts dominate our behavior.
- when our thoughts dominate our attention, we often talk about being “hooked,”
“entangled,” “caught up,” or “carried off” by them.
- Fusion means we’re stuck in the world of language: we’re so caught up in all
those words and pictures running through our head that we lose contact with the
world of direct experience.
- lose contact with many aspects of our here-and-now experience, and our
thoughts have such a huge influence over our behavior that our ability to act
effectively is significantly reduced.
- Defusion: purposes of defusion: to engage fully in our experience and facilitate
effective action. People often feel better when they defuse from painful thoughts
and memories. defusion is not some clever tool to control feelings: it’s a means
to become present and take effective action. More than reducing painful feeling
we transform the relationship with them in ACT.

Fusion Defusion
- A thought can seem like –
- he absolute truth;
- a command you have to obey or a rule you have to follow;
- a threat you need to get rid of as soon as possible;
- something that’s happening right here and now even though it’s about the past
or the future;
 - something very important that requires all your attention;
- something you won’t let go of even if it worsens your life
See the thought for what is –
- may or may not be true;
is definitely not a command you have to obey or a rule you have to follow;
- is definitely not a threat to you;
- is not something happening in the physical world—it’s merely words or pictures
inside your head;
- may or may not be important—you have a choice as to how much attention you
pay it;
 - can be allowed to come and go of its own accord without any need for
you to hold on to it or push it away.

Workability
- The whole ACT model rests on a key concept: “workability”.
- Thus in ACT we don’t focus on whether a thought is true or false, but whether it
is workable (“Is what you’re doing working to make your life rich, full, and
meaningful?”)
- Don’t see thought as good/bad or right/wrong - (“Is this working to give you the
life you want?)
- Not rational or irrational - “Does holding on tightly to those thoughts help you to
live the life you truly want)
- no attempt to change the content of the thoughts. In ACT, the content of a
thought is not considered problematic; it’s only fusion with the thought that
creates the problem

2. Experiential Avoidance
- the attempt to escape or avoid the form, frequency or situational sensitivity of
private events, even when the attempt to do so causes psychological harm’
(Hayes 1996).
- Opposite of acceptance-. ACT advocates acceptance under two circumstances: 1.
When control of thoughts and feelings is limited or impossible. 2. When control
of thoughts and feelings is possible, but the methods used reduce quality of life
- Experiential Avoidance Increases Suffering. The more time and energy we spend
trying to avoid or get rid of unwanted private experiences, the more we’re likely
to suffer psychologically in the long run. Eg anxiety disorders.
- Includes tolerance as well. Eg Griting teeth, we want acceptance not tolerating
- One core component of most ACT protocols involves getting the client in touch
with the costs and futility of experiential avoidance. This is done to undermine
the agenda of control (that is, the agenda of trying to control our thoughts and
feelings) and to create space for the alternative agenda: acceptance
- Don’t be mindful fascists - don’t insist that people must always be in the present
moment, always defused, always accepting. experiential avoidance and cognitive
fusion in and of themselves are not inherently “bad” or “pathological”; we only
target them when they get in the way of living a rich, full, and meaningful life. eg
aspirin
Cognitive fusion and experiential avoidance together give rise to SIX CORE PATHOLOGICAL
PROCESSES:
1. Fusion: fusion means entanglement in our thoughts so that they dominate our
awareness and have a huge influence over our behavior. Eg. Depressed clients fuse
with all sorts of unhelpful thoughts: I’m bad, I don’t deserve any better, I can’t
change. fuse with painful memories involving things such as rejection,
disappointment, failure, or abuse. (flashback – extreme fusion as if happening right
now )
2. Experiential Avoidance: experiential avoidance means trying to get rid of, avoid, or
escape from unwanted private experiences such as thoughts, feelings, and
memories. It’s the polar opposite of acceptance (which is an abbreviation of
“experiential acceptance”). EG depressed patient avoiding socialization.
3. Dominance of the Conceptualized Past and Future/Limited Self-Knowledge: We all
readily get caught up in a conceptualized past and future: we dwell on painful
memories and ruminate over why things happened that way; we fantasize about the
future, worry about things that haven’t yet happened, and focus on all the things we
have to do next. And in the process, we miss out on life in the here and now. Eg
Depressed clients commonly spend a lot of time fused with a conceptualized past:
ruminating on painful past events, often having to do with rejection, loss, and
failureIf we lose contact with our inner psychological world—if we’re out of touch
with our own thoughts and feelings— then we lack self-knowledge.
4. Lack of Values Clarity/Contact: due to defusion and avoidance, our values often get
lost, neglected, or forgotten. If we’re not clear about our values or not in
psychological contact with them, then we can’t use them as an effective guide for our
action. Eg Depressed clients often lose touch with their values around connecting
with and contributing to others, being productive, nurturing health and well-being,
having fun, or engaging in challenging activities such as sports, work, and hobbies.
Aim in ACT is to bring behavior increasingly under the influence of values rather than
fusion or avoidance.
5. Unworkable Action: Unworkable action means patterns of behavior that pull us away
from mindful, valued living; patterns of action that do not work to make our lives
richer and fuller, but rather get us stuck or increase our struggles. This includes
action that’s impulsive, reactive, or automatic. Common examples of unworkable
action in depression include using drugs or alcohol excessively, withdrawing socially,
being physically inactive, ceasing previously enjoyable activities, avoiding work etc.
6. Attachment to the Conceptualized Self: story about who we are. This story is
complex and multilayered. It includes some objective facts such as our name, age,
sex, cultural background, marital status, occupation, and so on. It also includes
descriptions and evaluations of the roles we play, the relationships we have, our
strengths and weaknesses, our likes and dislikes, and our hopes, dreams, and
aspiration. if we fuse with this story—if we start to think we are the story—it readily
creates all sorts of problems, all those thoughts are the very essence of who we are:
 self-as-description. Eg In depression, fuse with a very “negative” self-description. “I
bad, incompetent, loser, useless etc”

THE SIX CORE THERAPEUTIC PROCESSES OF ACT

All processes are facets of Psychological Flexibility. Psychological flexibility is the ability to be
in the present moment with full awareness and openness to our experience, and to take
action guided by our values. Put more simply, it’s the ability to “be present, open up, and do
what matters.” Technically speaking, the primary aim of ACT is to increase psychological
flexibilit

1. Contacting the Present Moment (Be Here Now)

Contacting the present moment means being psychologically present: consciously
connecting with and engaging in whatever is happening in this moment. Contacting the
present moment means flexibly bringing our awareness to either the physical world
around us or the psychological world within us, or to both simultaneously. It also means
consciously paying attention to our here-and-now experience instead of drifting off into
our thoughts or operating on “automatic pilot.”
2. Defusion (Watch Your Thinking)
Defusion means learning to “step back” and separate or detach from our thoughts,
images, and memories. It is about trying to dilute the impact of harmful functions
contained in language. It involves trying to shift focus from the content of thoughts to
the process of thinking itself, thus weakening the verbally ascribed functions. Defusion
creates distance from the thoughts, as if the individual were standing back from their
mind, like an observer.
3. Acceptance (Open Up)
Acceptance means opening up and making room for painful feelings, sensations, urges,
and emotions. Instead of fighting them, resisting them, running from them, or getting
overwhelmed by them, we open up to them and let them. This means taking a position
of non-judgemental awareness towards thoughts, feelings and bodily sensations as they
arise.
4. Self-as-Context (Pure Awareness)
observing self: the aspect of us that is aware of whatever we’re thinking, feeling, sensing,
or doing in any moment. Cognitive fusion with thoughts such as ‘I’m worthless’ is
referred to as self-as-content: the person’s identity is caught up in the content of the
particular thought. t, in order to fully experience painful feelings or really stand back
from difficult thoughts without trying to change them, a wider perspective is necessary.

5. Values (Know What Matter)

Values are desired qualities of ongoing action.These ‘values’ are neither feelings nor
goals, but connect to a deeper sense of purpose and meaning as an ongoing process of
behaviour. In ACT the individual focuses on the future, as opposed to exploring the past,
and their chosen values underpin all aspects of therapy. Clarifying values is an essential
step in creating a meaningful life. In ACT, we often refer to values as “chosen life
directions.”
6. Committed Action (Do What It Takes)
Committed action means taking effective action, guided by our values. It’s all well and
good to know our values, but it’s only via ongoing values-congruent action that life
becomes rich, full, and meaningful. Committed action is about learning to move in
valued directions while in the presence of unwanted or painful thoughts and feelings.
Values-guided action gives rise to a wide range of thoughts and feelings, both pleasant
and unpleasant, both pleasurable and painful. So committed action means “doing what it
takes” to live by our values even if that brings up pain and discomfort

The six core processes can be “lumped together” into three functional units,
A = Accept your thoughts and feelings, and be present.
C = Choose a valued direction.
T = Take action
OR
OPEN UP - Defusion + Acceptance
BE PRESENT – self as context + Contact the present moment
DO WHAT MATER – Values and committed action
 MINDFULNESS
Mindfulness means paying attention with flexibility, openness, and curiosity.
This simple definition tells us three important things. First, mindfulness is an awareness
process, not a thinking process. It involves bringing awareness or paying attention to your
experience in this moment as opposed to being “caught up” in your thoughts. Second,
mindfulness involves a particular attitude: one of openness and curiosity. Even if your
experience in this moment is difficult, painful, or unpleasant, you can be open to it and
curious about it instead of running from it or fighting with it. Third, mindfulness involves
flexibility of attention: the ability to consciously direct, broaden, or focus your attention on
different aspects of your experience
We can use mindfulness to “wake up,” connect with ourselves, and appreciate the fullness of
each moment of life. We can use it to improve our self-knowledge—to learn more about
how we feel and think and react. We can use it to connect deeply and intimately with the
people we care about, including ourselves. And we can use it to consciously influence our
own behavior and increase our range of responses to the world we live in. It is the art of
living consciously—a profound way to enhance psychological resilience and increase life
satisfaction.
Mindfulness, a cornerstone of ACT, plays a pivotal role in shaping one’s relationship with
thoughts and emotions. By being present in the moment without judgment, individuals
develop a heightened awareness that empowers them to respond thoughtfully rather than
react impulsively.

Acceptance and Commitment Therapy is a mindfulness-based therapy. It gives you various

ways to learn mindfulness skills, dividing these into 3 categories:

1. Diffusion: dissociating from, and letting go of, unhelpful thoughts or beliefs

Mindfulness, as a central element in ACT, plays a crucial role in reducing cognitive fusion
by promoting non-judgmental attention to one’s thoughts (Bishop et al., 2004). Through
mindfulness practices, individuals learn to observe their thoughts with an open and non-
reactive attitude, recognizing that thoughts are transient mental events and not
accurate reflections of reality.
Non-judgmental attention, a key aspect of mindfulness, allows individuals to step back
from their thoughts and emotions, viewing them from a more objective and detached
perspective (Keng et al., 2011). By distancing themselves from their thoughts, individuals
become less entangled in cognitive fusion and are better able to challenge the validity of
their beliefs
1. Acceptance: recognising and acknowledging painful sensations, and allowing them
to come and go without fighting them
Through mindfulness practices, individuals learn to embrace their experiences with
kindness and understanding, allowing difficult emotions and thoughts to come and go
without resistance (Kabat-Zinn, 1994). This non-judgmental attitude enables individuals
to break free from the struggle against their internal experiences and reduce emotional
distress (Goldin & Gross, 2010).
By embracing acceptance through mindfulness, individuals learn to acknowledge their
emotional pain without being overwhelmed by it.
In the therapeutic context, mindfulness-based interventions, such as the RAIN technique
(Recognize, Accept, Investigate, Non-identification), are often employed to facilitate
acceptance (Brach, 2003). The RAIN technique encourages individuals to recognize their
emotions and thoughts, accept them without judgment, investigate their underlying
causes, and foster a sense of non-identification with those experiences.
acceptance through mindfulness allows individuals to experience a sense of relief from
emotional struggle, as they recognize that it is natural to experience a wide range of
emotion and shift from problem solving view to acceptance orientation.
2. Connecting with the present moment: engaging completely with, and experiencing
what is happening right now, and doing so with openness and curiosity

Mindfulness, a foundational concept in Acceptance and Commitment Therapy (ACT),

encompasses various dimensions that contribute to its transformative impact on
psychological well-being.
The development of mindfulness within ACT is supported by various mindfulness
practices and meditation techniques. Mindfulness-based interventions, such as the Body
Scan and Sitting Meditation, encourage individuals to enhance their present-moment
awareness and deepen their connection with their internal experiences (Kabat-Zinn,
2003).
Mindfulness and psychological flexibility are two interrelated constructs that converge
within the framework of Acceptance and Commitment Therapy (ACT).
At the heart of psychological flexibility lies mindfulness, which serves as a pathway to
develop and strengthen the other core processes (Kashdan & Rottenberg, 2010). By
cultivating present-moment awareness, individuals become better equipped to observe
their thoughts and emotions, fostering greater acceptance and cognitive defusion. The
non-judgmental and receptive attitude cultivated through mindfulness enhances
individuals’ ability to remain open to their experiences, thus supporting contact with the
present momen
Mindfulness allows individuals to detach from the preoccupation with past regrets or
future worries, aligning with the concept of self as context in ACT (Hayes et al., 2006).
Through mindfulness practices, individuals develop a sense of observer self,
understanding that they are not solely identified with their thoughts and feelings, but
rather the conscious awareness that observes them.
Acceptance, a key component of psychological flexibility, involves willingly and non-
judgmentally experiencing internal experiences, including difficult emotions and
unwanted thoughts (Hayes et al., 2006). Mindfulness serves as a foundation for
cultivating acceptance by teaching individuals to adopt a compassionate and non-
reactive stance toward their experiences (Kashdan & Rottenberg, 2010).
The intersection of mindfulness and psychological flexibility represents a core
mechanism of change in ACT, underscoring the transformative potential of present-
moment awareness in promoting psychological wellbeing and resilience.