ACT Treatment Model

There are several ACT processes that are targeted to increase psychological flexibility in order to enhance individual’s effective behaviour in line with their identified values and goals. There is no correct order for addressing these processes and not all individuals need work in each of the domains (Strosahl et al., 2004). The ACT treatment model, referred to as the ‘hexaflex’, can be divided into two main components (see Figure 3.1). The first refers to acceptance and mindfulness components (acceptance, defusion, the present moment, and a transcendent sense of self); and the second reflect commitment and behavioural change components (values, committed action, the present moment and a transcendent sense of self).

The core ACT processes support each other and all are used to target psychological flexibility. Psychological flexibility refers to “the process of contacting the present moment fully as a conscious human being and persisting or changing behaviour in the service of chosen values” (S. C. Hayes et al., 2006, p. 7). To demonstrate the processes to clients or participants, clinicians and trainers use exercises for each process to enhance adoption and understanding of relevant skills (for more detail see S. C. Hayes et al., 1999; Strosahl et al., 2004). The skills employed by ACT clinicians include the use of metaphor, paradox and experiential exercises that are aimed to undermine the power of cognitive and linguistic processes. A brief description of each process will now be provided.

Acceptance involves developing and increasing an individual’s willingness and acceptance of private experiences. Therapeutic interventions involve exploring the futility

Contact with the Present Moment Committed Action Mindfulness Processes Transcendent Sense of Self Values Acceptance Defusion Psychological Flexibility Behavior Change Processes

Figure 3.1 Six Core ACT Processes

of engaging in EA and cognitive fusion in an attempt to control private experiences, which can paradoxically increase the level of distress an individual experiences. Instead,

individual’s are encouraged to engage in purposeful and vital, value-driven behaviour, regardless of their private experiences.

Defusion

Fusion, the opposite of defusion, decreases sensitivity to environmental

contingencies and one’s own experience in a situation, which also results in an increase in psychological inflexibility. Defusion is a process that involves undermining language processes that promote fusion, unnecessary reason-giving, and unhelpful evaluations and thus function as psychological barriers to meaningful goals and values (Strosahl et al., 2004). Defusion involves teaching individuals the ability to see thoughts for what they are

and not what they say they are (S. C. Hayes et al., 1999), and this will be described further in the next chapter. By doing this, individuals become more willing and accepting of difficult and negative private experiences and are thus able to respond effectively to these and pursue their values and goals.

Getting in contact with the present moment

This process is equivalent to mindfulness. It involves individuals connecting with and being fully open to what is happening in the present moment, including difficult and negative private experiences, and connecting with one’s values and living. According to Strosahl et al. (2004) the qualities that reflect this process are vitality, spontaneity, connection and creativity.

Self-as-context

In this process, individuals work on letting go of their attachment or fusion with a conceptualised self (i.e. I am boring; I am hopeless) and increase their experiential contact with a transcendent sense of self, or self-as-context. In this case, ‘I’ is constant and stable. Whereas an individual’s verbal content or evaluations are the content of their private experience and is differentiated from their ‘contextual self’. From this perspective, it is argued that acceptance and defusion can be engaged in and the content of an individual’s experience need not be so threatening (Pierson & Hayes, 2007).

Values

Values refer to directions in life that individuals choose which guide their behaviour and result in enrichment, vitality and authenticity. When an individual is stuck and fusion and EA dominate, it is easy for individuals to get ‘off track’ and engage in behaviours that are inconsistent with their values. For example, an individual may value meeting people and engaging socially with others. However, if they experience a significant amount of

anxiety when they think about this, they are likely to avoid such experiences. Helping individuals to let go of the struggle and control over negative private events allows them to regain their sense of direction and work on engaging in behaviour that is consistent with their values. Willingness and acceptance of all unpleasant private experiences, which are part of being human, are important processes that assist the individual in pursuing values and engaging in valued behaviour (Strosahl et al., 2004).

Committed Action

When we live a life according to our values, this inevitably produces psychological barriers and psychological inflexibility. Committed action involves engaging in behaviour, in spite of difficult private experiences that may ‘show up’, that is consistent with valued ends. There will be failures in commitment and we do not always live up to our

commitments from day to day. Thus, engaging in committed action can also result in barriers and distress. However, what commitment really involves is that in spite of the barriers, individuals will pick up where they left off, and take a direction that they value once again.