Acceptance and

Commitment Therapy
Steven C. Hayes
Kirk D. Strosahl
Kelly G. Wilson
www.acceptanceandcommitmenttherapy.com

There’s an old joke …

Overview of ACT
• To explain the ACT theoretical model
• To layout the general clinical approach
• To give examples of the techniques,
including some you can use
regardless of orientation
• To encourage you to explore the area

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 Pain and Pathology
• Dania, Fla. June 16 (AP) – A 6-year
old girl was killed today when she
stepped in front of a train, telling
siblings that she “wanted to be with her
mother.” The authorities said that her
mother had a terminal illness.
-New York Times, June 17, 1993

The Assumption of
Healthy Normality
• By their nature humans are
psychologically healthy
• Abnormality is a disease or syndrome
driven by unusual pathological
processes
• We need to understand these
processes and change them

The Ubiquity of
Human Suffering
• High lifetime incidence of major DSM
disorders
• High treatment demand from other
persons
• High rates of divorce, sexual concerns,
abuse, violence, prejudice, loneliness
• Some extremely destructive behaviors are
both common and non-syndromal, e.g.,
suicide

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 Alternative Assumption:
Destructive Normality
• Normal psychological processes often
are destructive
• We need to understand these
processes and work within them to
promote health
• Ancient nominee: human language
and cognition (e.g., the Genesis story)

Experiential Avoidance
• The tendency to attempt to alter the form,
frequency, or situational sensitivity of
historically produced negative private
experience (emotions, thoughts, bodily
sensations) even when attempts to do so
cause psychological and behavioral harm
• Is built into human language
• Is embedded in culture, science, and
technology

Experiential Avoidance

People tell me
it’s a sin to
know and to
feel too much
within …
Bob Dylan

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 Experiential Avoidance is …
Loneliness That we
and misery attempt to
and suffering avoid,
and dampen,
unhappiness suppress,
defend
against, etc.
You name it,
we do it!!

How We Make Things Worse

• Without the ability to open up to
discomfort without suppression, it is
simply not possible to face difficult
problems in a healthy way
• Experiential avoidance increases the
impact and often even the frequency
of avoided thoughts, feelings, and
sensations

Higher Experiential Avoidance ….

• Is associated with:
– Higher anxiety – History of sexual abuse
– More depression – High risk sexual behavior
– More overall pathology – BPD symptomatology
– Poorer work and depression
performance – Thought suppression
– Inability to learn – Alexithymia
– Substance abuse – Anxiety sensitivity
– Lower quality of life – Long term disability

Sources: Hayes et al (in press); Polusny (1997); Toarmino (1998); Pistorello (1997); Batten, Follette, & Aban (1998);
Stewart, Zvolensky, & Eifert (1998);

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 Yet it Seems to be Built into
Mainstream Assumptions
• Names of disorders
• Names of techniques
• Measures
• Models

A Simpler Version of the

Barriers that ACT Targets

FEAR:
• Fusion
• Evaluation
• Avoidance, and
• Reasons

Cognitive Fusion
• Excessive attachment to a thought
that does not allow us to “be” in the
present moment
• Living in the past or the future
• Constructing a world for ourselves
dominated by “literal language”
• Excessive labeling of our
experiences

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 Experiential avoidance and
Cognitive Fusion are basic
• We live in a verbal world “about” something,
somewhere else, some time else
• The chatter in our heads gets very dominant
• There is no place a human can go that is pain
free
• As much as we wish it were so, we cannot
regulate pain by regulating the situation
• So we do, in self-defense, experiential
avoidance, even though it does not ultimately
work

Five Components of ACT

1. Facing the current situation
• Creative Hopelessness
2. Cognitive Defusion
3. Acceptance
4. Self as Context
5. Valuing as a Choice

General ACT Techniques

1. Deliteralization
• Inherent paradox
• Verbal confusion and sensible incoherence
• Creation of healthy distance
2. Metaphor
• Point to the problem or encourage solutions without
directly instructing them
3. Experiential exercises
• contact with raw experiential material in a safe context
4. Radically functional talk
5. Behavioral commitment and change exercise

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 Creative Hopelessness:
Acceptance of Where You Start
• You’ve tried about everything
• Suppose your experience is valid?
Suppose it won’t work
• Metaphors
–Man in the hole
• Upset / Struggle / Workability
• Don’t believe a word I’m saying

Don’t believe a word I am saying

Don’t believe a word I am saying

•A core element of ACT is in getting clients to
experience their own emotions as purely and
authentically as possible
•The role of the therapist is not to provide his or
her way of doing it, but rather to provide
guidance so that the client can do it for himself or
herself
•The phrase “Don’t believe a word I am saying,”
is often used in ACT so that the client is not
tempted to simply adopt the therapist’s position,
but instead to lean into the experience as
authentically as possible

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 Cognitive Defusion
• De-Fusion
• Present contexts that reduce the
literal and evaluative functions of
language and cognition,
• Reduce the domination of problematic
interpretations that previously were
based on category, time, and
evaluation

Cognitive Defusion
Defusion Exercises
• Thank your mind for that thought
• There are four of us in the room
right now, you, me, your mind and
my mind
• Titchener’s Exercise

Titchener’s Exercise

Got Milk?

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 ACT Metaphors

Acceptance
• Encourage direct moment-to-moment
contact with previously avoided private
events (that functionally need not be
avoided) as they are directly experienced
to be
• If control is the problem, why does it
persist?
• If you are not willing to have it, you will
– Substitute just about any word for “it”
– e.g., “your depression,” “your anxiety,” etc

Acceptance Interventions
Metaphors
– Gun at the head
– Tug of war with a monster
– Quicksand
– Feed the tiger
– Train on tracks
– Remember three numbers
– Chinese Handcuffs

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ACT Metaphors

ACT Metaphors

ACT Metaphors

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 Self as Context
• Spirituality and transcendence as
human experiences
• Making contact with that sense of
self that is safe and consistent
perspective on the world and thus
promote present moment focus

Contact with the

Present Moment
• Mindfulness exercises begin each
session
• Leaves on the stream
• Relationship focus moment to moment
• During exposure, focus on the moment

Choice and Values

• Helping the patient clarify the values the
she or he holds
• Helping the patient get motivated for
treatment
• Helping the patient reorient her/his life from
avoidance to approach of valued goals
Exercises
• Declaration
• Tombstone
• What matters

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 A Simpler Version of
the Goals of ACT

ACT
•Accept
•Choose
•Take action

ACT Said Simply

• ACT uses acceptance and
mindfulness processes, and
commitment and behavior
change processes, to produce
greater psychological flexibility

Psychological Flexibility
• Psychological flexibility is a
continuous process of contacting the
present moment fully (without
defense; as it is) as a conscious,
human being, and based on what the
situation affords changing or
persisting in behavior in the service
of chosen values

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 The ACT Question
• Given a distinction between you and
the things you are struggling with and
trying to change, are you willing to
experience those things, fully and
without defense, as it is and not as it
says it is, and do what works for you
in this time and situation?

The goal is to
FEEL good not
to feel GOOD.

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Experiential Exercises

The Mountain Meditation

Doing mode

Being mode

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 Eye to Eye
• Sit in pairs, knees between
knees
• Look at the other person
• Notice the chatter
• Let go and be present to
being with another person

Leaves in a Stream
• Imagine that there are leaves floating in a stream below
you. You are sitting under a tree on a hill a few feet away
on a warm day watching the leaves float by. As each leaf
goes by, allow it to have a thought or image of a thought
on it, whichever applies for you. One thought is on each
leaf. I want you to simply watch the leaves go by in the
stream, without having to stop them or jumping in the
stream with them. You are just to let them flow. This will
probably be hard not to interrupt, and that is important.
When you catch yourself interrupting the flow – when you
are in the stream or have lost the exercise -- see if you
can back up and see what you were doing just before
that. Then go back to the tree and let the leaves float by
once again.

Taking Your Mind for a Walk

• Groups of two: One is a person, one is a
mind.
• Person goes where he/she chooses; Minds
must follow.
• Persons: this is your job
– Go wherever you choose to go
– See, hear, smell, feel –note what is happening
around you and in you. Feel your feet, leg,
torso, hands as you walk. Notice things you
normally would not.
– And gently, compassionately listen to your mind
…

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 Minds: this is your job …
• Get close to your person and communicate nearly
constantly: describe, analyze, encourage, evaluate,
compare, predict, summarize, warn, cajole, evaluate,
and so on.
• Persons cannot communicate with his or her mind. The
mind must monitor this, and stop the person ("Never
mind your mind") if the rule is violated.
• Persons should listen to their minds without minding
back and go where you choose to go.
• After five minutes, persons become minds and minds
become persons (minds watch the time).
• When each has had a turn, split up and walk quietly by
yourself for five minutes.
• While you are walking, walk mindfully … and notice that
you are still taking your mind for a walk. Persons
should follow the same as before rules during this time.

Experiential Timeout
• pair up
• mindful about client
• Job 1: express concern about a client
– don't be a clinician
– don’t try to explain
– be a concerned person
• Job 2: listener appreciate
– don't be a clinician
– don’t nod, smile, hand pat
– don’t try to understand (see & appreciate a sunset)
• Switch
• Job 3: Eyes on appreciate
– no talking

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