Psych · psychotherapy
Acceptance and commitment therapy
Also known as ACT · Acceptance & commitment therapy · Acceptance-based behaviour therapy · Contextual CBT · Hexaflex therapy · Psychological flexibility therapy · Third-wave ACT
Exam-exhaustive fellowship reference on acceptance and commitment therapy (ACT): psychological flexibility and the hexaflex, experiential avoidance and fusion, techniques, indication-specific evidence (anxiety, depression, OCD, psychosis adjunct, chronic pain), comparison with CBT/DBT/MBCT/ERP, AAQ-II, combined care, and CASC/MEQ pearls. FRANZCP-primary, globally tagged.
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Red flags
- Teaching 'acceptance' as resignation, passivity, or remaining in an abusive or unsafe situation
- Refusing indicated medication or ERP because of ideological 'pure ACT' fusion
- Deep experiential affect work during uncontained high suicide risk, mania, delirium, or medical emergency
- Labelling mindfulness apps or unstructured support as ACT without values and committed action
- Imposing therapist values under the guise of values clarification
- Claiming ACT is always superior to CBT when metas often show rough parity with active CBT
Meet the patient
A 47-year-old engineer has spent two decades trying to "control" her anxiety before she lives her life. She has tried four SSRIs, two courses of CBT, a mindfulness app, and a bottle of wine most evenings. Her marriage is fraying because she keeps cancelling plans "until I feel calmer". Her GAD-7 is 14 and rising. She tells you, flatly, that nothing has worked.[2][10]
The registrar heard "nothing has worked" and reached for a fifth medication. The examiner's question is the one ACT was built to answer: what if the attempt to control the anxiety is the thing keeping her life small?[1][2]
References18ShowHide
- [1]Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J Acceptance and commitment therapy: model, processes and outcomes Behav Res Ther, 2006.PMID 16300724
- [2]Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment J Consult Clin Psychol, 1996.PMID 8991302
- [3]A-Tjak JG, Davis ML, Morina N, Powers MB, Smits JA, Emmelkamp PM A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems Psychother Psychosom, 2015.PMID 25547522
- [4]Powers MB, Zum Vorde Sive Vording MB, Emmelkamp PM Acceptance and commitment therapy: a meta-analytic review Psychother Psychosom, 2009.PMID 19142046
- [5]Ost LG The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis Behav Res Ther, 2014.PMID 25193001
- [6]Ost LG Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis Behav Res Ther, 2008.PMID 18258216
- [7]Bach P, Hayes SC The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial J Consult Clin Psychol, 2002.PMID 12362963
- [8]Gaudiano BA, Herbert JD Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results Behav Res Ther, 2006.PMID 15893293
- [9]Twohig MP, Hayes SC, Plumb JC, et al. A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder J Consult Clin Psychol, 2010.PMID 20873905
- [10]Arch JJ, Eifert GH, Davies C, et al. Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders J Consult Clin Psychol, 2012.PMID 22563639
- [11]Forman EM, Herbert JD, Moitra E, Yeomans PD, Geller PA A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression Behav Modif, 2007.PMID 17932235
- [12]Wetherell JL, Afari N, Rutledge T, et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain Pain, 2011.PMID 21683527
- [13]Bond FW, Hayes SC, Baer RA, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance Behav Ther, 2011.PMID 22035996
- [14]Bai Z, Luo S, Zhang L, Wu S, Chi I Acceptance and Commitment Therapy (ACT) to reduce depression: A systematic review and meta-analysis J Affect Disord, 2020.PMID 31563072
- [15]Bluett EJ, Homan KJ, Morrison KL, Levin ME, Twohig MP Acceptance and commitment therapy for anxiety and OCD spectrum disorders: an empirical review J Anxiety Disord, 2014.PMID 25041735
- [16]Twohig MP, Abramowitz JS, Smith BM, et al. Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial Behav Res Ther, 2018.PMID 29966992
- [17]Shawyer F, Farhall J, Thomas N, et al. Acceptance and commitment therapy for psychosis: randomised controlled trial Br J Psychiatry, 2017.PMID 27979820
- [18]Wetherell JL, Afari N, Ayers CR, et al. Acceptance and Commitment Therapy for generalized anxiety disorder in older adults: a preliminary report Behav Ther, 2011.PMID 21292059