It is a new generation of cognitive behavioral therapy. It is the most representative empirical behavioral therapy method and helps clients through processes such as mindfulness, acceptance, cognitive dissociation, self-based background, clear value and committed action, as well as flexible and diverse treatment techniques. Enhance psychological flexibility and engage in a valuable and meaningful life.

Origin

Acceptance and Commitment Therapy is a new psychotherapy method based on behavioral therapy created by the famous American psychologist Professor Steven C. Hayes and his colleagues in the 1990s. Another major psychotherapy theory after behavioral therapy. ACT, together with Dialectical Behavior Therapy and Vipassana Cognitive Therapy, is called the third wave of cognitive behavioral therapy and is the latest development of cognitive behavioral therapy.

The goal of ACT is to improve psychological flexibility: that is, to increase the ability to make psychological changes or persist in functional behaviors to achieve valued goals. It aims to seek to establish a broader, flexible, and effective way of coping rather than just refuting the specific cognitive content of narrow psychological problems; the treatment emphasizes the connection between the problems examined.

Theoretical background

1. The philosophical background of ACT: functional contextualism
   ACT originated from behavior analysis, and modern behavior analysis is based on “functional contextualism” [4]. Contextualism understands psychological events as a continuous interaction between the whole and the specific situation (including history and environment), seeks to maintain the connection with the entire psychological event and its situation, and analyzes psychology in a way that its integrity is not destroyed events, and attempts to predict and influence the continuous interaction between the whole and the specific situation, striving to achieve a certain degree of accuracy, scope and depth in analysis. Relative to the form of psychological events, contextualism is most concerned with the functions of psychological events. Contextualism believes that, to some extent, any event that is divorced from the historical and current situation cannot be called an “event”; similarly, behavior should also be closely related to the specific situation.
   
   Functional contextualism as the philosophical background of ACT is mainly reflected in several aspects. First of all, ACT believes that there is no absolute universal truth in the world, emphasizes the importance of effectiveness, and takes values as the premise for measuring effectiveness. Secondly, ACT’s behavioral analysis takes “prediction and influence” as the overall goal, which requires multi-dimensional contextual variables to be included in the analysis. In addition, the pragmatic orientation of functional contextualism makes goals particularly important. ACT also emphasizes this point. Clients are encouraged to enthusiastically invest in a life consistent with their own values and achieve their life goals rather than pursue them. Empty theory.
   
2. The theoretical foundation of ACT: Relational Frame Theory
   Relational framework theory is a comprehensive functional context model for basic research on human language and cognition. It believes that humans have produced language in the process of evolution, and understanding language and cognition is the key to understanding human behavior. Central to human language and advanced cognition is the learned and context-controlled ability to artificially relate and combine events with each other, and to change the function of specific events based on these relationships.
   
   People’s learning of the relationship between language and cognition has three main characteristics: first, this relationship has the “mutual derivation”
   
   “Sex”. If a person learns that A has a specific relationship with B in a certain context, it means that B also has this relationship with A in this context. Second, this relationship has “joint inference” “Derived”. If a person learns that in a specific context, A and B have a specific relationship, and B and C have a specific relationship, then, in this context, there must also be some kind of relationship between A and B. The relationship between each other. Third, this relationship can make the function of the stimulus change in related stimuli, such as “looking at plums to quench thirst”. When you hear the sound of “plum”, you will think of the real “plum”, and then you will stimulate Saliva secretion. When all the above three characteristics are determined and form a specific relationship, we call this relationship a “relationship framework”.

Psychopathology model

Based on the basic assumptions of RFT, Hayes et al. (2006) summarized the psychopathological model of ACT into six major issues.

1. Experiential avoidance
   It refers to people’s efforts to control or change their specific inner experiences (including somatic sensations, thoughts, emotions, memories and automatic behaviors, etc.). Due to the paradoxical effect of thinking suppression, experiential avoidance cannot play a very effective role. In addition, even if the simple avoidance method can suspend negative emotions, it will often cause the client to become numb or allergic to the stimulus, resulting in a blocked living space.
   
2. Cognitive fusion
   Refers to excessive or inappropriate control of behavior by language processes. The laws of language generally narrow the range of actions directly experienced, limiting the influence of chance events. In this way, people do not have good contact with the experience and direct contingencies of the here and now, but are more inclined to be governed by the laws of language and evaluation [10]. According to ACT/RFT theory, cognitive content and form do not directly cause problems unless contextual characteristics cause the cognitive form to affect people’s behavior in an unhealthy way. For example, under the influence of the laws of language, people will confuse cognitive content with cognitive objects, and the explanation of an event with the event itself.
   
3. Conceptualizing the past and fearing the future
   It refers to the fact that due to cognitive fusion and experiential avoidance, people constantly think about past mistakes or terrible futures, which causes people to be unable to feel the present, lose direct and real experience at this moment, and new possibilities will be excluded.
   
4. Attachment to conceptualized self
   It refers to using conceptual language to limit oneself, making oneself narrow, resulting in inflexible behavior patterns. For example, the client describes himself as “I am a phobia patient” rather than “I am afraid.”
   
5. Lack of clear values.
   It refers to the client’s inability to choose a meaningful way to live due to the adverse social environment and past history, and lacks a sense of value and self-esteem.
   
6. Inaction, impulsiveness or avoidance:
   Refers to the client’s defense of the conceptualized self, which manifests as a lack of energy and action to effectively invest in various areas of life; from a short-term effect, it may reduce the client’s negative reactions and make the client The patient feels right, but such behavior will cause the client to lose contact with the lifestyle he wants, leading to long-term degradation of life quality (values).

Core process

1. Accept
   In ACT, acceptance is not just tolerance, but a positive, non-judgmental accommodation of experiences in the moment. That is, making room for painful feelings, impulses, and emotions, not resisting, controlling, or escaping from them, but observing them as objects.
   
2. Cognitive dissociation
   It means to separate the self from thoughts, images and memories, to observe thought activities objectively like observing a vehicle, and to regard thoughts as language and words themselves, rather than the meaning they represent, and are not controlled by them. Mindfulness exercises can effectively help clients pay attention to the processing of thinking itself.
   
3. Focus on the present
   ACT encourages clients to consciously pay attention to the environment and psychological activities at this moment, without making any evaluation, and to fully accept it. The purpose is to help clients experience the world around them more directly, thereby increasing the flexibility of their behavior and aligning with their own values.
   
4. Observing self
   Painful thoughts and feelings threaten the client’s self, and this negative feeling is particularly significant when the self is the object of conceptualization. The observing self can help clients focus on their true experiences and promote cognitive dissociation and acceptance. ACT typically uses mindfulness techniques, metaphors, and experiential processes to help clients reach the observing self.
   
5. Values
   Values in ACT refer to the language constructs and are the client’s overall, desired and chosen life direction. Values are inseparable from people’s behavior and run consciously through every purposeful action in life. Actions based on values are constructive, not an attempt to avoid painful feelings.
   
6. Commitment to action
   ACT is not only an acceptance-oriented treatment strategy, but also a change-oriented treatment strategy. The purpose of ACT is to help clients choose behavioral changes that are consistent with their own values, take responsibility for their actions, and support an effective values-based life.
   
   The six core processes of ACT can be divided into two parts. The first part is the mindfulness and acceptance process: ACT attempts to reduce subjective control, reduce subjective judgment, weaken language dominance, and reduce Experiential escape and living more in the present moment. Being connected to the here and now, to our values, allows for more flexibility in behavior. The second part is the process of commitment and behavior change: ACT helps clients mobilize and gather energy by focusing on the present, observing the self, clarifying values, and committing to action, moving toward goals, and living a valuable and meaningful life. The reason why this treatment model is called “Acceptance and Commitment Therapy” is that these two processes are integrated into an organic whole in ACT.

Healing Process

1. Challenge old ideas:
   Since ACT wants to challenge the coping strategies used by clients every day, the therapist usually asks the client to reflect on how many failed methods he has tried before at the beginning of the treatment, and asks the client whether he believes in his own thinking or not. I believe in actual experience, and the purpose is to use the personal experience of the visitor to challenge the previous idea of ​​directly eliminating problems.
   
2. Make it clear that “control is the problem”:
   Trying to suppress thoughts and emotions will only cause the number of suppressed objects to be repeated and increase. In order to make the client understand this principle, the therapist will guide the client to conduct the “Don’t think about coffee” experiment: First Briefly describe the various properties of coffee, and then ask the visitor that the only thing they have to do for the rest of the time is not to think about any of the previously mentioned properties of coffee. Through similar experiments, clients understand that their attempts to control automatic thoughts, emotions, and memory processes are playing a game they can never win.
   
3. Defusion exercise:
   “Milk milk” is a typical exercise of cognitive defusion technique: the therapist and the client repeat the word “milk” loudly in a short period of time. After a while, the client will find the word “milk” It lost its original meaning and became a simple word. This exercise allows the client to experience the meaning of cognitive defusion and understand that words are just words.
   
4. Learn mindfulness technology:
   In order to enable the client to better master the mindfulness technology, the therapist visualizes the mindfulness technology: the client is asked to imagine a team of little people walking out from the left ear, walking around in front of the eyes, and walking into the right ear. People hold signs with pictures and words on them, asking visitors to stay on the sidelines and let the queue move freely without getting caught in it. This process is often used as homework, allowing clients to experience the difference between observing their own thoughts and observing the world based on their thoughts. Vivid imagination makes it easy for clients to grasp the purposeful, here-and-now, and non-judgmental characteristics of mindfulness.
   
5. Situated self:
   In order to make the client switch from the perspective of the conceptualized self to the perspective of the contextualized self, the therapist will use a chessboard metaphor: Let the client imagine an infinitely extending chessboard with white and black pieces facing each other. The white piece is A positive experience, sunspots are a negative experience. The client strives to support White over Black, because Black’s dominance means that the client’s self-concept is threatened, so part of the client’s experience becomes his own enemy. The therapist will remind the client that instead of thinking that he is the white piece, it is better to realize that he is just a chessboard. The client can have painful memories and bad thoughts, and the battle between the white piece and the black piece will continue, but the client can let the battle Go on without having to live in a war zone. Through this metaphor, the client’s understanding of self changes from the self conceptualized by various labels to the self as background. Through this transformation, the client no longer sees negative experiences as a threat, thereby strengthening his connection with the here and now.
   
6. Clarify values:
   Using values as a guide for action is a characteristic of ACT. The therapist will ask the client what he hopes his life will demonstrate, and even ask the client to imagine his own funeral and what he would like to see written on the tombstone or eulogy, in order to clarify the client’s values in several major areas of life. The therapist will emphasize that values are a direction that is constantly pursued rather than a specific achievable goal, and that the clarification of values is a personal choice rather than subject to evaluation or judgment.
   
7. Action commitment:
   Finally, the client must commit to taking actions connected with values. This part widely uses various techniques of traditional behavioral therapy. At this stage, short-term and long-term specific goals will be set, allowing clients to practice more flexible behavior patterns step by step, achieve a balance between acceptance and change, and then create a valuable life.