The Acceptance and Commitment Therapy or ACT Is a technique belonging to the Third Generation or Contextual Therapies, and it is the most complete therapeutic approach.
If we look back and observe the development of psychotherapy to the present day, we appreciate the enormous variety of approaches that have been occupying a place in the history of psychology.
Currently, the psychological therapies that currently enjoy a better reputation are those based on scientific evidence and differ in their commitment to place their methods and foundations on experimental evidence. That is, by the commitment to show the experimental basis of their methods.
It all began with the sharp separation between academic psychology and clinical psychology. In the 1950s, the psychoanalysis and the Behavior therapy , Later, in the 1960s, the Humanistic therapy Y Systemic . Between the 1960s and 1970s, the approach became more cognitive, Cognitive therapy . And now the orientation is more eclectic, with a multiplicity of therapeutic approaches and the emergence of third generation therapies.
There are occasions in which the cognitive-behavioral approach is not able to give answers to cases of patients who are more chronic, refractory to treatment. Thus, the need for a therapeutic approach that allows to obtain to those affected a feeling of change, subjective well-being and functionality that this approach is not able to obtain.
This is where third-generation therapies come in that offer a totally different view than the one prevailing so far.
Theoretical Foundations of Third Generation Therapies
Third generation therapies are particularly sensitive to the context and functions of the psychological event and emphasize the role of contextual and experiential change strategies.
It is necessary to explain the events in your environment and give reasons for the behavior of others and your own. In the process of becoming a verbal being, the child learns to respond to his or her own and others' behavior and does so by following the reasons that the verbal community encourages.
The conceptualization of private events as responsible for actions does not correspond to the true causes of behavior.
Principles of Third Generation Therapies
The two major principles underlying these therapies are acceptance and the activation . The first refers to the acceptance of symptoms and discomfort as a normal life experience. And, the second refers to the pursuit of the promotion of a behavioral change towards the pursuit of valuable goals in life.
As variables that are addressed are related to processes such as acceptance, values that guide behavioral activation, therapy conceived within a dialectic relationship, attention to the self, contact with the present moment, spirituality or importance granted To the therapist-client relationship.
Therefore, the main objective of these therapies is the focus of interest in the psychological function of concrete events and intervention in the alteration of verbal contexts in which cognitive events are problematic.
Acceptance and commitment therapy
ACT arose through a series of conditions that were revealed in relation to the approach of psychological disorders, both in their formation and in their alteration.
Consequently a therapeutic system emerges that combines as basic characteristics the following:
1- Global framework referring to the advantages and disadvantages of the human condition.
2- Maintenance of a contextual-functional philosophy and, assumption of the presuppositions on the impact of the contingencies.
3 - Consistency with a functional model on cognition and language.
4- Psychopathology where the central concept is the function of destructive experiential avoidance.
Premises of the therapy Of acceptance and commitment
The ACT is structured around two central concepts; 1) the concept of Experiential avoidance , Which accounts for the maintenance of disorders and 2) human suffering and Personal values , As a guide for action.
The Experiential avoidance Constitutes an inflexible behavioral pattern, generated from a pattern of ineffective verbal regulation, consisting in the avoidance of suffering, trying to control private events, feelings and feelings, as well as the circumstances that generate them. This avoidance produces an immediate or short-term benefit, but before long, the personal malaise appears again, forcing it to try again to make it disappear.
The Personal values Are reinforcers established via verbal that have to do with what people give more importance in their life. The process of formation of these, explains why we direct our actions towards something.
Faced with these concepts, the following premises emerge, which in turn influence the intervention of the therapist.
1- The patient's problem is his Reaction to thoughts or feelings Rated negatively. These are considered normal because they are reactions that have been conforming throughout the history of the person and that constitute his repertoire.
2- Consideration of the Psychological discomfort as part of life . With an attitude of experiential avoidance there is a restriction that can be harmful.
3- Understanding psychological health as the Development and maintenance of useful behavioral patterns In the areas of the person's life.
4- Teach patients that their Mode of solving problems they have now is useless and unproductive And it is necessary to change plans.
5. Psychological problems are not caused by the presence of disturbing psychological contents, but by the Role that these contents acquire in relation to behavior control.
6 - Emphasis on the therapeutic context where the role of the therapist is defined not as the specialist with knowledge but as the Companion, assistant and caregiver of the patient in his personal way.
In the literature we find a metaphor that explains the basis of the Acceptance and Commitment Therapy. It is the metaphor of the building.
The ACT can be like a three-story building; In the last plant we find the specific development of ACT as therapy; On the second floor we find the Theory of relational frames ; On the first floor, we find the applied behavioral analysis and its functional analysis. And, finally, in the foundations of the building we observe that they are constituted by the paradigm of the Functional contextualism .
The paradigm of functional contextualism refers to the behavior framed in a specific environment, since the actions are historical and contextual and should be contemplated within the environment.
It uses as a root metaphor the act in the context, that is, to understand the nature and function of an event, the context is fundamental. In addition, it refers to pragmatism and, finally, specifies the scientific goals or objectives, which are applied under that criterion.
Theory of relational frames
Refering to Theory of relational frames Is an approach that attempts to account for complex human behaviors, such as verbal and cognitive behavior. The verbal is determined by the ability of the subject to relate events arbitrarily and to transform the functions of a stimulus based on their relationship with others.
Verbal behavior is based on relational learning. A stimulus is verbally defined when part of its functions have been established by its participation in a relational framework.
The derivation of relations between stimuli is a functional operant learned (response that provokes results) generalized functional and that is characterized by allowing to respond to a stimulus on the basis of the arbitrary relations formed through the personal history between the stimulus and others. (Example: relationship between the sound of the word ball in Spanish and the object is arbitrary).
Relational learning involves relations of mutual bonding (A = B and B = C), combinatorial bond relations (A = C and C = A) and transfer of functions. For example, if a person by his contingency story thinks that having a cat is a characteristic of solitary and independent people, and this characteristic causes him some rejection, if he knows someone who has a cat, he will transfer that rejection to the person , Even if you do not know it.
Let's give an example of what I just mentioned to make it a little clearer. "Let us think of a child, if he hears the sound of the word chocolate associated with real chocolate, and then hears the sound of the word chocolate associated with the written word, then a child will establish an equivalence or bond relationship between chocolate and His writing, although this did not involve previous training.
In addition, then the generalized operant of derived relational response arises. "Imagine that the child is told: take, here is your ball, then all the contextual keys present will begin to be associated and the child will learn that if the sound of the word ball is the ball object, when asked where it is The ball, the child will identify the sound with the actual object. Thus relational learning will be placed under the control of contextual keys.
An arbitrarily applicable context-controlled response pattern defines the concept of relational framework. This framework where words are related to events, acquires the functions of the same and can replace them in a way that control another behavior without having been reinforced previously.
For example, a person who thinks"I have to lose weight"handles a complex framework of relationships between events such as the assessment of being thin, social judgments of being thin in their social context, anxiety related to thinness... Endless reasons for their eating behaviors.
They are thoughts that function as stimuli of the situations it represents and generate a similar reaction to what it thinks as if it were real.
In summary, the functions acquired by words or thoughts through the different frameworks of relationship between stimuli and relational learning can lead to patterns of verbal regulation or rules that justify the behavior that is performed and can be maintained Although they are not effective and are outside the contingencies.
Acceptance and commitment therapy procedure
Once theoretically contextualized the origin of ACT and defined its fundamental principles, we come to define the structure of this therapy.
The goal of therapy will be to produce greater psychological flexibility in situations where experiential avoidance is predominant, and does not allow the person to live fully. Flexibility is the ability to fully contact the present moment, as a conscious human being to change or persist in what he does, always aimed at the desired goals or values.
The structure of the therapy is flexible and has different strategies depending on the objectives and steps to take. It will work with creative hopelessness, the orientation towards values, the approach of control as the problem, acceptance, cognitive defusion, self as context and committed action.
The creative hopelessness tries to make the subject aware of the uselessness of the attempts to solve the problems he is carrying out. We try to show that these attempts, instead of solving, make the problem worse.
With the orientation towards values, it is a question of providing the patient with the conditions to clarify his goals in life in terms of his values. You are asked to indicate which lands are valuable to him and to think about which direction and path are suitable to reach them.
On the other hand, an attempt is made to show the patient that his or her attempts at control are the problem itself. For example, someone who has anxiety if going to such a site and stops going, is actually making the problem worse, because more and more places are avoiding.
As for acceptance, it is instructed that the person open to the experience of thoughts, feelings, emotions and sensations without doing anything to make them disappear. Acceptance involves openness to suffering in the pursuit of values and goals. For example, feel the anxiety and discomfort and accept it as something that happens, as an emotion, as a thought, nothing more.
Cognitive defusion refers to the process of making a change in the use of language and cognitions in such a way that the thought process becomes more evident. Patients are encouraged to change the relationship with the thoughts and see them as mental events that come and go. Many patients act as people merged with their thoughts, and if they understand that these are mere thoughts you can act normally.
With respect to the self as context, the construction of the self as a person is placed verbally as the center from which to act, differentiating it from its emotions, thoughts or memories. This way, clients are expected to lose their ties to verbal content. For example, if a person who has a social phobia says,"I am a social phobic,"in this way he proceeds in his life confirming his sense of identity and preventing him from advancing through the right choices.
Finally, committed action implies defining goals in defined areas of the road, with acceptance, and despite obstacles that may appear along the way.
conclusion
Due to the high degree of flexibility of ACT, the therapist will be able to adjust the different components of the therapy to the ineffective types of regulation observed in functional analysis, adjusting clinical interventions and methods.
This therapy has been effective in numerous studies and has been applied in broad, brief, individual, group format and with different disorders such as depression, work stress, obsessive-compulsive patterns, anxiety...
It is very effective in monitoring and is useful for avoiding chronicity.
Bibliography
- Luciano, M.C. , Valdivia, S., Gutiérrez O. and Páez-Blarrina, M. (2006). Advances from Acceptance and Commitment Therapy. EduPsykhé. REVISTA DE PSICOLOGÍA Y PSICOPEDAGOGÍA, vol. 5, no. 2, pag., 173-201.
- Hayes, S.C., Strosahl, K.D. And Wilson, K.G. (2014). An Approach to Acceptance and Commitment Therapy. Argentine Journal of Behavioral Sciences, vol. 7, no. 3, pg 1-3.
- Olivares Rodríguez, J., Méndez Carrillo, F.X. (2010). Behavior modification techniques. Madrid. New library.
- Ruíz, M.A., Díaz, M.I., Villalobos, A. (2012). Manual of cognitive-behavioral intervention techniques. Madrid. Desclée de Brouwer, S.A.