Buddhism and Acceptance and Commitment Therapy

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Buddhism and Acceptance and Commitment Therapy

S t e v e n C. H a y e s , University o f N e v a d a , R e n o

The philosophy, basic theory, applied theory, and technology of Acceptance and Commitment Therapy (ACT) are briefly described. Several issues relevant to Buddhist teachings--the ubiquity of human suffering, the role of attachment in suffering, mindfulness, wholesome actions, and self--are examined in relation to ACT. In each case there are clear paraUels. Given that a major focus in the development of A C T has been on the identification of basic behavioral processes that make sense of acceptance and defusion-based treatments, these parallels suggest that the basic account may also provide a scientific grounding within the behavioral tradition for a range of Buddhist concepts and practices.

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HE PURPOSE of this p a p e r is to relate Acceptance a n d C o m m i t m e n t T h e r a p y (ACT; said as o n e word, "act," n o t A-C-T) to a Buddhist view of suffering a n d its amelio- ration. ACT was developed over the last 20 years from the c o n f l u e n c e of behavior analysis, the h u m a n potential m o v e m e n t , a n d experiential psychotherapies. T h a t de- v e l o p m e n t work refined the contextualistic philosophy u p o n which the therapy is based (e.g., Hayes & Brown- stein, 1986; Hayes, Hayes, Reese, & Sarbin, 1993), developed a contextual theory of language a n d cognition (Hayes & Hayes, 1992; see Hayes, Barnes-Holmes, & Roche, 2001, for a book-length t r e a t m e n t ) , a n d g e n e r a t e d a working a c c o u n t of relevant forms of psychopathology (e.g., Hayes, Wilson, Gifford, Follette, & Strosahl, 1996), as well as d e v e l o p i n g ACT as a technological a p p r o a c h (Hayes, Strosahl, & Wilson, 1999). Each of these areas will be t o u c h e d u p o n in the p r e s e n t paper.

T h e ACT work was always closely c o n n e c t e d to issues of spirituality (indeed, the first article o n this work was o n spirituality; Hayes, 1984) a n d the parallels b e t w e e n ACT a n d Buddhist t h i n k i n g are quite clear in some areas. However, there was n o conscious a t t e m p t to base ACT o n B u d d h i s m p e r se, a n d my own t r a i n i n g in B u d d h i s m was limited. It is for that very reason that these parallels may cast an i n t e r e s t i n g light o n the c u r r e n t discussion. It is o n e t h i n g to n o t e how Buddhist philosophy a n d practices can be h a r n e s s e d to the purposes of behavioral a n d cognitive therapy. It is a n o t h e r to n o t e how the d e v e l o p m e n t of a behavioral clinical a p p r o a c h has e n d e d u p d e a l i n g with themes that have d o m i n a t e d Buddhist t h o u g h t for t h o u s a n d s of years. Such an u n e x p e c t e d c o n f l u e n c e s t r e n g t h e n s the idea that b o t h are e n g a g i n g topics cen- tral to h u m a n suffering.

B u d d h i s m is a prescientific system a n d the processes it

Cognitive and Behavioral Practice 9, 58-66, 2002 1077-7229/02/58-6651.00/0

points to are n o t scientific concepts. Thus, while it may s o u n d sacrilegious, if Buddhist concepts a n d practice are pragmatically useful, it will fall to science, n o t B u d d h i s m itself, to provide a scientifically valid a c c o u n t of why a n d w h e n these concepts a n d practice are useful. T h e concepts a n d data u n d e r l y i n g ACT may be useful in that regard.

Given this purpose, a fair a m o u n t of this article will focus o n ACT p e r se, so that a g r o u n d may be established from which to e x a m i n e some Buddhist teachings. T h e following sections will c o n s i d e r the philosophy, theory, a n d technology of ACT. I will t h e n consider the parallels b e t w e e n this work a n d Buddhism.

T h e P h i l o s o p h y U n d e r l y i n g ACT: F u n c t i o n a l C o n t e x t u a l i s m

What was originally "radical" a b o u t "radical behaviorism" is that scientific observations themselves were thought of as behavior. W h e n applying c o n t i n g e n c y t h i n k i n g to scientists themselves, S k i n n e r (1945) saw that o n e could n o l o n g e r hold to the traditional m e t h o d o l o g i c a l behavioral rejection of thoughts, feelings, a n d the like, because u n d e r some c o n t i n g e n c y c o n d i t i o n s observing o n e ' s own feelings could be objective, while observing publicly accessible events m i g h t be subjective.

It is a bit strange to call this view "radical behaviorism" because it overturns m a n y of the major points that h a d previously d e f i n e d behavioral thinking. Skinner's approach is m a d e m o r e accessible by t h i n k i n g of behavior analysis as a v~pe of contextualism, or pragmatism (Biglan & Hayes, 1996; Hayes, 1993). T h e core analytic u n i t of contextualism is the o n g o i n g act in c o n t e x t (Pepper, 1942), with a focus o n the whole event, a sensitivity to the role of c o n t e x t in u n d e r s t a n d i n g the n a t u r e a n d f u n c t i o n of an event, a n d a firm grasp o n a pragmatic truth crite- rion (Hayes, Hayes, & Reese, 1988). T h e r e are various kinds of contextualism, d e f i n e d by their analytic goals (Hayes, 1993). F u n c t i o n a l contextualism is that wing of

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c o n t e x t u a l i s m t h a t a d o p t s the p r e d i c t i o n a n d i n f l u e n c e o f events as the goal o f t h e i r analysis.

A c o n t e x t u a l i s t always asks, "In what c o n t e x t d o e s that apply?" a n d looks for an answer t h a t orients the analyst to effective action. Given the goals o f a f u n c t i o n a l c o n t e x t u - alist, analysis s h o u l d h e l p e x p l a i n how to alter the p r o b - l e m a t i c events, a n d for that reason, the a c c o u n t m u s t eventually r e a c h the m a n i p u l a b l e e n v i r o n m e n t . Clients o f t e n take a quite d i f f e r e n t a p p r o a c h , focusing i n s t e a d o n w h e t h e r their i n t e r p r e t a t i o n s o f t h e i r own troubles are o n t o l o g i c a l l y "true," w h e t h e r o r n o t these analyses are p r a g m a t i c a l l y useful.

The Basic Theory Underlying ACT:

Relational Frame Theory

T h e t h e o r y o f l a n g u a g e a n d c o g n i t i o n u p o n which ACT is b a s e d is called Relational F r a m e T h e o r y (RFT; Hayes et al., 2001). T h e core c o n c e p t i o n in RFT is t h a t h u m a n s l e a r n to relate events mutually a n d in c o m b i n a - tion, that this r e l a t i o n a l r e s p o n s e is b r o u g h t u n d e r the c o n t r o l o f a r b i t r a r y c o n t e x t u a l cues, a n d that the stimulus functions o f events are m o d i f i e d by the functions o f o t h e r events r e l a t e d to them. C o n s i d e r a child who has l e a r n e d to relate events as "opposite." S u p p o s e the child is told, "A is the o p p o s i t e o f B a n d B is the o p p o s i t e o f C; A can be u s e d to buy candy; which d o you want, B o r C?" T h e relations a m o n g these events are arbitrarily specified. T h e r e l a t i o n is b o t h m u t u a l (-if A is the o p p o s i t e o f B, t h e n B is the o p p o s i t e o f A) a n d c o m b i n a t o r i a l (the re- l a t i o n b e t w e e n A a n d C m u s t be o n e o f sameness, because an o p p o s i t e o f an o p p o s i t e is the same). Further, the child will p r o b a b l y be able to select C over B, b a s e d o n the specified functions o f A (i.e., b u y i n g candy) a n d the r e l a t i o n o f B a n d C to A (since C is d e r i v e d to be the same as A you can p r o b a b l y also use it to buy candy, while B is the o p p o s i t e o f A, so p r e s u m a b l y you c a n n o t ) . Scores o f studies have b e e n d o n e in the basic l i t e r a t u r e o n such p e r f o r m a n c e s (see Hayes et al., 2001, for a review). Rela- tions o f this k i n d e m e r g e in infancy (Lipkens, Hayes, & Hayes, 1993) a n d a p p e a r to be a b s e n t in n o n h u m a n s .

Derived stimulus relations are what p e r m i t h u m a n verbal b e h a v i o r to be useful, b e c a u s e they e n a b l e functions o f the n a t u r a l e n v i r o n m e n t to be a l t e r e d by what o n e says. Unfortunately, they also greatly increase h u m a n c o n t a c t with painful events. W h e n a h u m a n b e i n g tells a story o f a painful event in the past, s o m e o f the negative f u n c t i o n s o f the original event will be a t t a c h e d to the telling. Even very positive e n v i r o n m e n t s can l e a d to p a i n t h r o u g h r e l a t i o n a l m e a n s , as w h e n a g r e a t success re- m i n d s o n e o f past failures.

U n a b l e to avoid p a i n simply by avoiding e x t e r n a l cir- cumstances, h u m a n b e i n g s b e g i n to try to avoid negative private e x p e r i e n c e s directly, a process we call " e x p e r i e n -

tial avoidance." F o r e x a m p l e , h u m a n s will "try to f o r g e t about" past traumas, o r will try n o t to feel anxious in situations t h a t l e a d to anxiety. All o f these processes substan- tially increase the h u m a n capacity for suffering.

The Theory of Psychopathology

Underlying ACT: FEAR

T h e a c r o n y m FEAR expresses f o u r o f the key c o n c e p t s in an ACT a p p r o a c h to p s y c h o p a t h o l o g y - - f u s i o n , evaluation, avoidance, a n d r e a s o n giving (Hayes et al., 1999). Cognitive fusion refers to the d o m i n a t i o n o f d e r i v e d f u n c t i o n s over d i r e c t ones. As b e h a v i o r b e c o m e s m o r e verbally r e g u l a t e d , it also t e n d s to b e c o m e m o r e insensi- tive to d i r e c t e x p e r i e n c e . P e o p l e can b e g i n to "live inside t h e i r heads."

T h e m i s c h i e f t h a t cognitive fusion p r o d u c e s is in- c r e a s e d by verbal evaluation. Verbal c o m p a r a t i v e relations are useful in h u m a n b e h a v i o r b e c a u s e they allow c o n c e p t u a l i z e d c o n s e q u e n c e s to be weighed, a n d thus fa- cilitate h u m a n p r o b l e m solving a n d p l a n n i n g . This s a m e process, however, also p e r m i t s the c o m p a r i s o n o f experi- e n c e d to f e a r e d o r wished-for events, greatly amplifying the capacity for h u m a n suffering. F o r e x a m p l e , a very successful p e r s o n can believe h i m s e l f to be a "failure" because the o u t c o m e s p r o d u c e d are less t h a n an i m a g i n e d ideal. A p e r s o n can i m a g i n e w o n d e r f u l o u t c o m e s a n d b e dissatisfied if only g o o d o u t c o m e s are achieved.

E x p e r i e n t i a l a v o i d a n c e occurs w h e n a p e r s o n is unwill- ing to r e m a i n in c o n t a c t with a p a r t i c u l a r private experi- e n c e (e.g., b o d i l y sensations, e m o t i o n s , t h o u g h t , m e m o - ries, b e h a v i o r a l p r e d i s p o s i t i o n ) a n d takes steps to alter the form, frequency, o r situational sensitivity o f these events, even w h e n d o i n g so causes psychological h a r m (Hayes et al., 1996). Unfortunately, the m o r e negative private events are avoided, the m o r e they t e n d to occur. D e l i b e r a t e (i.e., verbally g u i d e d ) a t t e m p t s to avoid private events r e m i n d the p e r s o n o f the events to be a v o i d e d (thus evoking t h e m ) , d e f l e c t the p e r s o n f r o m effective o r i e n t a t i o n to the c u r r e n t e n v i r o n m e n t , a n d often t e n d to elicit the very e m o t i o n b e i n g avoided.

Finally, r e a s o n giving draws the p e r s o n into useless at- t e m p t s to u n d e r s t a n d a n d e x p l a i n as a m e t h o d o f control- ling the o u t c o m e . Often the " g o o d reasons" o f f e r e d only increase e x p e r i e n t i a l a v o i d a n c e and, f u r t h e r m o r e , p r o - vide a verbal f o r m u l a that increases resistance to c h a n g e for fear o f " b e i n g wrong." Reason givers t e n d , as a result, to b e difficult to t r e a t (Addis & J a c o b s o n , 1996) a n d m o r e likely to e n g a g e in useless worry in r e s p o n s e to negative m o o d s (Addis & Carpenter, 1999), d e s p i t e the fact t h a t such worry a n d self-analysis has m i n i m a l i n s t r u m e n t a l b e n e f i t (Borkovec, Hazlett-Stevens, & Diaz, 1999).

W h i l e a careful analysis is b e y o n d the scope o f the p r e s e n t article, m o s t forms o f p s y c h o p a t h o l o g y s e e m to

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Hayes

involve specific forms o f FEAR. Such p r o b l e m s as sub- stance abuse, social withdrawal, a g o r a p h o b i c avoidance, ruminative worry, obsessive-compulsive behaviors, a n d so on all s e e m to have clear c o m p o n e n t s o f e x p e r i e n t i a l a v o i d a n c e a n d cognitive fusion for m a n y suffering with t h e m (see Hayes et al., 1996, for d a t a in several o f these areas).

The Applied Technology: ACT

F r o m an ACT perspective, psychological h e a l t h is the process o f increasingly living life in a c c o r d with c h o s e n values, while s i m u l t a n e o u s l y m a i n t a i n i n g a n o n d e f e n s i v e c o n t a c t with historically p r o d u c e d private reactions (thoughts, feelings, m e m o r i e s , b o d i l y sensations). De- fined in this way, psychological h e a l t h is available to any- one, N o history is so terrible that it is impossible to do a bet- t e r j o b o f noticing what one's history produces in the private d o m a i n , while placing o n e foot in front o f the o t h e r in a valued direction in the behavioral d o m a i n . T h e acronym "ACT" refers to the key steps involved: Accept, Choose, a n d Take action (cf. Emery & Campbell, 1986).

ACT i n t e r v e n t i o n s are d e s i g n e d :

• to r e d u c e cognitive fusion t h r o u g h the use o f exercises a n d p a r a d o x i c a l a n d p r o c e s s - o r i e n t e d lan- g u a g e in therapy;

• to u n d e r m i n e e x p e r i e n t i a l a v o i d a n c e by c o n f r o n t - ing the costs o f that a v o i d a n c e a n d the conflict it p r o d u c e s with client values;

• to teach a c c e p t a n c e a n d willingness as an alternative c o p i n g response, a n d to practice d e l i b e r a t e de- fused e x p o s u r e to t r o u b l e s o m e thoughts, feelings, b o d i l y sensations, a n d the like;

• to h e l p the client m a i n t a i n c o n t a c t with a transcen- d e n t sense o f self that makes a c c e p t a n c e a n d cognitive defusion less fearsome, t h r o u g h the use o f exercises a n d practices;

• to clarify life values; a n d

• to b e h a v e in a c c o r d with c h o s e n values t h r o u g h behavioral c o m m i t m e n t strategies.

T h e r e are several stages to ACT. T h e first is called "creative hopelessness." If it is the case that h u m a n suffering e m e r g e s in p a r t f r o m n a t u r a l a n d u b i q u i t o u s h u m a n verbal processes a n d is e x a c e r b a t e d by cognitive fusion a n d e x p e r i e n t i a l avoidance, as is suggested f r o m RFT, t h e n clients n e e d to face the possibility that what they have b e e n s e e i n g as a possible solution to t h e i r p r o b l e m s is ac- tually p a r t o f the p r o b l e m . In essence, d o i n g what seems rational a n d n o r m a l is nevertheless pathological. Clients are asked to c o n s i d e r the possibility that p e r h a p s they are having psychological p a i n in p a r t b e c a u s e trying to get rid o f p a i n is painful.

This is a difficult insight, b e c a u s e the alternative is n o t

obvious. Superficially, the literal alternative would be to "stop trying to get rid o f psychological pain," b u t if o n e d i d so in o r d e r to feel better, o n e would be d o i n g so to rid o f psychological pain, a n d thus the struggle would n o t have s t o p p e d .

T h e Chinese h a n d c u f f m e t a p h o r (Hayes et al., 1999) is c o m m o n l y used early on in ACT to p o i n t to the p r o b l e m :

T h e situation h e r e is s o m e t h i n g like those "Chinese handcuffs" we p l a y e d with as kids. Have you ever seen them? It is a t u b e o f woven straw a b o u t as big as y o u r i n d e x finger. You p u s h b o t h i n d e x fingers in, o n e into each e n d , a n d as you pull t h e m b a c k o u t the straw catches a n d tightens. T h e h a r d e r you pull, the smaller the tube gets a n d the s t r o n g e r it holds y o u r finger. You'd have to pull y o u r fingers o u t o f t h e i r sockets to get t h e m o u t by p u l l i n g t h e m o u t o n c e they've b e e n caught. Maybe this situation is s o m e t h i n g like that. Maybe these tubes are like life itself. T h e r e is n o h e a l t h y way to get o u t o f life, a n d any a t t e m p t to d o so j u s t restricts the r o o m you have to move. W i t h this little tube, the only way to get s o m e r o o m is to push y o u r fingers in, which makes the tube bigger. T h a t may be h a r d at first to d o because everything y o u r m i n d tells you to d o casts the issue in terms o f "in a n d out" n o t "tight a n d loose." But y o u r e x p e r i e n c e is telling you that if the issue is "in a n d out," t h e n things will be tight. Maybe you n e e d to c o m e at this situation f r o m a whole d i f f e r e n t a n g l e t h a n w h a t y o u r m i n d tells you to d o with y o u r own psychological experiences.

(p. 105).

T h e p u r p o s e s o f the creative hopelessness p h a s e o f -ACT are to u n d e r m i n e reason giving, block e x p e r i e n t i a l avoidance, a n d to d i s c o n n e c t l a n g u a g e f r o m its n o r m a l , literal functions.

In the n e x t phase o f ACT, what is n o t w o r k i n g is given a bit m o r e form: T h e c o r e p r o b l e m is often the conscious, d e l i b e r a t e a t t e m p t to c o n t r o l private events. T h e following m e t a p h o r is m e a n t to c a p t u r e the useless quality o f e x p e r i e n t i a l a v o i d a n c e as a c o p i n g strategy:

Let's i m a g i n e you were h o o k e d u p to the world's m o s t sensitive p o l y g r a p h a n d in such a way that b o t h o f us c o u l d clearly see its readings a n d t h e r e b y i m m e d i a t e l y know how anxious o r r e l a x e d you were. Now s u p p o s e I p r e s e n t e d you with the following t a s k - - a l l you have to d o is r e m a i n relaxed. Fur- t h e r m o r e , to increase y o u r motivation on the task, I take o u t a l o a d e d revolvex, p o i n t it to y o u r h e a d , a n d tell you I will pull the trigger if you fail at the task by b e c o m i n g anxious. W h a t will h a p p e n ?

In o t h e r exercises a n d t h o u g h t e x p e r i m e n t s , clients will be asked to d e l i b e r a t e l y try n o t to t h i n k thoughts, o r

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to e x a m i n e a n d score their own efforts to c o n t r o l private events t h r o u g h o u t the day.

Willingness, defusion, a n d acceptance is t h e n briefly p r e s e n t e d as an alternative focus for therapy, a n d exercises a n d m e t a p h o r s are used to help the client see this alternative. It is n o t yet p u r s u e d , however, because a safe place n e e d s to be carved o u t that will allow the client to o p e n u p to previously avoided private events without be- i n g overwhelmed. T h a t safe place is consciousness itself. T h e observer exercise (a variant of the "self-identification exercise" developed by Assagioli, 1971, pp. 211-217) is designed to b e g i n to establish a sense of self that exists in the p r e s e n t a n d provides a c o n t e x t for cognitive defusion. This is a key exercise in ACT. We will briefly summa- rize it here.

T h e client sits with eyes closed. After some time cen- tering the client, the therapist c o n t i n u e s :

"I want you to r e m e m b e r s o m e t h i n g that h a p p e n e d last summer. Raise y o u r finger w h e n you have a n image in m i n d . Good. Now j u s t r e m e m b e r all the things that were h a p p e n i n g then. R e m e m b e r the s i g h t s . . , the s o u n d s . . , your feelings . . . . A n d as you do that, see if you can notice that you were there t h e n n o t i c i n g what you were noticing. See if you can catch the p e r s o n b e h i n d your eyes who saw, a n d heard, a n d felt. You were there then, a n d you are h e r e now. I ' m n o t asking you to believe this. I ' m n o t m a k i n g a logic point. I a m j u s t asking you to n o t e the e x p e r i e n c e of b e i n g aware a n d see if it isn't true that in some d e e p sense the 'you' that is h e r e now was there then. T h e p e r s o n aware of what you are aware of is here now a n d was there then." After several m o r e cycles of such guidance, toward various m e m o r i e s at different ages, the therapist continues:

"You have b e e n you your whole life. Everywhere you've b e e n , you've b e e n there noticing. This is what I m e a n by the 'observer you.' A n d from that perspective or p o i n t of view, I want you to look at some areas of living. Let's start with your body. Notice how your body is constantly changing. Sometimes it is sick a n d sometimes it is well. It may be rested or tired. It may be strong or weak. You were once a tiny baby, b u t your body grew. You may have even h a d parts of your body removed, like in a n operation. Your cells have died a n d literally almost every cell in your body was n o t there as a teenager, or even last summer. Your bodily sensations come a n d go. Even as we have s p o k e n they have changed. So if all this is c h a n g i n g a n d yet the 'you' that you call 'you' has b e e n there your whole life, that must m e a n that while you have a body, as a m a t t e r of e x p e r i e n c e a n d n o t of belief, you do n o t

e x p e r i e n c e yourself to be j u s t your body. So j u s t notice your body now for a few m o m e n t s , a n d as you do this, every so often notice you are the o n e noticing." [Give the client time to do this.]

T h e exercise t h e n goes o n i n a similar way to e x a m i n e roles, emotions, behavioral predispositions, thoughts, a n d memories. It concludes:

"So as a m a t t e r of e x p e r i e n c e a n d n o t of belief, you are n o t j u s t your b o d y . . , your r o l e s . . , your emo- t i o n s . . , your thoughts. These things are the con- t e n t of your life, while you are the a r e n a . . . the c o n t e x t . . , the space i n which they unfold. As you see that, notice that the things you've b e e n struggling with, a n d trying to change, are n o t you any- way. No m a t t e r how this war goes, you will be there, u n c h a n g e d . See if you can take advantage of this c o n n e c t i o n to let go j u s t a little bit, secure i n the knowledge that you have b e e n you t h r o u g h it all, a n d that you n e e d n o t have such a n i n v e s t m e n t i n all this psychological c o n t e n t as a m e a s u r e of y o u r life. Just notice the experiences in all the d o m a i n s that show up, a n d as you do, notice that you are still here, b e i n g aware o f what you are aware o f . . .

[Leave a brief period of silence.]

These kinds of exercises help the client find a tran- s c e n d e n t part of themselves (namely, a sense of from- hereness or p u r e consciousness) that is n o t t h r e a t e n e d by difficult psychological c o n t e n t .

W h e n that c o n n e c t i o n is made, clients are ready m o r e assertively to expose themselves to their own emotions, thoughts, memories, a n d so on. Many t e c h n i q u e s are used to e n c o u r a g e defusion a n d willingness: physicaliz- i n g p a i n f u l experiences (e.g., "What color is it? W h a t shape is it?"), practicing l a n g u a g e c o n v e n t i o n s that increase the distance b e t w e e n thoughts a n d their referents (e.g., the c o n v e n t i o n of n a m i n g all reactions by kind, such as "I am having the t h o u g h t that I ' m g o i n g to lose control; a n d I am having the evaluation that this would be b a d " ) , o r p r a c t i c i n g d e f u s i o n exercises (e.g., saying a word over a n d over u n t i l all m e a n i n g is lost). P e r h a p s 100 such t e c h n i q u e s have b e e n i n c o r p o r a t e d i n t o A C T protocols, t h o u g h t most clients are e x p o s e d only to a few dozen.

T h e acceptance of previously avoided private events is n o t a goal i n its own right in ACT. Rather, these c o p i n g strategies are t a u g h t so that they can be p u t i n the service of m o v i n g behaviorally i n valued directions. ACT e n c o m - passes a detailed m e t h o d of values clarification. Values are verbally constructed, globally desired life directions. Goals are the o u t c o m e s that are achieved while h e a d i n g i n a valued direction. So defined, values u n f o l d as a n on- going process, they are n o t ever achievable in a static

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62 Hayes

sense. For example, o n e can value b e i n g a n honest, lov- ing person, b u t that is n o t a concrete o u t c o m e that o n e can have as an object. No m a t t e r how l o n g a value has b e e n pursued, there is m o r e to do if the value is retained; that is n o t true with goals. If s o m e o n e said, "Well, I ' m an h o n e s t p e r s o n now," a n d s t o p p e d b e i n g honest, the value would have changed. A concrete goal is different. If some- o n e said, "Well, I have my Ph.D. now," a n d stopped working for the Ph.D., the goal would merely have b e e n

achieved.

I n ACT, client values are e l a b o r a t e d in several major d o m a i n s (relationships, work, citizenship, health, a n d so o n ) a n d concrete actions that would instantiate these values are identified. W h e n actions are identified, usually barriers to a c c o m p l i s h i n g these actions immediately emerge. Often these barriers are m o r e private events. T h e strategies of acceptance, willingness, a n d defusion are t h e n practices with these barriers, a n d concrete behavioral c o m m i t m e n t exercises are arranged. At this point, ACT looks m o r e like traditional behavior therapy, b u t the earlier work c o n t i n u e s to i n f o r m behavior c h a n g e efforts.

T h e core q u e s t i o n in ACT is this: Based o n a distinc- tion between you a n d the things you've b e e n struggling with a n d trying to change, are you willing to e x p e r i e n c e those things, fully a n d without defense, as they are, a n d n o t as they say they are and do what takes you in a valued d i r e c t i o n in the c u r r e n t situation?

If the client can answer yes to this question, t h e n life itself o p e n s u p j u s t a bit. If the answer is no, then, psycho- logically speaking, the client becomes a bit smaller.

While a n e x a m i n a t i o n of the impact of ACT is b e y o n d the scope of this paper, r e c e n t studies have r e c o n f i r m e d its impact in r a n d o m i z e d c o n t r o l l e d trials with various clinical p o p u l a t i o n s (e.g., Bach, 2000; B o n d & Bunce, 2000). Effectiveness research has also shown that train- i n g in ACT p r o d u c e s generally m o r e effective clinicians

(Strosahl, Hayes, Bergan, & R o m a n o , 1998).

ACT a n d B u d d h i s t C o n c e p t s a n d P r a c t i c e s In c o n s i d e r i n g how ACT c o n n e c t s with Buddhist philosophy a n d practices, I will limit my c o m m e n t s to the following issues (each of which has b e e n t o u c h e d u p o n by Kumar, 2002, in the p r e s e n t volume) : the ubiquity of hu- m a n suffering, the role of a t t a c h m e n t , mindfulness, val- u e d action, a n d issues of self.

The Ubiquity o f Human Suffering and Its Source in Attachment

T h e Four Noble Truths b e g i n with the idea that hu- m a n suffering is ubiquitous. In the first s e r m o n delivered by the B u d d h a after e n l i g h t e n m e n t (the Dhammacakka Sutta, or Wheel of Dhamma Discourse), he said, "Birth is suf-

fering, death is suffering, sorrow, a n d l a m e n t a t i o n , pain, grief, a n d despair are suffering, association with the u n - loved or u n p l e a s a n t c o n d i t i o n is suffering, s e p a r a t i o n from the beloved or pleasant c o n d i t i o n is suffering, n o t to get what o n e wants is suffering" (as cited in D h a m m a , 1997, pp. 17-18). T h e list given is obviously m e a n t to be a partial one, a n d it is obviously u b i q u i t o u s . K u m a r ( p r e s e n t v o l u m e ) says it this way: "suffering is a n i n a l i e n - able part of existence, i n f l a m e d by any a t t e m p t to con- tain it."

T h e source of suffering is a t t a c h m e n t or craving. T h e B u d d h a said it this way: "This is the Noble Truth of the or- igin of suffering: It is craving which p r o d u c e s rebirth, b o u n d u p with pleasure a n d greed. It finds delight in this a n d that, in o t h e r words, craving for sense pleasures, crav- i n g for existence or b e c o m i n g a n d craving for nonexis- tence or self-annihilation" (Dhammacakka Sutta, as cited in D h a i n m a , 1997, p. 18). K u m a r (2002) states that, ac- c o r d i n g to Buddhism, "Suffering is g e n e r a t e d by the m e n t a l t e n d e n c y toward essentialism" based o n "experi- e n c i n g thoughts, emotions, behaviors, or self as discrete a n d u n c h a n g i n g . " A n o t h e r m o d e r n B u d d h i s t scholar says it this way:

T h e real cause of suffering is the reaction of the m i n d . . . . T h e reaction is r e p e a t e d m o m e n t after m o m e n t , intensifying with each repetition, a n d d e v e l o p i n g into craving or aversion. This is what in his first s e r m o n the B u d d h a called tanha, literally "thirst": the m e n t a l habit of insatiable l o n g i n g for what is not, which implies an equal a n d irremedia- ble dissatisfaction with what is. (Hart, 1987, p. 38) In ACT, suffering is also c o n s i d e r e d to be a n inalien- able part of h u m a n existence. A specific process is pos- ited as the source of the ubiquity of h u m a n suffering: the bidirectionality of h u m a n language. Pain is u n a v o i d a b l e for all complex liwing creatures, d u e to the exigencies of living, b u t h u m a n beings e n o r m o u s l y amplify their own pain t h r o u g h language. Because verbal relations are arbitrarily applicable, any situation can "remind" h u m a n s of past hurts of all kinds. I n n o n v e r b a l organisms, only for- really similar situations will p e r f o r m this f u n c t i o n . In- deed, because events can be related verbally in an infinite n u m b e r of ways, even situations that have the opposite f u n c t i o n s of previous pain can evoke this pain. For example, a person who has e x p e r i e n c e d a p a i n f u l death in the family may recall that death w h e n seeing a hearse, b u t may also recall it o n a spectacular spring day, or w h e n seeing a flower, or when seeing a child play with great i n n o - cence a n d joy.Just as a p e r s o n playing a word-association game can say "hot" w h e n given the clue "cold," so too can a p e r s o n seeing events that are joyful a n d frill of life be re- m i n d e d of painful deaths. Similar effects occur clinically: r e l a x a t i o n - i n d u c e d anxiety, suicide increases d u r i n g holi-

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days, d e p r e s s i o n p r o d u c e d by joyful events, o r p a n i c p r o - d u c e d by n o t i c i n g the c u r r e n t a b s e n c e o f anxiety.

T h e b i d i r e c t i o n a l i t y o f h u m a n l a n g u a g e also increases suffering by p r o v i d i n g a l a n g u a g e for self-knowledge, thus p r o v i d i n g an invitation to e x p e r i e n t i a l avoidance. E m o t i o n s p r o v i d e a g o o d e x a m p l e . In n o n v e r b a l o r g a n - isms, events t h a t p r o d u c e aversive r e a c t i o n s are avoided. In verbal organisms, the r e a c t i o n s themselves b e c o m e targets o f avoidance. H u m a n l a n g u a g e allows loose sets o f b o d i l y sensations, c o n t e x t u a l features, a n d b e h a v i o r a l p r e d i s p o s i t i o n s to be verbally c o n s t r u c t e d into "emotional states." We may l e a r n to call o n e loose set "depression" a n d a n o t h e r "anxiety." T h e aversiveness o f these verbally o r g a n i z e d events is in t u r n a m p l i f i e d by verbal evaluation (e.g., anxiety is "bad" a n d s o m e t h i n g that " p e o p l e who are t o g e t h e r d o n ' t have"), a n d by construct- ing verbal futures l i n k e d to these e m o t i o n s that are aversive (e.g., "If I have a p a n i c attack h e r e I w o u l d m a k e a c o m p l e t e fool o f myself'). T h e s e verbal c o n s t r u c t i o n s c o n s i d e r a b l y increase the aversiveness o f the e m o t i o n a l event itself.

H u m a n suffering is f u r t h e r i n c r e a s e d by h u m a n language b e c a u s e o f the verbal evaluation systems d e s c r i b e d earlier. H u m a n s constantly c o m p a r e the c u r r e n t situation to verbally c o n s t r u c t e d futures, which increases the d o m i n a n c e o f verbal sources o f b e h a v i o r a l c o n t r o l (e.g., "I w o u l d b e able to live if only I c o u l d get free o f this anxiety"). F u r t h e r m o r e , h u m a n s can verbally c o n s t r u c t out- comes that have never b e e n e x p e r i e n c e d . T h e s e processes can b e painful even when they are literally accurate. F o r e x a m p l e , everyone "knows" they will die, a n d e d u c a t e d p e r s o n s "know" that the universe will e i t h e r e x p a n d infinitely a n d b u r n o u t o r will b e drawn b a c k t o g e t h e r into an infinitely d e n s e pea. In e i t h e r case, they know that all o f h u m a n a c h i e v e m e n t is finite.

Finally, having e n o r m o u s l y i n c r e a s e d the h u m a n ex- p o s u r e to pain, h u m a n l a n g u a g e suggests solution strategies t h a t work j u s t fine in the e x t e r n a l world b u t are often p o i s o n o u s w h e n a p p l i e d to c o n d i t i o n e d private events. T h e s e i n c l u d e particularly ineffective t h o u g h t a n d e m o - tional s u p p r e s s i o n o r a v o i d a n c e strategies, which increase the f r e q u e n c y o f events b e i n g avoided, f u r t h e r de- fine the situation as an aversive o n e , a n d d e c r e a s e a t t e n t i o n to the c u r r e n t d e m a n d s o f the n a t u r a l environ- m e n t a n d thus d e c r e a s e i n s t r u m e n t a l effectiveness.

T h e B u d d h i s t c o n c e p t o f craving a n d a t t a c h m e n t draws its m e a n i n g f r o m lay language. T h e B u d d h a con- s i d e r e d the s o u r c e o f a t t a c h m e n t to be multilayered, a n d h e saw his own e n l i g h t e n m e n t as a k i n d o f p e e l i n g o f t h a t o n i o n b a s e d o n his d i r e c t e x p e r i e n c e . H e d i s c r i m i n a t e d m a n y steps in the W h e e l o f Suffering, e a c h b a s e d o n the next: likes a n d dislikes, sensations, c o n t a c t with events t h r o u g h the senses a n d the m i n d , the illusion o f m i n d a n d matter, consciousness, reaction, a n d i g n o r a n c e .

T h e t h e o r y u n d e r l y i n g ACT provides a process t h a t may h e l p e x p l a i n the B u d d h a ' s insights. F o r e x a m p l e , c o n s i d e r the i d e a t h a t a t t a c h m e n t c o m e s f r o m likes a n d dislikes, which in t u r n c o m e f r o m sensations. C o n s i d e r the d e f i n i t i o n o f a t t a c h m e n t q u o t e d e a r l i e r o f " l o n g i n g for what is n o t h e r e . " F r o m an RFT perspective, this long- ing has to d o with verbal k n o w l e d g e o f certain events, verbal relations a b o u t the past, present, a n d future, a n d with "frames o f c o m p a r i s o n " allowing events to b e e v a l u a t e d against o n e a n o t h e r (Hayes et al., 2001). To p u t this p r o - cess in a simple form, c o n s i d e r the s e n t e n c e "I w a n t X." T h e w o r d "want" c o m e s f r o m the O l d Norse t e r m rant, m e a n i n g literally "missing." T h e simple verbal act o f w a n t i n g s o m e t h i n g thus r e q u i r e s (a) n o t i c i n g verbally (in the RFT sense o f that term) w h a t is p r e s e n t , (b) n o t i c i n g verbally w h a t is n o t present, t h e r e b y c o n t a c t i n g this event t h r o u g h d e r i v e d relations, a n d (c) c o m p a r i n g the two. If these verbal f u n c t i o n s d o m i n a t e , the p e r s o n will b e c o m e "attached" to a verbally c o n s t r u c t e d f u t u r e in which w h a t is n o t p r e s e n t is present. Scientifically, w h a t is p r e s e n t all a l o n g is the process o f verbal c o n s t r u c t i o n . D o m i n a t i o n by a verbal f u t u r e t h a t m i n i m i z e s c o n t a c t with the p r e s e n t ( a t t a c h m e n t ) c o m e s f r o m a verbal c o m p a r i s o n o f verbally known a n d e v a l u a t e d e x p e r i e n c e s a n d sensations. T h e B u d d h a ' s insight remains, b u t a scientifically k n o w n process helps fill in the picture.

A c c e p t a n c e a n d M i n d f u l n e s s

F o r a Buddhist, "the first step toward e m e r g i n g f r o m such suffering is to a c c e p t the reality o f it, n o t as a philo- sophical c o n c e p t o r an article o f faith, b u t as a fact o f existence" (Hart, 1987, p. 38). T h e s e c o n d is s e e i n g its source in craving a n d a t t a c h m e n t . T h e B u d d h a d e s c r i b e d the cessation o f suffering in his T h i r d N o b l e Truth as "giving up, r e n o u n c i n g , r e l i n q u i s h i n g , d e t a c h i n g f r o m craving" (Dhammacakka Sutta, as cited in D h a m m a , 1997, p. 18). Giving u p a craving is n o t a d e l i b e r a t e c h a n g e in the craving. It is a p r o f o u n d type o f c h a n g e at a n o t h e r level. It is a c h a n g e in the a g e n d a o f craving itself, n o t im- m e d i a t e l y a c h a n g e in the f o r m o r f r e q u e n c y o f a craving. "Letting go o f a craving is n o t r e j e c t i n g it b u t allowing it to be itself' (Batchelor, 1997, p. 9).

ACT takes a similar view, b u t a specific set o f psychological processes is p o s i t e d as the source o f transfornla- d o n . J u s t as self-struggle c o m e s f r o m cognitive fusion, a c c e p t a n c e is a n a t u r a l result o f cognitive defusion. Cog- nitive b e h a v i o r therapists have d e c a d e s o f r e s e a r c h show- ing that p s y c h o p a t h o l o g y tends to b e associated with certain kinds o f thoughts. Usually this leads to c o n c r e t e efforts to c h a n g e the c o n t e n t o f thoughts, b u t the contextualistic qualities o f ACT o p e n a d i f f e r e n t solution: C h a n g e the c o n t e x t in which t h o u g h t s r e d u c e effective action. All verbal relations, like all b e h a v i o r in a c o n t e x t u - alistic system, are situated. F u r t h e r m o r e , the i m p a c t o f

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Hayes

thoughts, like all relations between psychological events, is also c o n t e x t u a l l y situated. T h e p r o b l e m with negative o r i r r a t i o n a l thoughts, f r o m a c o n t e x t u a l p o i n t o f view, is n o t the form o f the t h o u g h t b u t its excessive literal quality. C h a n g i n g the literal quality by literal i n t e r v e n t i o n (e.g., t h r o u g h cognitive d i s p u t a t i o n ) is f r a u g h t with diffi- culty because the process c o n t r a d i c t s the o u t c o m e . Con- versely, c h a n g i n g the c o n t e x t in which t h o u g h t s are taken literally c h a n g e s its literal quality., even if the t h o u g h t continues.

C o n s i d e r the t h o u g h t , "I m u s t be perfect." In n o r m a l cognitive behavioral a p p r o a c h e s , this t h o u g h t would be targeted, d i s p u t e d , tested, a n d c h a n g e d t h r o u g h d i r e c t means. A wide variety o f c o n t e x t u a l alternatives exist, all o f which are c o m p o n e n t s o f ACT. F o r e x a m p l e , the t h o u g h t c o u l d be watched dispassionately, as o n e watches t h o u g h t s while m e d i t a t i n g . T h e t h o u g h t would be re- p e a t e d ou.t l o u d rapidly for a few h u n d r e d times, until only its s o u n d remains. T h e t h o u g h t c o u l d be given a size, shape, colol, speed, form, texture, a n d so on, thus t r e a t i n g it as o n e treats obsmwations o f e x t e r n a l objects. T h e p e r s o n c o u l d t h a n k their m i n d for such an interest- ing t h o u g h t to watch. T h e p e r s o n c o u l d e x a m i n e the b o d i l y sensations, e m o t i o n s , m e m o r i e s , a n d behavioral p r e d i s p o s i t i o n s that e m e r g e in association with the t h o u g h t , a n d c o u l d take time e x p e r i e n c i n g these events as aspects o f an u n f o l d i n g , c h a n g i n g process o f living. T h e p e r s o n c o u l d label t h e i r own cognitive processes (e.g., "Now I am having that t h o u g h t that I m u s t be perfect"). T h e p e r s o n c o u l d t h i n k the t h o u g h t very, very slowly, so that each w o r d takes m i n u t e s to s o u n d out.

T h e s e various p r o c e d u r e s are d e s i g n e d to r e d u c e the literality o f the t h o u g h t - - w e a k e n i n g the t e n d e n c y to treat a t h o u g h t as if it is what it refers t o - - b u t without tar- g e t i n g the form o f the t h o u g h t itself. Instead, these meth- ods alter the c o n t e x t in which t h o u g h t s o f a given form are t r o u b l e s o m e .

W h i l e these m e t h o d s were n o t consciously drawn from B u d d h i s t practice, they have clear parallels there. In Bud- dhist traditions, Right Mindflflness, p a r t o f the E i g h t t o l d Path, includes m a n y practical m e t h o d s o f a c c e p t a n c e a n d d e l u s i o n . F o r e x a m p l e , "If o n e e x p e r i e n c e s any feelings in the body, w h e t h e r gross o r subtle, o n e s h o u l d be aware o f t h e m in the p r e s e n t m o m e n t . . , if t h e r e is liking o r dis- liking, desire, angm, o r d o u b t , these s h o u l d be taken as m e d i t a t i o n objects" ( D h a m m a , 1997, p. 39). Zazen, following the b r e a t h , a n d the like all seem d e s i g n e d to re- d u c e the d o m i n a t i o n o f the literal m e a n i n g o f events. Similarly, Zen koans are p r e s e n t e d as verbal puzzles, b u t t h e i r essence is n o t that at all. W h a t u n d e r l i e s koans is what is t h e r e when the puzzle is n o more. As was p o i n t e d o u t by the Zen m a s t e r Chung-feng, "It c a n n o t be u n d e r - s t o o d by logic; it c a n n o t be t r a n s m i t t e d in words; it can- n o t be e x p l a i n e d in writing; it c a n n o t be m e a s u r e d by

reason" (as q u o t e d in Kapleau, 1989, p. 77). T h e d u a l qualities o f o p e n n e s s to e x p e r i e n c e in the m o m e n t a n d r e d u c t i o n o f the literal d i m e n s i o n w h e n it interferes with that o p e n n e s s seem characteristic o f virtually all B u d d h i s t practices o f e n l i g h t e n m e n t .

T h e t e c h n i q u e s o f cognitive d e l u s i o n r e d u c e the be- hax4oral i m p a c t o f thoughts, at least in ACT. B o n d a n d Bunce (2000), for e x a m p l e , f o u n d that positive behavioral a n d psychological o u t c o m e s in ACT were p r o d u c e d by increases in the a c c e p t a n c e o f previously a v o i d e d private events. Similarl}; Bach (2000) f o u n d that severely mentally ill patients with h a l l u c i n a t i o n s o r d e l u s i o n s t r e a t e d with ACT showed a 48% r e d u c t i o n in rehospital- ization over 4 m o n t h s c o m p a r e d to t r e a t m e n t as usual, a n d that this o u t c o m e was p r o d u c e d by a significantly g r e a t e r d e c r e a s e in the believability, b u t n o t the frequency, o f psychotic symptoms.

Valued Action

B u d d h i s m is s o m e t i m e s called a religion, b u t it is, at its essence, without d o g m a o r b e l i e f (Batchelor, 1997). Even the F o u r N o b l e Truths are n o t so m u c h beliefs as orienta- tions to action: seeing suffering, letting go o f a t t a c h m e n t , a n d cultivating w h o l e s o m e deeds. T h e b o t t o m line in B u d d h i s m is n o t belief, b u t living a n d doing. T h e Eight- fold Path is intensely behavioral.

As a b e h a v i o r therapy; ACT takes the same stance. Ac- c e p t a n c e a n d cognitive defilsion is n o t an e n d in itself b u t a m e a n s to successful living. W h a t requires a c c e p t a n c e a n d d e l u s i o n will be d e t e r m i n e d by history a n d p u r p o s e . T h e goal is n o t to feel all o n e ' s feelings, b u t to feel all those that o c c u r in the c o n t e x t o f living a valued life. F o r e x a m p l e , if raising a family brings a p e r s o n in c o n t a c t with painful material, the task is to observe that p a i n a n d to raise o n e ' s family. This seems entirely c o m p a t i b l e with B u d d h i s m . S. N. G o e n k a , a m o d e r n B u d d h i s t teachm, says it this way: "This is holy indifference: n e i t h e r i n a c t i o n n o r reaction, b u t real, positive action with a b a l a n c e d m i n d " (Hart, 1987, p. 54).

S e l f

Issues o f self provide a n o t h e r relevant p o i n t o f connec- tion. T h r e e kinds o f self are c o n s i d e r e d in ACT: the con- ceptualized self, self as an o n g o i n g process o f knowing, a n d the t r a n s c e n d e n t self. ACT seeks to u n d e r m i n e the c o n c e p t u a l i z e d s e l f - - t h a t is, an a t t a c h m e n t to a literal c o n c e p t i o n o f who we a r e - - o n the same g r o u n d s that it seeks to u n d e r m i n e a t t a c h m e n t to any specific thought: that such a t t a c h m e n t is unnecessary a n d unhelpful. A p h r a s e used in ACT that c h a r a c t e r i z e d its p o s t u r e toward the c o n c e p t u a l i z e d self is, "Kill yourself every day."

Self as an o n g o i n g process o f knowing is a fluid, dy- n a m i c process o f knowing o n e ' s own flow o f e x p e r i e n c e s . E n h a n c i n g self-as-process is implicitly a goal o f various

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forms of therapy, particularly in h u m a n i s t i c a n d experiential camps. This k i n d of self supports o n g o i n g verbal (or "conscious") contact with events, such as feeling feelings, or sensing sensations. That, i n t u r n , can be clinically useful in r e d u c i n g excessive rule c o n t r o l a n d e n h a n c i n g contact with the effects of actions.

This seems very m u c h in line with Buddhist thinking. T h e self as discrete a n d u n c h a n g i n g is problematic. It is a form of a t t a c h m e n t . T h e self as a process is what o n e fos- ters t h r o u g h mindfulness.

T h e r e may be a p o i n t of divergence in the third area: a t r a n s c e n d e n t self. ACT relies o n this sense of self to sup- p o r t clients i n exposing themselves to feared private events. T h e t r a n s c e n d e n t self, or self as context, is theo- rized to result from deictic verbal relations, such as h e r e / now, I / y o u , or n o w / t h e n (Barnes & Roche, 1997; Hayes, 1984), a n d may be d e f i n e d as k n o w i n g from a locus or perspective. A n o t h e r term m i g h t be consciousness p e r se, as distinct from consciousness something. Some experi- m e n t a l s u p p o r t for this c o n c e p t i o n has recently b e e n shown in very y o u n g children: Teaching c h i l d r e n deictic verbal relations results in a n o t a b l e increase i n perspective t a k i n g - - i n c l u d i n g the ability to take a n o t h e r person's perspective into a c c o u n t (Barnes-Holmes, Barnes- Holmes, & Cullinan, 2001).

Consciousness is n o t thing-like for the p e r s o n b e i n g conscious. O n e can be conscious of the limits of every- t h i n g except o n e ' s own consciousness. Self as c o n t e x t is p r e s e n t everywhere we have ever b e e n , so far as we know, by definition. This m e a n s that o n e ' s own e x p e r i e n c e of a t r a n s c e n d e n t sense of self is that it has n o limits: It is n o t a thing. T h i n g s are n o t things unless they have limits. I n o n e i m p o r t a n t sense of the term, self, thus, is n o t h i n g (a word that was originally written as "no thing."). So far, this sounds very m u c h in line with Buddhist thought, a n d perhaps forms the psychological basis of the Eastern con- cept of spirituality, a n d of God, as " e v e r y t h i n g / n o t h i n g . " T h e r e may be a p o i n t of divergence, however, because while the p e r s o n is alive, a sense of perspective is n o t k n o w n by that p e r s o n to c h a n g e o n c e it emerges (in the preschool period). I n d e e d , in ACT this sense of self as c o n t e x t is a r g u e d to be critical therapeutically because it m e a n s that there is at least o n e stable, u n c h a n g e a b l e , im- m u t a b l e fact a b o u t o n e s e l f that has b e e n e x p e r i e n c e d directly a n d is n o t j u s t a belief or a h o p e or a n idea. I n the c o n t e x t of therapy, this k i n d of stability a n d constancy helps a client c o n f r o n t e x t r e m e psychological p a i n a n d trauma, k n o w i n g in some d e e p way that n o m a t t e r what comes up, the client's deepest sense of b e i n g is n o t t h r e a t e n e d .

I am n o t sure w h e t h e r this c o n c e p t diverges from Bud- dhist teachings. Speaking of a n i m m u t a b l e self from the p o i n t of view of a knower seems to conflict with K u m a r ' s (2002) s t a t e m e n t that "self as . . . u n c h a n g i n g deviates

from the n a t u r a l process of c h a n g e i n h e r e n t in all existence." Most Buddhist texts do n o t speak of self as context, t h o u g h a n observing self seems to be the implicit b a c k g r o u n d of all knowing. In all likelihood, it is the fear of reification of s e l f concepts that is at the basis of the rel- ative silence o n this issue since, after all, "everything that arises a n d passes away is n o t self' (Snelling, 1998, p. 31).

This topic is subtle a n d h a r d to talk a b o u t d u e to the reflective issues involved. It is a particularly difficult issue to frame w i t h i n a written m a n u s c r i p t . Nevertheless, I will try.

By a t r a n s c e n d e n t self I do n o t m e a n the belief in such a self or the belief in immutability, b u t the experience of from-here-now a n d the essential c o n t i n u i t y it provides for all verbally k n o w n events from the p o i n t of view of the knower. T h e claim is simply that all verbal k n o w i n g is k n o w n "from here now." T h a t e x p e r i e n c e is a n i m p o r t a n t sense of the word " I " - - n a m e l y , that in o n e i m p o r t a n t sense ' T ' am from-here-now. This sense of perspective is i m m u t a b l e from the p o i n t of view of the k n o w i n g person. It is n o t i m m u t a b l e in the sense that it assumes a form that c a n n o t or does n o t change. It is i m m u t a b l e in the sense that it has n o form at all. It has n o limits that c a n be k n o w n by the knower, by definition. I n that sense, it is n o t a thing, a n d only things can change. No t h i n g c a n n o t .

It is possible to i m a g i n e that a p e r s o n can e x p e r i e n c e events from somewhere else, some w h e n else. Some spir- itual traditions make such claims (e.g., claims of time travel, m u l t i p l e planes of existence, or of b e i n g in two places at o n c e ) , b u t even then, the "somewhere else" would t h e n be "here" a n d the "some w h e n else" would t h e n be "now" from the p o i n t of view of the p e r s o n d o i n g the experiencing. If that was n o t true, I see n o way that the e x p e r i e n c e could be "known" by the person, since k n o w i n g as a process is now.

C o n c l u s i o n

Buddhist concepts a n d practices have p r o v e n their hu- m a n value over the m i l l e n n i a , b u t the q u e s t i o n for cognitive behavior therapists is this: What a d d i t i o n a l value can be o b t a i n e d by c o n s i d e r i n g these practices from the p o i n t of view of cognitive behavioral psychology? Import- i n g Buddhist practices into the technical a r m a m e n t a r - i u m of cognitive behavior therapy is fine, b u t it is n o t a very ambitious step. These concepts a n d practices are t h o u s a n d s of years o l d - - t h e y are already d o i n g good in the culture. B u d d h i s m includes traditions of faith, ritual, practice, a n d c o m m u n i t y that are d e s i g n e d to s u p p o r t m i n d f u l n e s s a n d wholesome actions, a n d short of becom- i n g a religion, n o system of psychotherapy will i n c l u d e all of these elements.

A real step forward in empirical clinical practice could come, however, by c o n s i d e r i n g these concepts a n d prac-

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H a y e s t i c e s i n s c i e n t i f i c t e r m s . T h a t m i g h t l e a d t o s o m e t h i n g n e w . S c i e n t i f i c p s y c h o l o g y is still a n a d o l e s c e n t . W e d o n o t k n o w h o w m u c h c a n b e d o n e b y a p p r o a c h i n g a n c i e n t s o u r c e s o f w i s d o m f r o m t h e p o i n t o f xqew o f s c i e n t i f i c k n o w i n g . I n e a c h a r e a e x a m i n e d , t h e r e a r e c l e a r p a r a l l e l s b e - t w e e n A C T a n d B u d d h i s m . T h e s e p a r a l l e l s s u g g e s t t h a t t h e r e c a n b e a c o m m o n c o r e o f u n d e r s t a n d i n g a b o u t t h e n a t u r e o f h u m a n s u f f e r i n g w i t h i n t h e r e l i g i o u s a n d s c i e n - tific d o m a i n s . T h e y a l s o s u g g e s t t h a t i s s u e s o f a c c e p t a n c e , c o g n i t i v e f u s i o n a n d d e f u s i o n , self, a n d v a l u e d a c t i o n m a y b e w o r t h e x p l o r i n g as o n e w a y t h a t b e h a v i o r t h e r a - p i s t s m i g h t c o n s i d e r B u d d h i s t c o n c e p t s a n d p r a c t i c e s f r o m t h e p o i n t o f v i e w o f m o d e r n b e h a v i o r a l p s y c h o l o g y ' . R e f e r e n c e s

Addis, M. E., & Carpenter, K. M. (1999). Wh); why, why?: Reason-giving and rumination as predictors of response to activation- and insight-oriented treatment rationales.Journal of Clinical Psyehology, 55, 881-894.

Addis, M. E., &Jacobson, N. S. (1996). Reasons tot depression and the process and outcome of cognitive-behavioral psychotherapies. Journal of Consulting and Clinical P~ycholo~¢, 64, 1417-1424. Assagioli, R. ( 1971 ). 77~e act of will. New York: Viking.

Bach, E (2000). 77~e use qf Accepmnce and Commitment Therapy to pT~Jent the *ehospilalization ~f psychotie patients: A randomized continUed trial. Unpublished doctoral dissertation, Universig, of Nevada, Reno. Barnes, D., & Roche, B. (1997). A behaviot:analytic approach to behav-

ioral reflexivity. The Psychological Record. 4Z 543-572.

Barnes-Holmes, Y, Barnes-Holmes, D., & Cullinan, V. (2001). Educa- tion. In S. C. Hayes, D. Barnes-Holmes, & B. Roche (Eds.), Rda- tional fmme theoo,: A post-Skinmv'ian account t f human language and cognition (pp. 181-195). New York: Plenum Press.

Batchelor, S. (1997). Buddhism without bdi~: A contempora U guide to awakening. New York: Riverhead Books.

Biglan, A., & Hayes, S. C. (1996). Should the behavioral sciences become more pragmatic? The case for fimctional contexmalism in research on human behavior. Applied and P, eventive PD.chology: Current Scientific PerspeetiveL 5, 47-57.

Bond, E W., & Bunce, D. (2000). Mediators of change in emotion- focused and problem-fi-mused worksite stress management inter- ventions../ournal oj Occupational Health Psychology, 5, 156-163. Borkovec, T. D., Hazlett-Stevens, H., & Diaz, M. L. (1999). The role of

positive beliefs about worl T in generalized anxiety disorder and its treatment. Clinical PD'cholo~ and Psychotheral~); 6, 126-138. Dhamma, R. (1997). The.first distou~:w of the Buddha. Boston: Wisdonl

Publications.

ElneCr', G., & Campbell,J. (1986). Rapid relicfJ}om emotional dist~vss. New York: Rawson.

Hart, ~ \ (1987). The art of living: Vipassana meditation as taught by S. N. Goenka. San Francisco: Harper.

Hayes, S. C. (1984). Making sense of spirituali~ Behaviorism, 12, 99- 110.

Hayes, S. C. (1993). Analytic goals and the ~-arieties of scientific contextualism. In S. C. Hayes, L.J. Hayes, H. W. Reese, & T. R. Sarbin (Eds.), Varieties of scientific contextualism (pp. 11-27). Reno, NV: Context Press.

Hayes, S. C., Barnes-Hohnes, D., & Roche, B. (Eds.). (2001). tCdational fiame theory: A post-Skinnerian account of human langazage and cogni- tion. New York: Academic Press.

Hayes, S. C., & Brownstein, A.]. (1986). Mentalisin, behaviol:beha~4or relations and a behavior analytic view of the purposes of science. 77te Behavior Analyst, 9, 175-190.

Hayes, S. C., & Hayes, L.J. (1992). Verbal relations and the evolution of behavior analysis. A meriean Psychologist, 4 Z 1383-1395. Hayes, S. C., Hayes, L. J , & Reese, H. W. (1988). Finding the philo-

sophical core: A review of Stephen C. Pepper's WorM Hypotheses. .]ournal c~ the Experinwntal Analysis of Behavior," 50, 97-111. Hayes, S. C., Hayes, L.J., Reese, H. W., & Sarbin, T. R. (Eds.). (1993).

Varieties ofscienliji~ contextualism. Reno, NAt: Context Press. Hayes, S. C., Strosahl, F,L, & Wilson, K. G. (1999). Acceptance and Com-

mitment Therap'y: An expe, iential approach to behavior change. New York: Guilford Press.

Hayes, S. C., Wilson, K. G., Giftbrd, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A func- tional dimensional approach to diagnosis and treatment.Journal of Consulting and Clinical Psychology, 64, 1152-1168.

Kapleau, E (1989). The three piUars c?/' Z,n: Teaching, practice, and enlight- enment. New York: Anchor.

Lipkens, G., Hayes, S. C., & Hayes, L.J. (1993). Longitudinal study of derived stinmlus relations in an infant.Journal of Experimental Child Pw:holo~,, 56, 201-239.

PeppeL S. C. (1942). World hypotheses: A stucly in evidence. Berkeley: Uni- versity of California Press.

Skinnm, B. E (1945/1972). The operational analysis of psychological terms. Reprinted in Cumulative reeord: A selection of papers. New York: Appleton-Centtu~Crofts. (Originally published in Psycholog-

ical Rwiew in 1945)

Snelling, J. (1998). Buddhist traditions of meditation. In J. Smith (Ed.), Breath sweeps the mind: A first guide to meditation practice. New ~]~rk: Riverhead Books.

Strosahl, FL D., Hayes, S. C., Bergan,J., & Romano, R (1998). Assessing the field effectiveness of Acceptance and Commitment Therapy: An example of the manipulated training research method. Behav- ior Thera[o', 29, 35-64.

I would like to thank Amasamy, s.J., for his helptul comments on the manuscript.

Address correspondence to Steven C. Hayes, Ph.D., Department of Psychology, University of Nevada, Reno, NV 89557-0062; e-mail: hayes@ scs.unl2edn.

Received: .]anua U 10, 2000 Accepted: Februa O" 20, 2001